| Abstract [eng] |
Background Lung ultrasound (LUS) is an increasingly used bedside diagnostic tool in neonatal intensive care units (NICUs) for assessing respiratory disorders in preterm neonates and supporting the choice of respiratory treatment. Although the lung ultrasound score (LUS score) is well described in international literature, data on the standardised use of this tool in clinical practice in Lithuania are lacking. This is the first study in Lithuania evaluating the impact of standardised LUS protocol implementation on the choice of respiratory therapy. Aim The aim of this study was to evaluate the impact of lung ultrasound implementation on the choice of respiratory therapy in preterm neonates and to assess the safety of this diagnostic tool by comparing short-term clinical outcome rates. Objectives - To compare surfactant use and administration rates before and after lung ultrasound implementation. - To assess the association between lung ultrasound implementation and the choice of respiratory support modality. - To compare short-term clinical outcome rates before and after the implementation of a standardised lung ultrasound protocol. Results The study included 172 preterm neonates: 84 before and 88 after LUS protocol implementation. Baseline neonatal characteristics were generally similar between the two eras, although some maternal and pregnancy-related factors differed. After LUS protocol implementation, the need for mechanical ventilation (MV) after birth decreased, while the initiation rate of continuous positive airway pressure (CPAP) remained similar. However, the duration of both MV and CPAP was longer after LUS implementation. Surfactant administration frequency and instillation technique did not differ significantly between eras. The predictive value of the fraction of inspired oxygen (FiO2) for surfactant administration improved after LUS implementation. In the post-LUS cohort, the LUS score was an independent predictor of surfactant administration, whereas the FiO2 threshold alone was not statistically significant in the adjusted model. Regarding safety, the rates of common prematurity-related complications, including intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and sepsis did not differ significantly between the pre-LUS and post-LUS eras. Conclusions In this single-centre retrospective cohort study, the implementation of a standardised LUS protocol was associated with changes in the choice of respiratory therapy, including a reduced need for MV initiation. We demonstrated that LUS is a safe diagnostic tool, and its implementation was not associated with increased complication rates. After protocol implementation, LUS score-based lung assessment also provided clinically useful information for surfactant decision-making. Further prospective multicentre studies are needed to confirm these findings. |
