Back to all available

A lung ultrasound B‑line score to stratify Oxygen therapy in Transient Tachypnea of the Neonate: A prospective cohort study

pediatrics
radiology-and-medical-imaging

Abstract

Background: Transient tachypnea of the neonate (TTN) is the most common cause of respiratory distress in newborns. While often self-limiting, the severity of TTN varies significantly, ranging from mild tachypnea to severe respiratory failure requiring non-invasive ventilation. Early and objective grading of TTN severity remains difficult in routine practice. Clinical scores are subjective, and chest radiography is insensitive to the extent of lung fluid. This study evaluated a semi-quantitative lung ultrasound (LUS) B-line score as a predictor of oxygen requirement in neonates with TTN

Methods: In a prospective cohort at a tertiary NICU, we enrolled 267 neonates (gestational age ≥33 weeks) with a clinical diagnosis of TTN. Within 6 hours of admission, we recorded a standardized twelve‑zone LUS B‑line score, respiratory rate, and arterial blood gas values. The primary outcome was the highest level of oxygen therapy within 72 hours, classified as room air, low‑flow oxygen, or high‑flow support. Analyses included Spearman correlation, receiver‑operating‑characteristic (ROC) curves, and multivariable ordinal logistic regression.

Results: The LUS score correlated inversely with PaO₂ (ρ = -0.705, P<0.001) and positively with PaCO₂ (ρ = 0.399, P<0.001). Mean scores rose with increasing support (0.5±2.1, 15.0±6.4, and 27.0±4.8 for room air, low‑flow, and high‑flow groups; P<0.001). For predicting any oxygen use, the AUC was 0.982 (95% CI, 0.968–0.997) with an optimal cutoff of 5.5. A cutoff of 22.5 identified infants needing high‑flow support (AUC 0.965). In multivariable analysis, the LUS score was the strongest independent predictor of higher oxygen therapy (adjusted odds ratio per point, 1.70; 95% CI, 1.41–2.05; P<0.001).

Conclusions: A semi‑quantitative LUS B‑line score provides a non‑invasive and physiologically coherent measure of disease severity in TTN and can help stratify oxygen therapy requirements at the bedside. These findings suggest that incorporating LUS B‑line scoring into early NICU assessment may help standardize decisions about initiation and escalation of respiratory support in infants with TTN.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].