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CME Credit Offered
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Poster Session 2

(573) Ultrasonographic fetal lung echotexture analysis in the prediction of neonatal respiratory distress syndrome

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: To determine if ultrasonographic fetal lung echotexture analysis is predictive of neonatal respiratory distress syndrome (RDS).

Study Design: Prospective cohort study of singleton gestations with medically-indicated ultrasound examinations from October 2017 through September 2021. Grayscale transverse fetal lung images were obtained at the level of the four-chamber heart view with GE Voluson E8 and E10 ultrasound machines with convex array transducers. A region of interest was selected in each fetal lung image. Fetal lung heterogeneity index (HI) was determined with MATLAB software using a dithering technique with ultrasound image pixels transformed into a binary map from which a dynamic range value was determined. The fetal lung HI ultrasound occurred < 7 days prior to delivery. Pregnancies were categorized by delivery timing: late preterm (34+0 to 36+6 WGA), early term (37+0 to 38+6 WGA), and full-term (39+0 to 40+6 WGA). Pregnancies with delivery occurring > 7 days from HI measurement were excluded from the analysis.

Results: In total, 468 singletons were delivered < 7 days from the HI ultrasound examination. Of these, 94 (20.1%), 276 (59.0%), and 98 (20.9%) delivered preterm, early term, and full term, respectively. RDS occurred in 20 (21.3%) of late preterm, 3 (1.0%) of early term, and 1 (1.0%) of full term deliveries. Figure 1 shows the receiver operating characteristic (ROC) curve for fetal lung HI as a predictor of RDS in the preterm delivery cohort. HI was modestly predictive of RDS in the late preterm cohort (AUC: 0.632), but not in the early or full term cohort, potentially from low incidences of RDS in these time frames.

Conclusion: Fetal lung HI had a modest association with RDS in the late preterm time period which is the time of greatest fetal lung HI change and greatest risk of RDS. While fetal lung HI alone may not be a great predictor of RDS, it may be a useful adjunct when combined with other pregnancy risk factors.
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