| Objective:The purpose of this study was to make a semi-quantitative analysis of the changes of neonatal respiratory distress syndrome through pulmonary ultrasound images,pulmonary ultrasound score and cerebral blood flow spectrum,to explore the pulmonary ventilation function and cerebral hemodynamics in children with NRDS,and to compare the LUS score with chest X-ray grading in children with NRDS to explore whether they are consistent in evaluating the severity of NRDS.Through the analysis of the correlation between LUS score and cerebral blood flow spectrum in children with NRDS,to explore whether there is a certain correlation between pulmonary severity and cerebral hemodynamic changes in children with NRDS.Methods:A total of 57 premature infants admitted to the NICU of Ganzhou Maternal and Child Health Hospital from November 2021 to December 2022 were selected as the case group,and 54 premature infants without abnormal diseases were admitted during the same period.for the control group.Ultrasound examination equipment is Mindray M9 cv,GE Versana Active,and chest X-ray examination equipment is GE bedside digital X-ray camera.The first LUS,cranial ultrasound and chest X-ray examination in the control group and case group were completed within the first day after birth in the case group,LUS and cranial ultrasound will be re-examined on the 3rd and 7th days after birth,and the blood flow spectrum of the middle and anterior arteries of the brain,the imaging characteristics of the lungs,the LUS score of each region and the classification of the chest X-ray will be recorded.SPSS26.0 software was used to analyze the data.The measurement data that conformed to the normal distribution were compared using the t test,and the non-parametric rank sum test was used to compare the non-conformity.The count data were compared using the c2 test.The LUS score and cerebral blood flow spectrum of the case group were consecutively used for three times.Measurements were compared using repeated measures ANOVA.ROC curve was used to establish the optimal cut-off value,sensitivity and specificity of LUS score for NRDS diagnosis.Kappa consistency test was used to analyze the consistency of LUS and chest X-ray in the diagnosis of NRDS.The Kendall’s tau-b rank correlation coefficient was used to analyze the correlation between the LUS score and the severity of NRDS assessed by chest X-ray.Pearson correlation analysis and Spearman rank correlation analysis were used to analyze the correlation between LUS score and cerebral blood flow spectrum.Bland-Altman analysis method was used to test the repeatability of LUS score images and middle cerebral artery blood flow spectrum images of 30 randomly selected subjects,and compare the inter-observer and intra-observer differences.Results:1.Comparison of LUS results between NRDS group and control group.In the LUS signs of the two groups,the abnormal pleural line,disappearance of A line,fusion B line,dense B line,lung consolidation with bronchial inflation sign in the NRDS group were significantly different from those in the control group(P < 0.001).The LUS scores of the NRDS group were compared on the 1st,3rd and 7th day after birth(P < 0.001),indicating that with the passage of time,the LUS score of the NRDS group decreased gradually,and the condition of the children gradually improved.According to the LUS score of NRDS and the control group,the ROC curve showed that the area under the curve of LUS score in NRDS diagnosis was 0.986(P < 0.001),and the best cutoff value was 11.5.in NRDS diagnosis,the predictive sensitivity was 94.73% and the specificity was 96.30%.2.Comparison of LUS and chest X-ray in the diagnosis and evaluation of NRDS.The overall consistency between the cut-off value of LUS score of diagnostic NRDS group and chest X-ray diagnosis of NRDS was 95%,Kappa value = 0.910(P < 0.001),indicating that LUS and chest X-ray diagnosis of NRDS have a good consistency.There was a positive correlation between LUS score and chest X-ray grade in the diagnosis of NRDS severity(r =0.828,P < 0.001).3.Evaluation of the results of cerebral blood flow spectrum between NRDS group and control group.The EDV of MCA in the NRDS group was significantly lower than that in the control group on the first day after birth(P < 0.001).The RI and PI of MCA in the NRDS group were significantly higher than those in the control group(P < 0.001).There was no significant difference in PSV and Shand D of MCA between the NRDS group and the control group.With the passage of time,the PSV and EDV of MCA in NRDS group increased gradually on the 1st,3rd and 7th day,and the difference was statistically significant.However,the RI and PI of NRDS group decreased gradually with the passage of time,and the difference was not statistically significant.4.Correlation analysis between LUS score and MCA blood flow spectrum in NRDS group.There were significant correlations between EDV,RI,PI,PI and LUS scores of MCA in NRDS group.There was no significant correlation between the PSV of MCA in NRDS group and LUS score.5.Repeat the consistency test results.The LUS score images and MCA blood flow spectrum images of 30 subjects were randomly selected,and the LUS score was measured.The intra-group correlation coefficient ICC between observers was 0.941(95%CI:0.880-0.972),and the intra-observer ICC was 0.954(95%CI:0.906-0.978).Repeated measurement of blood flow spectrum parameters of MCA(PSV,EDV,RI,PI,Scarp D),the consistency among observers: ICC was 0.816(95%CI:0.648-0.908),0.874(95%CI:0.752-0.938),0.817(95%CI:0.651-0.909),0.814(95%CI:0.646-0.907),0.758(95%CI:0.552-0.877),respectively.Intra-observer consistency: ICC was 0.819(95%CI:0.654-0.909),0.885(95%CI:0.772-0.943),0.828(95%CI:0.670-0.914),0.833(95%CI:0.679-0.917)and 0.805(95%CI:0.630-0.902),respectively.The results showed that the LUS score and blood flow spectrum parameters of MCA were consistent between observers and within observers.Conclusion:1.The imaging features of LUS in children with NRDS are abnormal pleural line,disappearance of A line,presence of fused B line,dense B line,and subpleural lung consolidation with air bronchial sign,among which subpleural lung consolidation with air bronchial sign is NRDS has the most specific manifestations.2.The best cut-off value of LUS score in the diagnosis of NRDS in this study is 11.5,its sensitivity is 94.73%,and its specificity is 96.30%,which provides a quantitative index for the diagnosis of NRDS.3.There is a positive correlation between LUS score and chest X-ray grading in the diagnosis of NRDS severity,indicating that LUS score can be used to assess the severity of lung diseases in children with NRDS,and provide a new reference for clinicians to choose treatment options.4.The MCA blood flow spectrum of children with NRDS showed low perfusion and high resistance on the first day after birth,and the LUS score was negatively correlated with EDV of MCA and positively correlated with RI,PI and S/D of MCA,indicating that there was a certain correlation between lung condition and cerebral blood flow spectrum of NRDS children,so regular monitoring of cerebral hemodynamics can reduce the risk of brain injury. |
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