| Abstract [eng] |
Background. Lung ultrasound is increasingly being used to assess the respiratory condition of preterm neonates as an alternative to chest radiography. Radiological examinations are associated with cumulative exposure to ionizing radiation, posing additional risks to this vulnerable population. While the clinical value of LUS is actively being studied worldwide, data from Lithuania remain limited. Aim. This study aims to evaluate the impact of implementing a structured lung ultrasound protocol on the assessment and management of preterm neonates after birth. Objectives: - To conduct a literature review on the most common causes of respiratory insufficiency in preterm neonates and the role of lung ultrasound in diagnosis. - To systematize and perform statistical analysis of the clinical data of preterm neonates and their mothers before and after implementation of the lung ultrasound protocol. - To calculate and compare the number of chest radiographs during hospitalization before and after lung ultrasound protocol implementation. - To assess changes in the frequency and duration of antibiotic therapy before and after lung ultrasound protocol implementation. - To evaluate the average duration of hospitalization and treatment in the neonatal intensive care unit before and after lung ultrasound protocol implementation. - To compare the rates of major preterm neonatal complications before and after the protocol implementation to assess safety. Methods. This retrospective study was approved by the regional biomedical ethics committee. It included 117 preterm neonates (67 before [58%] and 50 after [42%] protocol implementation) born between 23 and 32 weeks of gestational age and treated in the intensive care unit. The main evaluated outcomes were number of chest X-rays, duration and frequency of antibiotic therapy, length of hospitalization and intensive care unit stay. To assess protocol safety, rates of common neonatal complications were compared between periods. Statistical analysis was performed using R software (version 4.4.2). Wilcoxon, t-tests, chi-square, Fisher’s exact tests, and regression models were applied. A p-value <0.05 was considered statistically significant. Results. No significant differences in baseline characteristics were observed between groups. After LUS protocol implementation, a statistically significant reduction was observed in the number of neonates undergoing at least one and multiple chest X-ray imaging. A significant decrease in the use of antibiotic therapy was found, and a trend toward shorter antibiotic duration was noted in extremely preterm neonates. Although the duration of hospitalization and NICU stay did not differ significantly between groups, a downward trend was seen in the overall and more mature neonate groups. Importantly, the rate of common complications did not increase during the LUS period. Conclusions. Lung ultrasound is a safe diagnostic tool that can help reduce the need for radiological imaging and antibiotic use in preterm neonates. Its integration into clinical practice may contribute to better outcomes and more rational and effective healthcare resource utilization. |
