Lung Ultrasound-Guided Respiratory Management in Infants

Infants, especially premature infants, frequently require respiratory support in the neonatal intensive care unit (NICU). Lung ultrasound is a bedside, radiation-free tool that can assess lung aeration and guide respiratory management, but its effect on clinical outcomes has not been evaluated in a U.S. randomized trial.

This single-center randomized controlled study will compare lung ultrasound-guided respiratory management with standard clinical care in premature infants requiring respiratory support. In the intervention group, lung ultrasound scores will guide surfactant administration, weaning non-invasive respiratory support, and weaning from non-invasive respiratory support to room air using predefined thresholds. The control group will use standard care to guide surfactant administration, weaning non-invasive respiratory support, and weaning from non-invasive respiratory support to room air.

The primary outcome is length of NICU stay. Secondary outcomes include duration of respiratory support, time on non-invasive respiratory support, time to successful weaning to room air, need for re-intubation, surfactant dosing, and mortality prior to discharge. This study aims to determine whether lung ultrasound-guided management can improve respiratory care and reducive hospital length of stay in infants requiring respiratory suppport.

Inclusion criteria

• Infants admitted to the Tufts Medical Center NICU
• Requiring invasive or non-invasive respiratory support
• Requiring surfactant therapy
• Parental or guardian informed consent obtained

Exclusion criteria

• Major congenital anomalies
• Known chromosomal abnormalities
• Congenital diaphragmatic hernia
• Decision for comfort care
• Surfactant administered prior to transfer from outside hospital (only excluded for surfactant decisions)