Daniel Ibarra-Ríos, Expresidente, Asociación de Neonatólogos de la Ciudad y Valle de México; Servicio de Investigación Clínica, Hospital Infantil de México Federico Gómez. Ciudad de México, México
Federico Franchi, Departamento de Neonatología, Azienda Ospedaliera Carlo Poma, Mantova, Italia
Deneb A. Morales-Barquet, Departamento de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
Edgar A. Jorge-Chang, Departamento de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
Carolina Valencia-Contreras, Departamento de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
Juvenal Salgado-Valencia, Departamento de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
Irma A. Coronado-Zarco, Departamento de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
Alejandra Sánchez-Cruz, Departamento de Neonatología, Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia No. 4, Luis Castelazo Ayala, Ciudad de México, México
Horacio Márquez-González, Servicio de Investigación Clínica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
Introduction: Lung ultrasound (LU) has proven to be the best method for diagnosing surfactant deficiency (Respiratory Distress Syndrome [RDS]) and continuous positive airway pressure (CPAP) failure; experience in Mexico is limited. Methods: The objective was to determine the usefulness of a LU program and a lung ultrasound score (LUS) for predicting surfactant need in a perinatal hospital. LUS and FiO2 of patients who received or did not receive surfactant were compared with Mann-Whitney U test. Using LU as the gold standard, FiO2 thresholds were tested using receiver operating characteristic curves. Results: 69 newborns (33 weeks [30, 35]; birth weight 1925 [1470, 2590]) were evaluated for differential diagnosis and to determine surfactant needs. 74 studies were performed: 54 for the first dose (14 administrations, 26%) and 20 for re-surfactant (six administrations, 30%). Among the group evaluated for a first dose, LU diagnoses were RDS 30%, transient tachypnea of the newborn (TTRN) 59%, TTN/air leak 6%, TTRN/pleural effusion 1.6%, congenital pneumonia 1.6%, and meconium aspiration syndrome 1.6%. There was a statistically significant difference between the LUS of patients who received the first (12 [10, 12] vs. 6 [5, 6]) and second dose of surfactant (12 [11, 12] vs. 4 [4, 7]). FiO2 ≥ 30% was found in 34% of patients with TTN pattern in whom CPAP optimization improved all cases. An optimal FiO2 threshold of 24% was found with an area under the curve of 0.85. Conclusions: LU provides very valuable information through pattern recognition and a LUS, allowing differential diagnosis and tailored physiological care.
Keywords: Lung ultrasound. Neonatology. Ultrasound. Respiratory distress syndrome. Transient tachypnea of the newborn. Surfactant. Neonatology. Continuous airway pressure.
