Lung ultrasound during newborn resuscitation predicts the need for surfactant therapy in very- and extremely preterm infants

Introduction: Early identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants. Methods: Infants born at <32^0/7 weeks were prospectively enrolled at 2 centres. LUS videos of both sides of the chest were obtained 5−10 min, 11−20 min, and 1−3 h after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 (‘whiteout’) LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO₂ threshold of 0.3 to predict subsequent surfactant therapy. Results: Fifty-two infants with a median age of 27^6/7 weeks (IQR 26^0/7–28^6/7) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5–10 min, 11–20 min and 1−3 h was 0.78 (95% CI, 0.66–0.90), 0.76 (95% CI, 0.65–0.88) and 0.86 (95% CI, 0.75–0.97) respectively, outperforming FiO₂ at the 5−10 min timepoint (AUC 0.45, 95% CI 0.29–0.62, p = 0.001). At 11–20 min, LUS had a specificity of 95% (95% CI 77–100%) and sensitivity of 59% (95% CI, 39–77%) to predict surfactant therapy. All infants born at 23–27^6/7 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment. Conclusions: LUS in the delivery room and accurately predicts surfactant therapy in infants <32^0/7 weeks.