Lung ultrasound for prediction of bronchopulmonary dysplasia in preterm newborns

• Grant number: 24/15021-8
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: November 01, 2024
• End date: October 31, 2025
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: João Cesar Lyra
• Grantee: Henrique Akira Rodrigues Watanabe
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Introduction: Bronchopulmonary dysplasia (BPD) is a disease predominantly affecting premature newborns, potentially impacting up to 45% of infants born before 29 weeks of gestational age. It is associated with high mortality and a significant reduction in quality of life among survivors. The etiopathogenesis of BPD is multifactorial, complicating its diagnosis and representing a substantial challenge in clinical practice, with limitations in developing preventive and therapeutic strategies. Research in this area aims to identify methods for early prediction of the disease in at-risk newborns, among which lung ultrasonography stands out. This examination is harmless, rapid to perform, and can be conducted at the bedside. Images obtained via ultrasound are used to create a score that assesses the risk of BPD. The objectives of this study are to investigate the utility of early lung ultrasonography for predicting BPD in premature newborns with a gestational age of less than 34 weeks; to compare the scores obtained from the examination in patients who do or do not develop BPD, as evaluated at 36 weeks corrected age; and to correlate the ultrasonographic scores with the different degrees of BPD. Methods: This is a retrospective cohort study, including premature newborns born at the study site with a gestational age of less than 34 weeks who survived until 36 weeks postmenstrual age (PMA), conducted from June 2023 to May 2024. Cases of major malformations, congenital infections, chromosomal abnormalities, or specific pulmonary malformations will be excluded. Data will be collected through patient record analysis and the Unit's data registry. Maternal, gestational, and neonatal variables will be assessed. Pulmonary score values obtained from ultrasound performed between two and three weeks of life and on the day the patient reaches 36 weeks PMA will be collected. The score ranges from 0 to 18, is validated for neonates, and is based on classical ultrasonographic lung semiology performed in three anterior and three posterior thoracic areas. Patients will be assessed at 36 weeks PMA for the diagnosis of BPD according to criteria commonly proposed in the literature. The sample will be a convenience sample, including all cases that meet the inclusion criteria during the study period. Continuous variables will be described as medians and percentiles, and categorical variables will be expressed by the number and proportion of events. Chi-square tests will be used to study associations between categorical variables, and the Mann-Whitney test will be used for continuous variables. Risk scores will be evaluated through calculations of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) (with a significance level of 5%). The project has been approved by the Institutional Ethics Committee. Expected Results: The results of this research are expected to contribute to the development of protocols for performing lung ultrasonography in at-risk newborns for BPD and may be useful for developing strategies for the prevention and treatment of the disease.