| Objective Neonatal respiratory distress syndrome(NRDS)is the extensive alveolar collapse of both lungs caused by the lack of pulmonary surfactant(PS),which can lead to dyspnea,hypoxemia and respiratory failure several hours after birth.Exogenous PS alternative therapy(Curosurf)is recommended in the guideline of NRDS management.In the past blood gas analysis and chest X-ray are usually used to diagnose and assess NRDS.In recent years,lung ultrasound(LUS)has been used to diagnose NRDS and other neonatal pulmonary diseases,however,there is few research about its application in assessing treatment of NRDS with exogenous PS replacement.Children with NRDS often have severe hypoxemia,and the brain tissue is very sensitive to ischemia and hypoxia.It is not clear whether the hypoxic state of the children has any effect on the cerebral parenchyma and cerebral hemodynamic indexes,and the changes of this effect after the treatment with Curosurf.Therefore,in this study,combined lung and craniocerebral ultrasound was used to evaluate the pulmonary and cerebral parenchyma,cerebral hemodynamic characteristics and changes after treatment with Curosurf in children with NRDS,so as to provide references for early clinical diagnosis and treatment of NRDS.Methods 1.A total of 49 NRDS newborns admitted to the neonatal intensive care unit(NICU)of Tangdu hospital of the Air Force Medical University from May 2018 to March 2019 were prospectively selected.They were divided into two groups according to whether PS treatment was applied according to the guideline,including 31 neonates in the treatment group,and 18 newborns in the control group without any exogenous PS replacement therapy.Before receiving any treatment,LUS examination and scoring were performed in the two groups of children,besides LUS examination was performed in the treatment group at 4 h,1 d and 3 d after the use of Curosurf.Children continued to receive routine nursing care after the ultrasound examination.2.From January to June 2019,a total of 123 neonates born in obstetrics department of our hospital were prospectively divided into three groups,including 42 NRDS infants(case group),49 full-term infants(full-term group),and 32 premature infants(premature group).Cerebral ultrasonic examination was performed for all newborns within 24 hours after birth,measuring the thickness of the frontal lobe and transverse diameter,observing parenchymal hemorrhage or not,recording blood flow spectrum parameters of middle cerebral artery(MCA)including the peak systolic velocity(PSV),end-diastolic velocity(EDV),mean flow velocity(MFV),resistance index(RI)and pulse index(PI).Among the42 selected neonates with NRDS,25 patients received exogenous pulmonary surfactant(PS)and craniocerebral ultrasound was re-examined for them after treated with the drug.Results 1.LUS score was(20.59±5.46)in the treatment group before the use of Curosurf,and(11.20±2.10)in the control group before the use of any treatment,showing a statistically significant difference between the two groups(P<0.001).ROC curve was drawn according to the difference in LUS score between the treatment and control group before receiving any therapy,and the area under the curve was 0.886(P<0.001).When using 14 points as the cut-off point,the sensitivity,specificity,positive predictive value and negative predictive value of LUS score predicting children’s needs for Curosurf were81.48%,83.33%,91.7% and 66.7%.2.LUS score in the treatment group significantly decreased(14.30±4.79 vs20.59±5.46)at 4h after treatment compared with that before treatment(P<0.001).The LUS score was significantly lower at 3d after treatment than at 4h after treatment(9.12±3.45 vs 14.30±4.79,P=0.001).3.Two-dimensional cranial ultrasound showed that in the case group,42 cases(100%)showed periventricular echodensities,in the full-month control group,4 cases(8.16%)showed periventricular echodensities,and in the premature infants,25 cases(78.13%)showed periventricular echodensities,inducing a statistical difference between the three groups(P<0.001).The results of transcranial Doppler ultrasound showed that the average PSV、EDV、MFV、RI and PI of the control group of full-term newborns,premature infants and the case group was statistically significant(P<0.01).In the 25 neonates of NRDS,PSV decreased significantly after treatment with Curosurf(43.89±16.78 vs 36.26±12.43;P=0.044).RI decreased significantly before and after treatment,with statistically significant difference(0.75±0.12 vs 0.69±0.07;P=0.016).Conclusion: 1.LUS can be used to predict the need of NRDS neonates for Curosurf and monitor the change of alveolar ventilation status and the severity of NRDS.It provides important information for early intervention and treatment.2.Hypoxemia status of NRDS newborns and the use of exogenous PS could affect cerebral hemodynamics.Two-dimensional and Doppler ultrasound could clearly show the neonatal brain parenchyma,and effectively detect changes of cerebral blood flow velocity,providing a certain reference basis for the clinical prevention and treatment of brain injury in newborns with NRDS. |
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