209 - Correlation between Lung Ultrasound Score and Early Weight Change in preterm infants for the prediction of Bronchopulmonary Dysplasia.

Poster Number: 209
Publication Number: 209.2949

Background: Recent research demonstrated that early positive weight-change (WC) is associated with the need for invasive mechanical ventilation (IMV) and the development of bronchopulmonary dysplasia (BPD) in preterm neonates. Similarly, early high lung ultrasound score (LUS) has shown good prediction of BPD in the same population. We questioned if LUS correlates with positive WC as a marker of extravascular lung edema.

Objective: To examine the correlation between LUS and early weight-change (EWC) in preterm infants with respiratory distress syndrome in relation to future development of BPD.

Design/Methods: This is a secondary analysis involved infants born at < 29 weeks’ gestation, who were admitted to a tertiary NICU between July 2019 and December 2020, and had LUS assessment at days 3, 7, and 14 after birth. These infants were categorized into two groups: BPD group, who still required oxygen or respiratory support at 36 weeks postmenstrual age and the no-BPD group. LUS was measured using common technique in 6 regions in both lungs with a score ranging from 0-18. The study also calculated weight-change at postnatal days 3, 7, and 14 using the following formula [(Current weight – Birth weight) / Birth weight] × 100. Data on Mean Airway Pressure (MAP) and Respiratory Severity Score [RSS= fraction of inspired oxygen x MAP) at the time of LUS assessment were collected. Descriptive statistics and Area Under the Receiver Operating Characteristic Curve (AUC) analyses were utilized to compare LUS and EWC in both the BPD and no-BPD groups.

Results: Among the 132 infants included in this study, 70 (53%) were diagnosed with BPD. Demographic characteristics for both the BPD and no-BPD groups are summarized in Table 1. There were significant differences in LUS, EWC, RSS, and MAP at postnatal day 3, 7 and 14 between infants with BPD and those without, (p < 0.001, Table 2). The AUC has shown that LUS is better than EWC in predicting need for IMV at postnatal day 14 and development of BPD (p < 0.0001) (Table 3, Figure 1). There was positive but weak correlation between LUS and EWC at all points of assessment (Figure 2).

Conclusion(s): While early high LUS and positive EWC were associated with later development of BPD in preterm infants, the correlation between the two variables was relatively week. suggesting that EWC may not directly reflect the extent of extravascular lung edema. A randomized trial of adjusting early intravenous fluid therapy based on LUS in preterm infants with RDS and impact on development of BPD is warranted.