Lung ultrasound score for predicting surfactant therapy in preterm neonates with respiratory distress syndrome a systematic review and meta analysis

Abstract

Abstract Respiratory distress syndrome (RDS) is the common cause of respiratory morbidity in preterm neonates due to the primary surfactant deficiency. Early surfactant delivery improves outcomes, whereas oxygen-based criteria may not quickly recognize the surfactant requirement. Lung ultrasound (LUS), a radiation-free bedside tool, help in guiding surfactant therapy using scoring systems. Therefore, this systematic review and meta-analysis evaluated the diagnostic accuracy of LUS score in predicting surfactant requirement in preterm neonates (< 37 weeks’ gestational age [GA]) with RDS. Eighteen studies including 997 neonates were analyzed using a bivariate random-effects model. The pooled sensitivity and specificity of overall studies were 0.85 (95% CI: 0.83–0.87) and 0.80 (95% CI: 0.77–0.82). A diagnostic odds ratio (DOR) was 32.12 (95% CI: 18.99–54.33), indicating strong overall discriminatory ability. The area under sROC curve was 0.682. Subgroup analysis  ≤  6 had higher sensitivity but lower specificity which is more useful for early screening, cutoff between 7 and 8 had balanced diagnostic value and ≥  9 cutoff had higher specificity which showed stronger confirmation for surfactant requirement. Overall, LUS can support timely clinical decision making and early surfactant administration in the neonatal intensive care unit (NICU) when used alongside clinical assessment.