Abstract The study aims to determine the utility of lung ultrasound aeration scoring (LUS Aeration Scores) in predicting successful weaning off nasal continuous positive airway pressure (nCPAP) in preterm neonates. This was a prospective cohort study conducted in a tertiary neonatal unit between September 2022 and September 2023. Preterm neonates born < 33 weeks gestational age (GA) needing any respiratory pressure support after birth were included. LUS was performed at two time points; LUS1 at 300–306 weeks for those born < 30 weeks GA or between 48 and 72 h of life for those born at 300–326 weeks GA, and LUS2 within 12 h prior to trial off nCPAP to room air or low flow after 32 weeks corrected GA. LUS was scored for disease severity. Univariate and multivariate analyses compared the LUS Aeration Score between successful and failed nCPAP groups. Receiver operator characteristic (ROC) curves analyzed the reliability of the LUS Aeration Score in predicting the successful cessation of nCPAP post-LUS2. Of 50 preterm neonates included, 32 (64%) were successfully weaned from nCPAP after LUS2 at a mean (SD) GA of 33.3 (0.3). The median (IQR) LUS Aeration Score at LUS2 (LUS Score-2) was significantly lower in the successful group compared to the failed group [7 (6–8) vs 9 (7–11), p = 0.006]. The ROC curve showed AUC 0.72 (95% CI = 0.56–0.86) for an LUS Score-2 cutoff of 8 (sensitivity 0.75 [95% CI = 0.60–0.90], specificity 0.61 [95% CI = 0.38–0.84], Youden’s index 0.361). Independent of GA at birth and at nCPAP trial off, LUS Score-2 ≤ 8 was associated with increased odds of cessation of nCPAP by 9.0 (95% CI = 1.9–42.6), p = 0.005; each additional week of GA at first trial off increased this odd by 2.2 (95% CI = 1.1–4.4), p = 0.031. Conclusion: LUS is a reliable tool to assess readiness for nCPAP trial off. A pre-trial off LUS Aeration Score ≤ 8 was associated with higher successful weaning off nCPAP after 32 weeks GA.<Table Float="No" ID="Taba"> <tgroup align="left" cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> What is Known: • Lung ultrasound is a useful bedside tool to assess various neonatal respiratory disorders and for prediction of need for respiratory support and surfactant therapy. </entry> </row> <row> <entry nameend="c2" namest="c1"> What is New: • This study presents lung ultrasound as a precision-based tool to assess pulmonary readiness for weaning from non-invasive respiratory support in preterm infants. • Lung ultrasound aeration score at the time of trial-off reliably predicted successful weaning, independent of gestational age at birth or operator expertise. </entry> </row> </tbody> </tgroup> </Table>

Lung ultrasound aeration scores and their utility in predicting success of weaning off respiratory support in preterm neonates—A prospective cohort study

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发表日期：

2025年11月6日

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Ahmed Elkordy,
Ahmed Abuelnour,
Andrea De La Hoz,
Michael R. Miller,
Jagraj Brar,
Sriya Roychaudhuri,
Renjini Lalitha

摘要

Abstract

The study aims to determine the utility of lung ultrasound aeration scoring (LUS Aeration Scores) in predicting successful weaning off nasal continuous positive airway pressure (nCPAP) in preterm neonates. This was a prospective cohort study conducted in a tertiary neonatal unit between September 2022 and September 2023. Preterm neonates born < 33 weeks gestational age (GA) needing any respiratory pressure support after birth were included. LUS was performed at two time points; LUS1 at 30⁰–30⁶ weeks for those born < 30 weeks GA or between 48 and 72 h of life for those born at 30⁰–32⁶ weeks GA, and LUS2 within 12 h prior to trial off nCPAP to room air or low flow after 32 weeks corrected GA. LUS was scored for disease severity. Univariate and multivariate analyses compared the LUS Aeration Score between successful and failed nCPAP groups. Receiver operator characteristic (ROC) curves analyzed the reliability of the LUS Aeration Score in predicting the successful cessation of nCPAP post-LUS2. Of 50 preterm neonates included, 32 (64%) were successfully weaned from nCPAP after LUS2 at a mean (SD) GA of 33.3 (0.3). The median (IQR) LUS Aeration Score at LUS2 (LUS Score-2) was significantly lower in the successful group compared to the failed group [7 (6–8) vs 9 (7–11), p = 0.006]. The ROC curve showed AUC 0.72 (95% CI = 0.56–0.86) for an LUS Score-2 cutoff of 8 (sensitivity 0.75 [95% CI = 0.60–0.90], specificity 0.61 [95% CI = 0.38–0.84], Youden’s index 0.361). Independent of GA at birth and at nCPAP trial off, LUS Score-2 ≤ 8 was associated with increased odds of cessation of nCPAP by 9.0 (95% CI = 1.9–42.6), p = 0.005; each additional week of GA at first trial off increased this odd by 2.2 (95% CI = 1.1–4.4), p = 0.031.

Conclusion: LUS is a reliable tool to assess readiness for nCPAP trial off. A pre-trial off LUS Aeration Score ≤ 8 was associated with higher successful weaning off nCPAP after 32 weeks GA.

What is Known:

• Lung ultrasound is a useful bedside tool to assess various neonatal respiratory disorders and for prediction of need for respiratory support and surfactant therapy.

What is New:

• This study presents lung ultrasound as a precision-based tool to assess pulmonary readiness for weaning from non-invasive respiratory support in preterm infants.

• Lung ultrasound aeration score at the time of trial-off reliably predicted successful weaning, independent of gestational age at birth or operator expertise.