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  • Clinical Research Article
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Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants

Pediatric Research volume 95, pages 1022–1027 (2024)Cite this article

Abstract

Background

We investigated whether combining lung ultrasound scores (LUSs) and respiratory system reactance (Xrs) measured by respiratory oscillometry explains the severity of lung disease better than individual parameters alone.

Methods

We performed a prospective observational study in very preterm infants. Forced oscillations (10 Hz) were applied using a neonatal mechanical ventilator (Fabian HFOi, Vyaire). We used the simultaneous respiratory severity score (RSS = mean airway pressure × FIO2) as a primary outcome. We built linear mixed-effect models to assess the relationship between Xrs z-score, LUS and RSS and compared nested models using the likelihood ratio test (LRT).

Results

We enrolled 61 infants (median (Q1, Q3) gestational age = 30.00 (26.86, 31.00) weeks) and performed 243 measurements at a postnatal age of 26 (13, 41) days and postmenstrual age of 33.14 (30.46, 35.86) weeks. Xrs z-score and LUS were independently associated with simultaneous RSS (p < 0.001 for both). The model including Xrs and LUS explained the RSS significantly better than Xrs (p value LRT < 0.001) or LUS alone (p value LRT < 0.001).

Conclusions

Combining LUS and Xrs z-score explains the severity of lung disease better than each parameter alone and has the potential to improve the understanding of the underlying pathophysiology.

Impact

  • Combining respiratory system reactance by oscillometry and lung ultrasound score explains the respiratory support requirement (e.g., proxy of the severity of lung disease) significantly better than each parameter alone.

  • We assessed the relationship between lung ultrasound and respiratory system reactance in very preterm infants for the first time.

  • Combining respiratory oscillometry and lung ultrasound has the potential to improve the understanding of respiratory pathophysiology.

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Fig. 1: Respiratory severity score, lung ultrasound score and respiratory system reactance z-score during different respiratory support modes.
Fig. 2: Relationship between lung ultrasound score and respiratory system reactance.
Fig. 3: Respiratory severity score corresponding with different lung ultrasound and respiratory system reactance patterns.

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Data availability

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Author information

Author notes

  1. These authors contributed equally: Camilla Rigotti, Emanuela Zannin.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy

    Camilla Rigotti, Emanuela Zannin & Maria Luisa Ventura

  2. TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy

    Raffaele L. Dellacà

Authors
  1. Camilla Rigotti
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  2. Emanuela Zannin
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  3. Raffaele L. Dellacà
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  4. Maria Luisa Ventura
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Contributions

C.R. contributed to the study design, performed lung ultrasound scans and scored the images, interpreted the results and approved the final manuscript as submitted. E.Z. contributed to the study design, processed the respiratory oscillometry data, performed formal analysis and drafted the first version of the manuscript. R.L.D. interpreted the data, revised the manuscript and approved the final manuscript as submitted. M.L.V. interpreted the data, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Emanuela Zannin.

Ethics declarations

Competing interests

R.L.D. reports that Politecnico di Milano received research grants from Vyaire and licensed a patent for using FOT to assess lung volume recruitment to Vyaire. C.R. has received honoraria for lectures from Vyaire. The other authors have nothing to disclose. None of the authors received any form of payment to produce the manuscript.

Ethics approval and consent to participate

The local ethics committee (nr. 3804/21) approved the study and written informed consent was obtained from parents before enrollment.

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Rigotti, C., Zannin, E., Dellacà, R.L. et al. Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants. Pediatr Res 95, 1022–1027 (2024). https://doi.org/10.1038/s41390-023-02829-2

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