Discussion
We modified the LUS scanning method and developed a simplified assessing
system(based on ”high-risk” image patterns) to predict respiratory
support need for the first time. As far as we know, this system is
practical and useful in obstetrics and gynaecology hospital that need to
identify infants with potential lung diseases in several hours right
after birth. It can help physicians to pick up these potential patients
before their respiratory symptoms deteriorated and chest X-ray applied
so that physicians can implement NICU cares earlier.
Findings and interpretation: This study has two clinically
relevant findings. (1) There are four ”low-risk” patterns and two
”high-risk” patterns can be found in late-preterm or term infants right
after birth. Even if two of ”low-risk” patterns, ”moderate discrete
B-line” pattern and ”abundant discrete B-line”, was reported to be
pathological in previous studies27-28, our study shows
they can be seen as strong evidence of healthy infants right after
birth. This ddiscrepancy may be because these two patterns are only the
result of the delay of lung fluid clearance. This delay make a small
amount of alveoli uninflated and full of fluid29-31but not enough to cause TTN. (2) Two ”high-risk” patterns have high
predictive reliability for respiratory support need. These two patterns
are also regarded as evidence of other diseases, such
RDS15, MAS8 and
pneumonia32. This concordence indicated that our
findings of ”high-risk” patterns are high likely to be a early stage of
RDS or MAS, especially when infants just have mild respiratory symptoms.
Because of the total ten scanning regions, the number of regions with
”high-risk” reversely relate to those with ”low-risk” patterns. Thus ROC
of ”low-risk” patterns can support the predictive reliability of
”high-risk” patterns.