Efficacy evaluation of pulmonary surfactant guided by lung ultrasound score in neonatal respiratory distress syndrome: a prospective observational study in Ganzi Tibetan Autonomous Prefecture

We aimed to evaluate the therapeutic efficacy of pulmonary surfactant (PS) in neonatal respiratory distress syndrome (NRDS) when guided by lung ultrasound (LUS) score. A prospective cohort of 121 surfactant-treated NRDS infants was included. After 1:1 propensity score matching, 99 matched pairs (NRDS vs. healthy controls) were established. Clinical baseline characteristics, chest X-ray (CXR) grading, LUS, arterial blood gas indices, and adverse events were collected. Comparisons were made between pretreatment (within 4 h of birth) and post-treatment (12 h after PS) findings in the NRDS group. Correlations between LUS and CXR grading were assessed, and receiver operating characteristic curves were used to examine the predictive value of early CXR grading and bilateral LUS scores for post-treatment improvement. After PS administration, NRDS infants showed significant reductions in partial pressure of carbon dioxide, CXR grading, LUS score, and clinical signs, accompanied by increased partial pressure of oxygen and potential of hydrogen (P < .001). The overall improvement rate was 90.91%. Both pre- and post-treatment LUS scores correlated positively with CXR grading (|r| > 0.5). Early CXR grading and bilateral LUS scores were strong predictors of treatment response, with LUS showing superior performance (P = .006). Adverse reactions occurred in only 8.08% of treated infants, indicating acceptable safety. PS therapy improves arterial blood gas parameters and clinical symptoms in NRDS infants with good safety. LUS scoring not only facilitates treatment guidance but also provides predictive value for therapeutic efficacy, offering a practical basis for clinical management of NRDS.