Combined Lung and Cranial Ultrasound for Early Identification and Severity Stratification of Neonatal Respiratory Distress Syndrome

Early identification and severity stratification of neonatal respiratory distress syndrome (NRDS) are essential for timely respiratory support and prevention of complications. This prospective observational study evaluated the clinical utility of a combined lung ultrasound (LUS) and cranial ultrasound (CrUS) framework for multidimensional bedside risk assessment in 137 neonates with respiratory distress. Baseline LUS and CrUS examinations were performed within 6 h of admission, followed by dynamic LUS monitoring at 24 h and 72 h. The integrated model (Clinical + LUS + CrUS) demonstrated superior diagnostic performance (AUC = 0.941). Optimal neonatal LUS (nLUS) thresholds were 8.5 for NRDS diagnosis, 9.5 for surfactant therapy, and 12.0 for prediction of invasive mechanical ventilation. In addition, improvement in nLUS at 24 h was significantly correlated with oxygenation response (r = 0.52, p < 0.001). These findings indicate that combined LUS-CrUS assessment provides a non-invasive and dynamic strategy for early NRDS identification and management optimization while enabling concurrent neurological risk monitoring.