Lung Ultrasound for the Differential Diagnosis of Respiratory Distress in Neonates

Neonatology. 2019;115(1):77-84. doi: 10.1159/000493001. Epub 2018 Oct 10.


Background: Respiratory distress (RD) is the most common neonatal illness. Lung ultrasound (LUS) is a technique previously tested in neonatal studies on RD, but literature regarding its routine clinical applicability is still lacking.

Objective: To assess the concordance between LUS performed by neonatologists with different training levels and chest X-ray (CXR) for the diagnosis of RD in newborns during the first 24 h of life.

Methods: We enrolled newborns with RD during the first 24 h of life. Patients underwent LUS and CXR. LUS and CXR diagnosis were compared to evaluate concordance. Twenty percent of patients received two LUS (one from an experienced and one from a novice sonographer) to calculate the interobserver agreement. The difference in time needed to reach a diagnosis with LUS and CXR, and from novice and expert operators, was measured.

Results: We studied 124 patients; 134 diagnoses were reported. The concordance between LUS and CXR diagnosis was 91% (95% CI 86-96%) with a κ statistic of 0.88 (95% CI 0.81-0.94). The median time to diagnosis was shorter for LUS (9.5 min, IQR 5-15) than for CXR (50 min, IQR 33-64) (p < 0.0001). In 25/124 patients, LUS was performed by both novice and experienced sonographers with complete concordance. The median time to diagnosis was shorter for expert (9 min, IQR 5-15) than novice operators (15 min, IQR 10-20) (p < 0.0002).

Conclusion: LUS and CXR have a high concordance in the differential diagnosis of neonatal RD in the first 24 h of life. LUS has a shorter operation time than CXR.

Keywords: Chest X-ray; Neonatal intensive care; Point-of-care ultrasound.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diagnosis, Differential
  • Female
  • Humans
  • Infant, Newborn
  • Intensive Care, Neonatal / standards*
  • Italy
  • Lung / diagnostic imaging*
  • Male
  • Point-of-Care Systems
  • Prospective Studies
  • Radiography, Thoracic
  • Respiratory Distress Syndrome, Newborn / diagnosis*
  • Time Factors
  • Ultrasonography