Lung Volume Head Ratio: A Potential Parameter for Prediction of Respiratory Distress in Newborn

Abstract

Objective This study aimed to evaluate the role of fetal lung biometry profile including fetal lung volume head ratio (LVHR) in predicting the occurrence of respiratory distress (RD) in early preterm newborn.

Study Design Prospective analytical cohort study was done to evaluate the clinical value of fetal sonographic measures, such as the total lung area (TLA), total lung volume (TLV), TLA head ratio (TLHR), LVHR, in pregnant women between 30 to 34 weeks' gestation who were expected to deliver within the next 72 hours. The cases with RD were compared with controls who had normal outcome.

Result A total of 30 (27.4%) out of 110 patients, who underwent early preterm delivery, with RD rest 80 (72.6%) were controls. The TLA was 694.1 ± 373.1 mm² in cases whereas 1,149.0 ± 506 0.7 mm² in controls with significant difference between the two groups (p < 0.001). Similarly the lung volume (p < 0.001) and the LVHR were significantly less (p < 0.001) in cases compared with controls. The TLV was a better parameter (sensitivity, 73.7% and specificity, 86.4%) compared with TLA (sensitivity, 68.4% and specificity, 81.5%). Among the lung head ratios, LVHR had the best sensitivity of 95.5%, specificity: 80.3%, positive predictive value (PPV): 58.3%, and negative predictive value (NPV): 97.0% at the cut-off of 46.5.

Conclusion RD was observed in nearly one-third of the preterm infants born between 30 and 34 weeks of gestation and could be predicted accurately in over 9 out of 10 cases using the novel parameter TLVR.

Key Points

• Preterm newborn.

• Fetal lung volume.

• Respiratory distress.

Keywords

fetal lung volume - total lung area - respiratory distress - Apgar's score - early preterm - lung head ratio

Data Availability Statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

Publication History

Received: 29 May 2021

Accepted: 13 September 2021

Accepted Manuscript online:
20 September 2021

Article published online:
08 November 2021

• References

• 1 Blencowe H, Cousens S, Chou D. et al; Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013; 10 (1, suppl 1): S2
• 2 Liu L, Oza S, Hogan D. et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016; 388 (10063): 3027-3035
• 3 Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. N Engl J Med 2008; 358 (16) 1700-1711
• 4 Hibbard JU, Wilkins I, Sun L. et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304 (04) 419-425
• 5 St Clair C, Norwitz ER, Woensdregt K. et al. The probability of neonatal respiratory distress syndrome as a function of gestational age and lecithin/sphingomyelin ratio. Am J Perinatol 2008; 25 (08) 473-480
• 6 Peralta CF, Cavoretto P, Csapo B, Vandecruys H, Nicolaides KH. Assessment of lung area in normal fetuses at 12-32 weeks. Ultrasound Obstet Gynecol 2005; 26 (07) 718-724
• 7 Johnson A, Callan NA, Bhutani VK, Colmorgen GHC, Weiner S, Bolognese RJ. Ultrasonic ratio of fetal thoracic to abdominal circumference: an association with fetal pulmonary hypoplasia. Am J Obstet Gynecol 1987; 157 (03) 764-769
• 8 Roberts AB, Mitchell JM. Direct ultrasonographic measurement of fetal lung length in normal pregnancies and pregnancies complicated by prolonged rupture of membranes. Am J Obstet Gynecol 1990; 163 (5, pt. 1): 1560-1566
• 9 Moeglin D, Talmant C, Duyme M, Lopez AC. CFEF. Fetal lung volumetry using two- and three-dimensional ultrasound. Ultrasound Obstet Gynecol 2005; 25 (02) 119-127
• 10 Kim SM, Park JS, Norwitz ER. et al. Acceleration time-to-ejection time ratio in fetal pulmonary artery predicts the development of neonatal respiratory distress syndrome: a prospective cohort study. Am J Perinatol 2013; 30 (10) 805-812
• 11 Jani J, Peralta CFA, Van Schoubroeck D, Deprest J, Nicolaides KH. Relationship between lung-to-head ratio and lung volume in normal fetuses and fetuses with diaphragmatic hernia. Ultrasound Obstet Gynecol 2006; 27 (05) 545-550
• 12 Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev 2010; 31 (12) 487-495 , quiz 496
• 13 Wu J, Wang Y, Zhao A, Wang Z. Lung ultrasound for the diagnosis of neonatal respiratory distress syndrome: a meta-analysis. Ultrasound Q 2020; 36 (02) 102-110
• 14 Nagendra K, Wilson CG, Ravichander B, Sood S, Singh SP. Incidence and etiology of respiratory distress in newborn. Med J Armed Forces India 1999; 55 (04) 331-333
• 15 Condò V, Cipriani S, Colnaghi M. et al. Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants?. J Matern Fetal Neonatal Med 2017; 30 (11) 1267-1272
• 16 Laban M, Mansour GM, El-Kotb A, Hassanin A, Laban Z, Saleh A. Combined measurement of fetal lung volume and pulmonary artery index is more accurate for prediction of neonatal respiratory distress in preterm fetuses: a pilot study. J Matern Fetal Neonat Med 2019; 32 (04) 626-632
• 17 Yoshimura S, Masuzaki H, Miura K, Muta K, Gotoh H, Ishimaru T. Diagnosis of fetal pulmonary hypoplasia by measurement of blood flow velocity waveforms of pulmonary arteries with Doppler ultrasonography. Am J Obstet Gynecol 1999; 180 (2, pt. 1): 441-446