TOP 36 - The Role of Lung Ultrasound in Identifying Ventilator-Associated Pneumonia Among Extremely Preterm Infants

Publication Number: 1796.TOP 36

Gordon Martins, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Jenna Ibrahim, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Adel Mohamed, University of Toronto Temerty Faculty of Medicine, Mississauga, ON, Canada

Background: Ventilator-associated pneumonia (VAP) is a common and serious complication among extremely preterm infants requiring prolonged mechanical ventilation. It contributes significantly to morbidity, mortality, and the development of bronchopulmonary dysplasia. Accurate diagnosis in this population remains challenging, as current criteria, adapted from older patients, lack sensitivity and rely on nonspecific clinical signs and imaging modalities such as chest X-ray (CXR). Lung ultrasound (LUS) has emerged as a safe, radiation-free, and reliable bedside imaging tool capable of identifying lung pathology with high diagnostic accuracy. Its application in detecting VAP in this vulnerable population offers the potential for earlier diagnosis, targeted treatment, and improved outcomes, though data in preterm neonates remain limited.

Objective: To evaluate the diagnostic accuracy of LUS compared with CXR for identifying VAP in extremely preterm infants. Secondary objectives are to characterize the LUS features of VAP and to assess the diagnostic performance of the LUS score alone versus LUS plus endotracheal aspirate (EA) culture results using the Ventilator-Associated Pneumonia Lung Ultrasound (VPLUS-EAgram) score

Design/Methods: This retrospective cohort study includes infants born at < 28 weeks’ gestation admitted to the Mount Sinai Hospital NICU (Toronto, Canada) between July 2023 and July 2025. Eligible infants are those requiring invasive ventilation for ≥48 hours and who underwent both CXR and LUS for suspected VAP. Diagnosis of confirmed VAP requires clinical suspicion or diagnosis, antibiotic treatment >5 days, and a positive EA culture. Infants with major congenital anomalies will be excluded. All LUS studies performed at the time of VAP suspicion will be retrospectively reviewed by two blinded neonatologists. A VPLUS–EAgram score will be applied (subpleural consolidations ≥2 areas = 1 point; ≥1 area with air bronchogram = 2 points; positive EA = 1 point; total score 0–8).
Statistical Analysis:Diagnostic accuracy of LUS and the VPLUS–EAgram scores will be assessed using sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves with area under the curve (AUC) analysis. Agreement between reviewers will be evaluated using Cohen’s κ coefficient. Continuous variables will be analyzed with t-tests or Mann–Whitney U tests, and categorical data with χ² or Fisher’s exact tests. A p-value < 0.05 will be considered statistically significant.
Ethics approval was obtained from the Mount Sinai Hospital Research Ethics Board (REB #1439).