Introduction: Early targeted surfactant therapy for preterm infants is recommended but the best criteria to personalize treatment are unclear. We validate a previously published multivariate prognostic model based on gestational age (GA), lung ultrasound score (LUS), and oxygen saturation to inspire oxygen fraction ratio (SatO2/FiO2) using an independent data set. Methods: Pragmatic, observational study in 10 Italian and Spanish NICUs, including preterm babies (250 and 336 weeks divided into 3 GA intervals) with clinical signs of respiratory distress syndrome and stabilized on CPAP. LUS and SatO2/FiO2 were collected soon after stabilization. Their prognostic accuracy was evaluated on the subsequent surfactant administration by a rigorously masked physician. Results: One hundred seventy-five infants were included in the study. Surfactant was given to 74% infants born at 25–27 weeks, 38.5% at 28–30 weeks, and 26.5% at 31–33 weeks. The calibration curve comparing the validation and the development populations showed significant overlap with an intercept = 0.08, 95% CI (−0.34; 0.5) and a slope = 1.53, 95% CI (1.07–1.98). The validation cohort had a high predictive accuracy. Its ROC curve showed an AUC = 0.95, 95% CI (0.91–0.99) with sensitivity = 0.93, 95% CI (0.83–0.98), specificity = 0.81, 95% CI (0.73–0.88), PPV = 0.76, 95% CI (0.65–0.84), NPV = 0.95, 95% CI (0.88–0.98). LUS ≥9 demonstrated the highest sensitivity (0.91, 95% CI [0.82–0.97]) and specificity = 0.81, 95% CI (0.72–0.88) as individual predictor. LUS and SatO2/FiO2 prognostic performances varied with GA. Conclusion: We validated a prognostic model based on LUS and Sat/FiO2 to facilitate early, customized surfactant administration that may improve respiratory management of preterm neonates.

1.
Bahadue
FL
,
Soll
R
.
Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome Cochrane
.
Database Syst Rev
.
2012 Nov 14
11
11
CD001456
.
2.
Polin
RA
,
Carlo
WA
Committee on Fetus and Newborn
American Academy of Pediatrics
.
Surfactant replacement therapy for preterm and term neonates with respiratory distress
.
Pediatrics
.
2014 Jan
133
1
156
63
.
3.
Sweet
DG
,
Carnielli
V
,
Greisen
G
,
Hallman
M
,
Ozek
E
,
Te Pas
A
et al
.
European consensus guidelines on the management of respiratory distress syndrome: 2019 update
.
Neonatology
.
2019
;
115
(
4
):
432
50
.
4.
Dargaville
PA
,
Aiyappan
A
,
De Paoli
AG
,
Dalton
RG
,
Kuschel
CA
,
Kamlin
CO
et al
.
Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences
.
Neonatology
.
2013
;
104
(
1
):
8
14
.
5.
Raimondi
F
,
Migliaro
F
,
Corsini
I
,
Meneghin
F
,
Pierri
L
,
Salomè
S
et al
.
Neonatal lung ultrasound and surfactant administration: a pragmatic, multicenter study
.
Multicenter Study Chest
.
2021 Dec
160
6
2178
86
.
6.
De Martino
L
,
Yousef
N
,
Ben-Ammar
R
,
Raimondi
F
,
Shankar-Aguilera
S
,
De Luca
D
.
Lung ultrasound score predicts surfactant need in extremely preterm neonates
.
Pediatrics
.
2018 Sep
142
3
e20180463
.
7.
Rodriguez-Fanjul
J
,
Jordan
I
,
Balaguer
M
,
Batista-Muñoz
A
,
Ramon
M
,
Bobillo-Perez
S
.
Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial
.
Eur J Pediatr
.
2020 Dec
179
12
1913
20
.
8.
Raschetti
R
,
Yousef
N
,
Vigo
G
,
Marseglia
G
,
Centorrino
R
,
Ben-Ammar
R
et al
.
Echography-Guided surfactant therapy to improve timeliness of surfactant replacement: a quality improvement project
.
J Pediatr
.
2019 Sep
212
137
43.e1
.
9.
Brat
R
,
Yousef
N
,
Klifa
R
,
Reynaud
S
,
Shankar Aguilera
S
,
De Luca
D
.
Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure
.
JAMA Pediatr
.
2015 Aug
169
8
e151797
.
10.
Aldecoa-Bilbao
V
,
Balcells-Esponera
C
,
Herranz Barbero
A
,
Borràs-Novell
C
,
Izquierdo Renau
M
,
Iriondo Sanz
M
et al
.
Lung ultrasound for early surfactant treatment: development and validation of a predictive model
.
Pediatr Pulmonol
.
2021 Feb
56
2
433
41
.
11.
Collins
GS
,
Reitsma
JB
,
Altman
DG
,
Moons
KG
.
Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement
.
BMJ
.
2015 Jan 7
67
6
1142
51
.
12.
Jensen
EA
,
Dysart
K
,
Gantz
MG
,
McDonald
S
,
Bamat
NA
,
Keszler
M
et al
.
The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach
.
Am J Respir Crit Care Med
.
2019 Sep 15
200
6
751
9
.
13.
Pavlou
M
,
Qu
C
,
Omar
RZ
,
Seaman
SR
,
Steyerberg
EW
,
White
IR
et al
.
Estimation of required sample size for external validation of risk models for binary outcomes
.
Stat Methods Med Res
.
2021
;
30
(
10
):
2187
206
.
14.
Verder
H
,
Albertsen
P
,
Ebbesen
F
,
Greisen
G
,
Robertson
B
,
Bertelsen
A
et al
.
Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation
.
Pediatrics
.
1999
103
2
E24
.
15.
De Luca
D
,
Autilio
C
,
Pezza
L
,
Shankar-Aguilera
S
,
Tingay
DG
,
Carnielli
VP
.
Personalized medicine for the management of RDS in preterm neonates
.
Neonatology
.
2021
;
118
(
2
):
127
38
.
16.
Gomond-Le Goff
C
,
Vivalda
L
,
Foligno
S
,
Loi
B
,
Yousef
N
,
De Luca
D
.
Effect of different probes and expertise on the interpretation reliability of point-of-care lung ultrasound
.
Chest
.
2020 Apr
157
4
924
31
.
17.
Raimondi
F
,
Migliaro
F
,
Corsini
I
,
Meneghin
F
,
Dolce
P
,
Pierri
L
et al
.
Lung ultrasound score progress in neonatal respiratory distress syndrome
.
Pediatrics
.
2021 Apr
147
4
e2020030528
.
18.
Raimondi
F
,
Yousef
N
,
Rodriguez Fanjul
J
,
De Luca
D
,
Corsini
I
,
Shankar-Aguilera
S
et al
.
A multicenter lung ultrasound study on transient tachypnea of the neonate
.
Neonatology
.
2019
;
115
(
3
):
263
8
.
19.
Badurdeen
S
,
Kamlin
COF
,
Rogerson
SR
,
Kane
SC
,
Polglase
GR
,
Hooper
SB
et al
.
Lung ultrasound during newborn resuscitation predicts the need for surfactant therapy in very- and extremely preterm infants
.
Resuscitation
.
2021 May
162
227
35
.
20.
Gulczyńska
E
,
Szczapa
T
,
Hożejowski
R
,
Borszewska-Kornacka
MK
,
Rutkowska
M
.
Fraction of inspired oxygen as a predictor of CPAP failure in preterm infants with respiratory distress syndrome: a prospective multicenter study
.
Neonatology
.
2019
;
116
(
2
):
171
8
.
21.
De Luca
D
,
Tingay
DG
,
van Kaam
AH
,
Courtney
SE
,
Kneyber
MCJ
,
Tissieres
P
et al
.
Epidemiology of neonatal acute respiratory distress syndrome: prospective, multicenter, international cohort study
.
Pediatr Crit Care Med
.
2022 Jul 1
23
7
524
34
.
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