284 - Use of Lung Ultrasound Aids in Prediction of Successful CPAP Discontinuation in Preterm Infants

Poster Number: 284
Publication Number: 284.344

Faith Myers, Stanford University School of Medicine, Palo Alto, CA, United States; Jacklin H. Tong, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Shelby Vallandingham-Lee, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Christine Manipon, Lucile Packard Children's Hospital Stanford, Redwood City, CA, United States; Alex Dahlen, Stanford University School of Medicine, Palo Alto, CA, United States; Reedhi Dasani, Stanford University School of Medicine, Palo Alto, CA, United States; Daniele De Luca, Paris Saclay, Paris, Ile-de-France, France; Yogen Singh, Loma Linda University School of Medicine, Loma Linda, CA, United States; Valerie Y. Chock, Stanford University School of Medicine, Sunnyvale, CA, United States; Shazia Bhombal, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: For infants born prior to 32 weeks’ gestation at high risk of respiratory distress syndrome (RDS) due to surfactant insufficiency, continuous positive airway pressure (CPAP) is the mainstay of clinical management. Despite the importance of we­aning an infant when they are most likely to succeed, clinicians lack a consensus of factors to aid in predicting successful discontinuation. As a result, the practice of CPAP discontinuation varies widely, and failure remains common. The lung ultrasound score (Brat R. JAMA Pediatr 2015) correlates with oxygenation and has been shown to guide surfactant therapy and predict extubation success. Scant data exists assessing the score’s ability to predict successful CPAP discontinuation.

Objective: Determine if lung aeration assessment using the lung ultrasound score is predictive of successful CPAP discontinuation (defined as remaining off CPAP at least 7 days following discontinuation attempt) in preterm neonates.

Design/Methods: We analyzed the electronic medical records of 132 patients with RDS born between 24 and 32 weeks’ gestation admitted to a Level IV neonatal intensive care unit. We analyzed common clinical variables 24 hours prior to CPAP discontinuation, as well as the lung ultrasound obtained within one week of attempted CPAP discontinuation. Expert ultrasound “scorers” were blinded to the outcome of the discontinuation attempt. We performed univariate and penalized multivariate logistic regression for clinical features as well as for the lung ultrasound score. A cross-validated area under the curve was calculated using the lasso method to determine predictive capability of clinical variables alone, versus clinical variables plus the lung ultrasound score.

Results: Lower lung ultrasound scores (indicating more well-aerated lungs) obtained within seven days of CPAP discontinuation was associated with successful CPAP discontinuation (OR 0.43 [0.23, 0.80]; p=0.008; Figure 1). A lung ultrasound score < 4 was associated with 100% successful CPAP discontinuation. Area under the curve improved from 70% with clinical variables alone, to 87% when the lung ultrasound score was added to a model predicting successful CPAP discontinuation (Figure 2).

Conclusion(s): In preterm infants on respiratory support, a lower lung ultrasound score is associated with successful CPAP discontinuation and improves predictive capability when added to a model using common clinical variables. Performing bedside lung ultrasound may aid in the decision to discontinue CPAP in neonatal intensive care units.