Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study

• Published in: American journal of obstetrics and gynecology Vol. 217; no. 2; pp. 196.e1 - 196.e14
• Main Authors: Palacio, Montse, MD, PhD, Bonet-Carne, Elisenda, MSc, PhD, Cobo, Teresa, MD, PhD, Perez-Moreno, Alvaro, MSc, Sabrià, Joan, MD, PhD, Richter, Jute, MD, PhD, Kacerovsky, Marian, MD, PhD, Jacobsson, Bo, MD, PhD, García-Posada, Raúl A., MD, Bugatto, Fernando, MD, PhD, Santisteve, Ramon, MD, Vives, Àngels, MD, Parra-Cordero, Mauro, MD, PhD, Hernandez-Andrade, Edgar, MD, PhD, Bartha, José Luis, MD, PhD, Carretero-Lucena, Pilar, MD, Tan, Kai Lit, MRCOG, Cruz-Martínez, Rogelio, MD, PhD, Burke, Minke, MD, Vavilala, Suseela, MD, Iruretagoyena, Igor, MD, Delgado, Juan Luis, MD, PhD, Schenone, Mauro, MD, Vilanova, Josep, MD, PhD, Botet, Francesc, MD, PhD, Yeo, George S.H., FRCOG, Hyett, Jon, MD, PhD, Deprest, Jan, MD, PhD, Romero, Roberto, MD, DMedSci, Gratacos, Eduard, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017; Elsevier
• Subjects: Adult; amniocentesis; amniotic fluid analysis; biomarker; Complicacions en l'embaràs; Complications of pregnancy; computational methods; diagnostic indices; Embaràs; Female; fetal lung maturity; Humans; Infant, Newborn; Lung - diagnostic imaging; Lung - embryology; Lung - pathology; Malalties dels pulmons; Male; Morbiditat; Morbidity; neonatal respiratory morbidity; Neonatologia; Neonatology; Obstetrics and Gynecology; Obstetrics, Gynecology and Reproductive Medicine; Predictive Value of Tests; predictive values; Pregnancy; Prospective Studies; Pulmonary diseases; quantitative texture analysis; Reproduktionsmedicin och gynekologi; respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - epidemiology; sonography; Tachypnea - epidemiology; transient tachypnea; Ultrasonography, Prenatal; ultrasound; computational methods; amniocentesis; amniotic fluid analysis; fetal lung maturity; biomarker; transient tachypnea; ultrasound; respiratory distress syndrome; neonatal respiratory morbidity; quantitative texture analysis; predictive values; sonography; diagnostic indices
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2017.03.016

Background Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. Objective The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. Study Design This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0–38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. Results A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. Conclusion The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.