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PACULit Literature Updates August 2025: Pediatrics

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  1. Assessments and ACPE
    4 Topics
  2. Pediatrics AAV9-Mediated Gene Therapy for Infantile-Onset Pompes Disease
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    1 Quiz
  3. Early relapse during B lymphocyte depletion of children with frequently relapse steroid dependent nephrotic syndrome after rituximab treatment
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  4. Prophylactic hydrocortisone and the risk of sepsis in neonates born extremely preterm
    1 Topic
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  5. Late Permissive Hypercapnia for Mechanically Ventilated Preterm Infants A Randomized Trial
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    1 Quiz
  6. Reevaluating bicarbonate therapy in pediatric DKA A propensity scorematched analysis of neurological and respiratory outcomes
    1 Topic
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    1 Quiz
  7. Prehospital pain medication disparities among pediatric trauma patients transported to a single Level I center
    1 Topic
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    1 Quiz
  8. Pediatric respiratory syncytial virus rehospitalization rate a retrospective observational study from Switzerland
    1 Topic
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    1 Quiz
  9. A Simplified Regional Lung Ultrasound Score for Surfactant Administration in Neonatal RDS A Prospective Observational Study
    1 Topic
  10. Dupilumab Plus Medium-Dose Inhaled Corticosteroid ICS Improves Outcomes Compared With Placebo Plus Continued HighDose ICS in Children With Uncontrolled ModeratetoSevere Type 2 Asthma
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  11. Clinical Decision Support for Septic Shock in the Emergency Department A Cluster Randomized Trial
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PACULit Daily Literature Update

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Daily Literature Update

A Simplified Regional Lung Ultrasound Score for Surfactant Administration in Neonatal RDS A Prospective Observational Study

Raimondi F, Dolce P, Veropalumbo C, et al. A Simplified Regional Lung Ultrasound Score for Surfactant Administration in Neonatal RDS A Prospective Observational Study. Pediatr Pulmonol. 2025;60(7):e71206. doi:10.1002/ppul.71206.

Study Type: Secondary analysis of a multicenter, prospective observational study

Population: 175 preterm infants with Respiratory Distress Syndrome (RDS) stabilized on non-invasive continuous positive airway pressure (nCPAP)

Intervention: Regional lung ultrasound scores (rLUS) and total lung ultrasound score (tLUS) within 2 hours of life; oxygen saturation/inspired oxygen fraction ratio (SatO2/FiO2) measured

Outcomes: Predictive accuracy of rLUS and combined scores for surfactant administration need blinded to ultrasound results

Key Findings

  • Midclavicular (MC) regional lung ultrasound score ≥2 early indicates aeration heterogeneity in RDS
  • Left MC score AUC: 0.86; sensitivity: 0.79; specificity: 0.90 (cut-off = 2)
  • Right MC score AUC: 0.87; sensitivity: 0.74; specificity: 0.93 (cut-off = 2)
  • Combined left + right MC score improved predictive accuracy with AUC: 0.90; sensitivity: 0.82; specificity: 0.89 (cut-off = 3)
  • Prediction model incorporating gestational age, SatO2/FiO2, and combined MC score achieved highest AUC: 0.95
  • Regional LUS heterogeneity in early RDS underscores importance of regional assessment for surfactant decisions

Context & Related Research

  • Systematic Review, 2023: LUS sensitivity 89%, specificity 86%, AUC 0.88 for surfactant need prediction (PMID:36717970)
  • Study, 2020: LUS score ≥4 predicted surfactant with 96% sensitivity and 100% specificity (PMID:32674204)
  • Secondary Analyses, 2022: Early surfactant administration guided by LUS reduces invasive ventilation and improves outcomes (PMID:35412891)
  • Multicenter Trials, 2021: LUS use aids extending noninvasive strategies and timely surfactant replacement (PMID:33796374)
  • Meta-Analysis, 2024: Validated lung ultrasound scoring systems enhance clinical decisions in neonatal RDS management (PMID:39246789)

Strengths & Limitations

Strengths Limitations
Large preterm cohort across multiple centers (N=175) Observational design limits causality
Blinded physician surfactant decision reduces bias Ultrasound scoring requires trained operators; inter-rater variability possible
Novel focus on regional lung score heterogeneity Study limited to early first 2 hours of life assessment

Clinical Implications & Impact

Pharmacists can support prompt, precise surfactant administration by advocating for early regional lung ultrasound assessments alongside noninvasive markers (gestational age, SatO2/FiO2). This approach may reduce neonatal handling stress and optimize respiratory outcomes by guiding tailored surfactant replacement therapy.

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Citations

  • Raimondi F et al. Pediatr Pulmonol. 2025;60(7):e71206. PMID:40671421
  • Systematic Review, 2023. PMID:36717970
  • Study, 2020. PMID:32674204
  • Secondary Analyses, 2022. PMID:35412891
  • Multicenter Trials, 2021. PMID:33796374
  • Meta-Analysis, 2024. PMID:39246789

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