Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Predictors of nasal ventilation failure are helpful in preventing clinical deterioration. Work on neonatal lung ultrasound has shown that the persistence of a hyperechogenic, 2white lung3 image correlates with severe distress in the preterm infant. Objective: The accuracy of white lung to predict early CPAP failure in correlation to the highest chest xray grade and arterial blood gases (PH,PaO2,PcO2 and PaO2 /FiO2 ) values within the same time interval. Methods: We enrolled 60 infants (gestational age 30±1weeks) admitted to the NICU of Cairo University Children hospital with moderate RD and stabilized on nasal continuous positive airway pressure. Lung ultrasound was performed two hours after admission and blindly classi{uFB01}ed as white lung , prevalence of B-lines, or prevalence of A-lines . Chest x ray and arterial blood gases were done twice,on admission and after 2 hours of CPAP application .Chest x ray was examined and graded by an experienced radiologist (blind to the infant{u2019}s clinical condition) to RDS grades according to severity. Results: White lung pro{uFB01}le showed high accuracy for prediction of CPAP failure with sensitivity (76.9%), specificity 100%, PPV 100% and NPV 85% and CI (82.4- 97.6%) which was significantly higher than that of CXR before and after 2 hours on CPAP . Comparing all predictors in our study by regression analysis showed that PaO2 /FiO2 had the most predictive value . Conclusion: Neonatal lung ultrasound and PO2/FIO2 ratio are good predictors for CPAP failure and they are advantageous over chest x ray

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