Assessing the Reliability of Lung Ultrasound in Neonatal Acute Care Setting: A Systematic Review Protocol

Introduction: Choosing appropriate diagnostic imaging modalities in neonates is often challenging. Lung ultrasound (LUS) has been increasingly adopted in the diagnosis and monitoring of respiratory diseases in this population. However, since LUS interpretation relies heavily on operator skills and recognition of artefact patterns, concerns persist regarding its reliability. While numerous studies have explored the clinical utility of LUS, the study of its reliability – particularly inter-rater and intra-rater – remains substantially underrepresented. This systematic review aims to assess the reliability of LUS within neonatal acute care settings and explore associated influencing factors in this context. Methods: We will include studies of LUS examinations performed on neonatal patients (aged <28 days) presenting with respiratory signs, symptoms, or conditions and treated in acute care settings. The systematic review will follow the COSMIN guidelines. The search strategy will include searches of MEDLINE, Embase, Web of Science, Scopus, CINAHL, theses and dissertation repositories, and other gray literature sources. Studies will be assessed by two independent reviewers against the inclusion criteria. We will consider studies published from the 1990s to the present, in any language and of any methodological quality. The COSMIN Risk of Bias checklist will be used. We will extract inter-rater and intra-rater reliability metrics and synthesize the findings narratively and, if appropriate, with meta-analyses. Assessment of certainty of evidence will follow the modified GRADE approach. Conclusion: The findings of this study will address the gap in LUS evaluation on its reliability in neonatal care to guide safe and reproducible clinical practices.