Clinical Application Value Of Critical Ultrasound In Neonatal Respiratory Dysfunction

Objective:This study compared the consistency of lung ultrasound with chest X-ray in the diagnosis of neonatal respiratory dysfunction(NRD),and analyzed the correlation between pulmonary ultrasound score and disease severity.To explore the clinical value of critical ultrasound in neonatal respiratory disorders.Methods:This study selected 60 cases of neonates with NRD who were transferred from the Department of Obstetrics of the First Affiliated Hospital of Kunming Medical University to the pediatric neonatal intensive care unit(NICU)from August 2018 to January 2019(respiratory dysfunction group),and the newborns 30 cases who were transferred to the non-respiratory disorder during the same period(non-respiratory dysfunction group).According to the gestational age,the respiratory dysfunction components were the term infant group and the premature infant group.All subjects were enrolled with critical ultrasound,including pulmonary and inferior vena cava ultrasound,and pulmonary ultrasound scores.The NRD group underwent chest X-ray examination and clinical diagnosis.The clinical data were collected from all subjects.The NRD group received Silverman-Anderson(SA)score and Downes score.All data are analyzed as follows:(1)The NRD group used clinical diagnosis as the "gold standard" to analyze the sensitivity and specificity of pulmonary ultrasound diagnosis,and analyzed the accuracy of the two diagnostic methods separately and the consistency.(2)Analysis of the correlation between lung ultrasound score and SA score,Downes score and PiO2/FiO2 value in children with NRD.(3)Compare the differences in Inferior vena cava collapse index(IVC-CI)between in the NRD group and those in the non-respiratory dysfunction group.(4)Analysis of the correlation between IVC-CI and heart rate(HR)and mean arterial pressure(MAP)with each group.All data were analyzed by SPSS 23.0 statistical software.Results:(1)The NRD group,the clinical diagnosis is the "gold standard".the sensitivity and specificity of the lung ultrasound diagnosis are 96.7%,the accuracy of lung ultrasound diagnosis is 88.3%,and the accuracy of chest X-ray diagnosis is 83.3%;The consistency of the two diagnostic methods was Kappa 0.523,P<0.001,with moderate intensity consistency.(2)For the NRD,lung ultrasound score was positively correlated with SA score and Downes score(rs=0.585 and 0.533,P<0.001),and negatively correlated with P/F(rs=-0.424,P<0.001).(3)There was a difference in IVC-CI between the NRD and non-respiratory dysfunction group(P>0.05).There was no difference IVC-CI between the preterm infant group and the full-term infant group(P>0.05).(4)There was no significant correlation between IVC-CI and HR and MAP regardless of NRD group or non-respiratory dysfunction group(P>0.05).Conclusion:1.Lung ultrasound and chest x-ray have a good consistency in the diagnosis of NRD;Lung ultrasound score can predict the severity of the respiratory dysfunction.Critical ultrasound has important clinical application value with NRD2.For neonates with respiratory dysfunction,hemodynamic changes should be monitored during critical ultrasound examination.