• Almudena Alonso-Ojembarrena, Iker Serna-Guerediaga, Victoria Aldecoa-Bilbao, Rebeca Gregorio-Hernández, Paula Alonso-Quintela, Ana Concheiro-Guisán, Alicia Ramos-Rodríguez, de Las Heras-MartínMónicaMNeonatal Intensive Care Unit, Basurto Universitary Hospital, Bilbao, Spain., Lorena Rodeño-Fernández, and Ignacio Oulego-Erroz.
• Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain. Electronic address: almudena.alonso.sspa@juntadeandalucia.es.
• Chest. 2021 Sep 1; 160 (3): 1006-1016.

BackgroundDifferent lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous.Research QuestionsWhat is the diagnostic accuracy of the LUS score to predict moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy?Study Design And MethodsThis was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point.ResultsEight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve [AUC] 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52).InterpretationThe LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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