Research on the Diagnostic Precision of Ultrasound Imaging Characteristics of Common Neonatal Pulmonary Disorders: A Cross-sectional Study

Background: This cross-sectional study examines the characteristic lung ultrasound (LUS) patterns of prevalent pulmonary diseases in infants. Neonatal lung disorders pose diagnostic challenges that require accurate ultrasonographic characterization to guide management. Objectives: The present study aimed to characterize LUS features of prevalent neonatal lung conditions and enhance LUS-based diagnosis of pulmonary diseases in newborns. Methods: A cross-sectional study was conducted from March 2018 to January 2024, including 466 newborns. Lung ultrasound images were analyzed to describe common lung disease patterns. Results: Normal neonatal lungs displayed lung sliding, parallel A-lines, smooth pleural lines, and a “sandpaper sign” on M-mode. The duration ranged from 48.12 hours (95% CI, 45.80 - 50.44) to 143.23 hours (95% CI, 137.27 - 149.19). B-lines were infrequently observed. Alveolar-interstitial syndrome (AIS), "white lung", pulmonary point symptoms, pleural effusion, and reduced or missing A-lines were present in transient tachypnea of the newborn (TTN). As gestational age increased, the incidence of TTN reduced. Comparing TTN to controls, the B-line duration was greater, ranging from 77.09 hours (95% CI, 73.42 - 80.76) to 221.75 hours (95% CI, 212.80 - 230.70). B-lines alone were not sufficient to diagnose TTN [48.12 hours (95% CI, 45.80 - 50.44) to 143.23 hours (95% CI, 137.27 - 149.19), P < 0.05]. Neonates with neonatal respiratory distress syndrome (NRDS), neonatal acute respiratory distress syndrome (ARDS), meconium aspiration syndrome (MAS), pneumonia (PN), neonatal pulmonary hemorrhage (NPH), and bronchopulmonary dysplasia (BPD) showed lung consolidation, ground-glass opacities, "snowflake sign", lung pulsation, persistent "sandpaper sign" and possible pleural effusions or AIS. Lung consolidation (liver-like appearance) was prevalent. Consolidation of atelectasis was observed without pulmonary point signs or pleural effusions. A layering sign, possible pulmonary point signals, and absent or uneven lung sliding were signs of pneumothorax. Conclusions: The results of our study indicate that common lung conditions in newborns show unique ultrasonographic features. Multiple imaging features may be present in a single disease, and a single imaging feature may be seen in several different diseases. Lung ultrasound findings require clinical correlation.