The Clinicai Application Value Of Lung Ultrasound In Neonatal Distress Syndrome

Objective: To analyze the value of lung ultrasound(LUS) in judging the severity of neonatal respiratory distress syndrome(RDS) and evaluating the curative effect of pulmonary surfactant(PS), and to explore the feasibility of LUS score as a quantitative standard in estimating the severity of RDS.Methods: Choose 85 RDS infants who were hospitalized in neonatal intensive care unit in Chenzhou’S No.1 hospital affiliated with University of South China from November 2014 to 2015. All infants were devided into two groups on the basis of clinical symptoms and chest X-Ray,one group with 49 mild cases and the other with 36 severe cases. All infants were examined and scored by lung ultrasound before treatment, later 12 hours and 24 hours respectively,then analyzed the change of both the ultrasound signs and LUS score, explored the consistency between lung ultrasound and X-ray and the feasibility of LUS score being quantitative index.Results:1. The lung ultrasound signs in mild RDS cases consisted of focal lung consolidation with obscure air-filled bronchograms, alveolar interstitial syndrome, faint pleural line and absence of A-lines, while in severe cases wide-range of lung consolidation with evident air-filled bronchograms, severe alveolar interstitial syndrome, absence of both pleural line and A-lines, and pleural effusion. In the process of recovering, the signs included shrink of lung consolidation, remission of air-filled bronchi, disappearance of pleural effusion, and remission of pulmonary edema.2. Before treatment,LUS score in severe group was higher than that in mild group(18.2±2.3 VS 27.6±4.1,t=7.482,P=0.037); The sensitivity and specificity of LUS score in estimating the severity were 85.7% and 83.3% for mild group, 87.1% and 86.5% for severe group respectively.3.Before treatment,compared lung ultrasound with chest X-ray in the ability of judging RDS severity, the difference was of no significance(X2=0.634, P>0.05).4. In the mild group and severe group, LUS score gradually decreased after treatment(P<0.01/0.001). Compared with non-PS treatment group, LUS score in PS tredtment group decreased by about 24.4% to 28.9% latter 12 hours after treatment, and about 37.3% to 50.0% latter 24 hours after treatment. The drop of LUS score in severe group was about higher than that in mild group after treatment, and the difference was significant(P<0.001).5.Latter 12 hours after treatment, lung consolidation ratio, pulmonary edema ratio, abnormal pleural line ratio and A-line disappearance ratio decreased by 26.3% to 42.1% in mild group, and by 15.3% to 23.1% in severe group; pulmonary slip sign increased by 19.2%. Latter 24 hours after treatment, lung consolidation ratio, pulmonary edema ratio, abnormal pleural line ratio and A-line disappearance ratio decreased by above 50% in mild group, compared with about 40% in severe group.6. There was no significant difference between X-ray and ultrasound in evaluating curative effect in mild group(X2=0.677,P>0.05) and in severe group(X2=0.589)latter 24 hours after treatment.Conclusions:1. The lung ultrasound have good value of judging the severity of neonatal RDS and evaluating the curative effect.2. LUS score can be a index to quantify RDS severity and assess curative effect.