الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
Respiratory distress syndrome (RDS) continues to represent a crucial problem for preterm neonates despite the new advancement in its management. Currently, management of RDS is mainly through using early continuous positive airway pressure (CPAP) in the management of preterm neonates since birth together with early selective administration of surfactant. On the other hand, surfactant prophylaxis is no longer indicated for preterm neonates stabilized by non-invasive respiratory support.
New methods in diagnosis for assessment of endogenous surfactant and lung maturity and there is an increasing need for a simple bedside test that can be done within the NICU. LUS may be a helpful tool. LUS can be used in diagnosis of RDS with high sensitivity and specificity, as reported in a literature review, about 97% and 91% respectively.
In this study we assessed the applicability of lung ultrasonography to evaluate the surfactant need in preterm neonates ≤ 34 weeks treated with early CPAP according to European guidelines 2019 update. We also assessed the response need for second dose of surfactant.
We studied 60 neonates ≤ 34 weeks treated with early CPAP; LUS was done in the first 2 hours of life. 16 neonates received surfactant therapy according to European guidelines 2019 update. LUS was repeated after the surfactant within 2 hours. 7 neonates received a second dose of surfactant if the oxygen needs remained high ≥10 hours (the median half-life of surfactant) after the first administration.
Detailed medical history was taken and detailed physical examination was performed. Also, basic laboratory tests and chest x-ray findings were obtained from medical records for each case. The result of lung ultrasound was masked to clinicians who decided whether to use surfactant or not and the LUS performer wasn’t involved in decision-making in treating the preterm neonates.
The result of our study shows that in the group received surfactant the median LUS score was 10, While in the group didn’t need surfactant therapy the median LUS score was 4. in the group received one dose of surfactant the median LUS score was 8, While in the group received two doses of surfactant the median LUS score was 11.
We found that there is a strong positive Correlation ( r = 0.802 ) between No of surfactant doses and LUS score and a strong positive Correlation ( r = 0.736 ) between chest x ray score and LUS score. Both are statistically significant (P=<0.001).
About the reliability of LUS score for prediction of surfactant treatment. Our results showed that LUS score at a cut off value of ≥ 6 has a sensitivity of 93.8 % and specificity of 84.1 %. while Chest X ray score at a cut off value of ≥ 5 has a sensitivity of 81.3 % and specificity of 77.3 %.
On the other hand, our study showed that about the reliability of LUS score pre and post surfactant for prediction of surfactant retreatment. LUS score pre surfactant at a cut off value of ≥ 10 has a sensitivity of 85.7 % and specificity of 77.8 %. LUS score post surfactant at a cut off value of ≥ 6 has a sensitivity of 85.7 % and specificity of 88.9 %.
We concluded that LUS score is a useful tool in early prediction of need for surfactant administration in preterm neonates on CPAP. LUS score at a cut off value of ≥ 6 has a sensitivity of 93.8 % and specificity of 84.1 % for prediction of need for surfactant treatment and at a cut off value of ≥ 10 has a sensitivity of 85.7 % and specificity of 77.8 % for prediction of need for second dose of surfactant.
Finally, we recommended that further studies needed to determine a universal protocol for performing LUS, validity of its scoring system and to define the reference cut off value for LUS score at which surfactant should be administered in early hours of life for better outcome. Also, our results should be replicated in larger groups of preterm infants with RDS, and it will be especially important to do so in a larger population of extremely preterm infants (gestational age < 30 weeks), as these may potentially benefit the most from LUS.