Prospective, Non-Blinded, Randomized Controlled Trial of Pulmonary Surfactant Administration Guided by Lung Ultrasound in Preterm Infants with Gestational Age < 32 Weeks

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Abstract
Objectives: Current guidelines for pulmonary surfactant (PS) administration in preterm infants with respiratory distress rely on clinical signs and FiO2 thresholds. Lung ultrasound offers a promising alternative for accurately diagnosing neonatal respiratory distress syndrome (NRDS) and assessing its severity. This randomized controlled trial aimed to evaluate whether a lung ultrasound-guided strategy for NRDS diagnosis and lung ultrasound scores (LUS)-guided PS administration could improve respiratory outcomes in preterm infants (2 requirements). Results: The ultrasound group demonstrated a significantly lower rate of invasive mechanical ventilation (p = 0.007) and a shorter duration of ventilation (p = 0.005) compared to the control group. Furthermore, the ultrasound group required less PS (p = 0.03), received their first dose at an earlier time (p = 0.017), and experienced fewer radiation exposures both before surfactant treatment and within the first week after birth (p = 0.023 and p = 0.019, respectively). Conclusions: The integration of lung ultrasound for NRDS diagnosis and LUS-guided surfactant therapy facilitates more precise and timely PS use. This strategy reduces the need for and duration of invasive mechanical ventilation and limits early radiation exposure in very preterm infants.
Funding Information
  • Natural Science Foundation of Beijing Municipality (M22018)
  • Key Clinical Projects of Peking University Third Hospital (BYSYZD2024012)

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