399 - Serial Lung Ultrasound Correlates with Respiratory Severity Score in Infants with Severe Bronchopulmonary Dysplasia- A Prospective Observational Sudy

Publication Number: 1382.399

Ruby Gupta, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Matthew R. Plunk, Medical College of Wisconsin, Milwaukee,, WI, United States; Elizabeth Awe, Medical College of Wisconsin, Milwaukee, WI, United States; Joanne Lagatta, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Bronchopulmonary dysplasia (BPD) remains a major morbidity in preterm infants, with incidence rates ranging from 38% to 64% in extremely preterm populations. Monitoring lung disease progression relies mainly on clinical and radiographic assessments. Lung ultrasound (LUS) is a noninvasive bedside tool with potential for serial evaluation, correlating with clinical severity and oxygenation. However, the feasibility of integrating LUS into routine BPD care is not yet well established.

Objective: To evaluate the feasibility of weekly LUS exams in infants with BPD, including image acquisition consistency, scoring reliability, LUS score trends, and correlation with respiratory severity score.

Design/Methods: This prospective observational study was conducted at a level IV NICU. Preterm infants ( < 30 weeks gestation) with grade 2 or 3 BPD defined by 2019 NRN criteria were enrolled. Four weekly LUS exams were performed from 36 to 40 weeks postmenstrual age using a GE Venue machine with an 8-18 MHz linear probe. Six lung zones were scanned in the supine position and scored using the BRAT scoring system with a maximum score of 18. A four-second LUS video clip for each zone was stored on a password-protected device. Images were acquired by only one neonatologist (RG). LUS scores were assessed by a radiologist (MP) and a neonatologist (RG). Feasibility outcomes included enrollment rate, proportion of scheduled scans completed, and inter-rater reliability. LUS scores were correlated using Pearson Correlation Coefficient (PCC) with clinical data, including Respiratory Severity Score (RSS)= Mean Airway Pressure (MAP) X FiO2. The study was approved by the local IRB.

Results: Of 25 eligible infants, 15 (60%) were enrolled; one withdrew after enrollment. Of 56 planned scans, 50 (89%) were completed. Image quality was rated adequate in 90% of scans, with excellent inter-rater agreement. Table 1: Mean birth weight 867 grams, median GA was 25.5 weeks, median RSS at 36 weeks was 3. Table 2a & 2b: Weekly LUS scores showed significant strong Correlation with RSS as PCC of r=0.58, p=0.04 at 37 weeks, r=0.72, p=0.008 at 38 weeks, r=0.66, p=0.03 and MAP. Correlations with FiO₂ were significant at weeks 38-39. Figure 1: Represent the graphic correlation of LUS score with RSS.

Conclusion(s): Serial LUS is feasible and reproducible in infants with BPD, providing high-quality images and reliable scoring. LUS scores strongly correlate with indices of respiratory severity, supporting their potential role in monitoring BPD progression. Future studies should evaluate the predictive value of LUS scoring for BPD severity and clinical outcomes.

Table 1. Baseline Patient Characteristics (N=14)


Table 2a: Weekly Lung Ultrasound Scores and Respiratory Severity mean (±SD) in Infants with BPD Table 2b: Correlation of Weekly Lung Ultrasound Scores and Respiratory Severity Scores in Infants with BPD
Pearson Correlation coefficient = r * Represent clinically significant correlation

Figure 1: Pearson Correlation Coefficient of Lung Ultrasound Scores with Respiratory Severity Score
Graphic representation of Correlation of Lung Ultrasound Scores with Respiratory Severity Score