Lung ultrasound for neonatal respiratory distress in a resource-limited county hospital: a pilot study

While tertiary centers have widely adopted lung ultrasound (LUS) as a diagnostic alternative to chest X-ray (CXR), recent evidence emphasizes its growing prognostic utility. This pilot study investigated the feasibility and clinical utility of LUS aeration scores in triage decisions within a resource-limited county-level hospital. This prospective pilot observational study enrolled neonates exhibiting signs of respiratory distress within 24 h of birth, employing a symptom-driven approach without predefined gestational age restrictions. Bedside LUS and CXR were performed within the first two hours of non-invasive respiratory support, prior to surfactant administration. LUS aeration scores were calculated using a standardized six-zone protocol (score range: 0–18). Following respiratory distress syndrome (RDS) diagnosis based on clinical and sonographic criteria, we evaluated the predictive performance of a predefined high-risk threshold (LUS aeration score ≥ 10) for triage outcomes (transferred vs. locally managed). A total of 34 neonates (gestational age range: 30 to 40 + 2 weeks) were enrolled, of whom 17 (50%) were diagnosed with RDS based on composite clinical and sonographic criteria. Within the RDS subgroup, 6 neonates (35%) required tertiary transfer due to severe clinical progression (e.g., requirement for invasive mechanical ventilation), while 11 (65%) were successfully managed locally. Transferred neonates showed a non-significant trend toward higher baseline LUS aeration scores than locally managed peers (median 12 vs. 10, P = 0.242). However, when applying a predefined threshold (LUS aeration score ≥ 10), the score yielded a sensitivity of 83.3% and a negative predictive value (NPV) of 80.0% for predicting tertiary transfer. Bedside LUS is a feasible tool for assessing the severity of neonatal respiratory distress in resource-limited settings. Specifically, the promising negative predictive value of the LUS aeration score provides an objective basis and clinical confidence for managing low-risk neonates locally, thereby optimizing regional healthcare resources. Further large-scale studies are needed to validate these preliminary findings.