A Refined Score, Namely Thoracic Ultrasound Score, to Predict the Need for Surfactant in Preterm Neonates: A Prospective, Multicenter, Observational Study.

Summary

In a prospective multicenter cohort of preterm neonates (N=170), the thoracic ultrasound score (TUS) correlated with oxygenation similarly to LUS but showed superior prediction of surfactant need in infants with GA ≥34 weeks (AUC 0.971 vs 0.797; p=0.02). Performance was comparable to LUS in GA <34 weeks.

Key Findings

• Preterm neonates (N=170): 58 received surfactant vs 112 did not; GA and birth weight were lower in the treated group.
• TUS and LUS correlated with oxygenation metrics: S/F ratio (r = -0.670 and r = 0.615) and OSI (r = 0.524 and r = 0.423), all p < 0.001.
• In GA ≥34 weeks, TUS outperformed LUS for predicting surfactant need (AUC 0.971 vs 0.797; p=0.02); in GA <34 weeks, performance was similar (AUC 0.956 vs 0.952).

Clinical Implications

TUS may be adopted to guide early surfactant decisions in preterm neonates, particularly GA ≥34 weeks, potentially reducing unnecessary intubations or delayed therapy. Implementation requires standardized scanning protocols and operator training.

Limitations

• Moderate sample size and potential operator dependence of ultrasound assessments
• Clinical impact on hard outcomes (e.g., intubation rates, LOS) not tested in interventional trials

Future Directions

External validation in independent cohorts and randomized implementation studies to test whether TUS-guided protocols improve clinical outcomes and resource use.