Comparative Analysis of Lung Ultrasound Scoring and Oxygen Methods for Neonatal Mechanical Ventilation
Abstract
To investigate the feasibility and effectiveness of targeted lung recruitment and the titration of optimal positive end-expiratory pressure (PEEP) in neonates under the guidance of lung ultrasound.
The atelectasis neonates from June 2022 to June 2024 in the Neonatology Department of People's Hospital of Pidu were collected and randomly divided into a lung ultrasound scoring (LUS) group and an oxygen (OXY) group, both of which were given mechanical ventilation treatment. The lung recruitment and optimal PEEP were performed by the LUS and OXY methods, respectively. The optimal PEEP and the respiratory and hemodynamic indexes of the two groups were compared before and after lung recruitment and after the optimal PEEP was titrated.
After the intervention, the dynamic lung compliance (Cdyn) in the LUS group increased by 38.2% compared with the baseline (from 30.6 ± 4.3 to 42.3 ± 5.1 mL/cmH2O), which was significantly higher than the 21.4% increase in the OXY group (from 29.8 ± 4.1 to 35.6 ± 4.8 mL/cmH2O). The improvement in PaO2/FiO2 in the LUS group was 22.5% higher than in the OXY group. There was no statistically significant difference in the incidence of complications between the two groups.
Lung ultrasound can guide neonatal lung recruitment and optimal PEEP titration, improving lung compliance and oxygenation without affecting the safety of treatment.
2. Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr. 2024;183(3):1079-89.
3. Abushady NM, Awad H, Kamel DR, Fouda EM, Ahmed NT, Dawoud MO. Role of lung ultrasound in the assessment of recruitment maneuvers in ventilated preterm neonates with respiratory distress syndrome and its correlation with tracheal IL-6 levels: A randomized controlled trial. J Neonatal Perinatal Med. 2021;14(3):369-74.
4. Du Y, Yang A, Wang X. Accuracy of transthoracic lung ultrasound for diagnosing pulmonary embolism: An updated systematic review and meta-analysis. Thromb Res. 2024;241:109112.
5. Gao Q, Ji H, Wu Z, Zhao P. Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young infants: A randomised controlled trial. J Clin Anesth. 2023;86:111075.
6. Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney D. 2021;28(3):252-61.
7. Raimondi F, Migliaro F, Corsini I, Meneghin F, Dolce P, Pierri L, et al. Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome. Pediatrics. 2021;147(4)
8. Pierro M, Chioma R, Ciarmoli E, Villani P, Storti E, Copetti R. Lung ultrasound guided pulmonary recruitment during mechanical ventilation in neonates: A case series. J Neonatal Perinatal Med. 2022;15(2):357-65.
9. Zhang X, Fu Y, Yue G, Yang S, Ju R. Lung ultrasound for the assessment of lung recruitment in neonates with massive pneumothorax during extracorporeal membrane oxygenation: a case report. J Artif Organs. 2022;25(2):163-9.
10. Kasniya G, Weinberger B, Cerise J, Pulju M, Boyar V, Frunza F, et al. Lung ultrasound assessment of pulmonary edema in neonates with chronic lung disease before and after diuretic therapy. Pediatr Pulm. 2022;57(12):3145-50.
11. Zheng L, Jing H, Liu L, Wang L. Feasibility of ultrasound in the diagnosis of neonatal respiratory distress syndrome in preterm infants. J Trop Pediatrics. 2023;69(2)
12. Li Z, Mu X, Dang D, Lv X, Si S, Guo Y, et al. Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia. Eur J Pediatr. 2023;182(4):1697-705.
13. Chen LGR, Cheung P, Law BHY. Lung Recruitment Using High-Frequency Oscillation Volume Guarantee in Preterm Infants with Evolving Bronchopulmonary Dysplasia. Neonatology. 2022;119(1):119-23.
14. Wang Y, Tan YP, Zhang L, Zheng LN, Han LP, Xie J, et al. Application of lung ultrasound in monitoring bronchopulmonary dysplasia and pulmonary arterial pressure in preterm infants. Eur Rev Med Pharmaco. 2023;27(13):5964-72.
15. Vivalda L, Loi B, Bisceglie V, Ben-Ammar R, De Luca D. Effect of preterm chorioamnionitis on lung ultrasound score used to guide surfactant replacement. Pediatr Pulm. 2023;58(10):2761-8.
16. Tapak M, Sadeghi S, Ghazanfari T, Mossafa N, Mirsanei SZ, Masiha Hashemi SM. Mesenchymal Stem Cell Therapy Mitigates Acute and Chronic Lung Damages of Sulfur Mustard Analog Exposure. Iran J Allergy Asthma Immunol. 2024;23(5):563-77.
17. Aldecoa-Bilbao V, Velilla M, Teresa-Palacio M, Esponera CB, Barbero AH, Sin-Soler M, et al. Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants. Neonatology. 2021;118(5):537-45.
18. Xie C, Xu W, Rao S, Xie Y, Liang Q, Chen L, et al. The Role of Th17/Treg Imbalance, FeNO, Eosinophils, IgE and Their Correlation with Lung Function Parameters with Asthma-chronic Obstructive Pulmonary Disease. Iran J Allergy Asthma Immunol. 2024;23(6):625-40.
19. Hadley L, Flemmer AW, Kitchen MJ, Croughan MK, Crossley KJ, Lee KL, et al. Sustained inflation improves initial lung aeration in newborn rabbits with a diaphragmatic hernia. Pediatr Res. 2024;95(3):660-7.
20. Zha J, Yu Y, Zhu J, Li G, Deng X, Xie H. Nebulized Dexmedetomidine Alleviates Oxidative Stress in Ventilator-induced Lung Injury via Keap1-Nrf2-ARE Pathway. Iran J Allergy Asthma Immunol. 2024;23(3):330-8.
21. Perunicic Z, Lalatovic I, Spahic L, Asic A, Pokvic LG, Badnjevic A. Enhancing mechanical ventilator reliability through machine learning based predictive maintenance. Technol Health Care. 2025;33(3):1288-97.
| Files | ||
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Lung recruitment Lung ultrasound Newborns Positive end expiratory pressure Targeting | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |

