Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score, oxygenation index, and chest radiography grading

Figure 1 X-ray imaging manifestations corresponding to different X-ray grades. A-D: X-ray grades 1, 2, 3, and 4, respectively.

Figure 2 X-ray grade 1 respiratory distress syndrome neonatal pulmonary ultrasonography images. A, B, E: Representative images showing increase in B-lines in the anterior chest of R1–R2/L1–L2. Real-time ultrasonography shows that B-lines and A-lines alternate with lung slip, resulting in 1 point each; C, D, F, G: Representative images showing ground-glass-like changes in each region of R3–R4/L3–L4 R5–R6/L5–L6, with 2 points each and a total ultrasonography score of 10 points.

Figure 3 X-ray grade 2 respiratory distress syndrome neonatal pulmonary ultrasonography images. A, B, F–H: Representative images showing ground-glass-like changes in the R1–R4/L1–L4 region. Transverse scanning confirms continuous interruption of pleural lines with snowflake-like changes, similar to lung adenocarcinoma in situ, but in reality, they indicate early or mild lung consolidation changes, with 2 points for each region; C–E, I, J: Representative images showing the disappearance of pleural and A-lines in the R5–6/L5–6 region, with pulmonary consolidation accompanied by bronchial inflation sign. Transverse scan confirms that each area scores 6 points, and the total ultrasonography score is 20 points.

Figure 4 X-ray grade 3 respiratory distress syndrome neonatal lung ultrasonography images. A: Ground-glass-like changes in the right lung R1–R2, as shown by the A-line, resulting in 2 points; B, E–G: Representative images showing consolidation of the left lung L1–L4 and right lung L3–L4 in half of the lung field, with 5 points for each area; C, D, H–J: Representative images showing consolidation of R5–R6/L5–L6 involving the entire lung field, with 6 points for each area and a total ultrasonography score of 29 points.

Figure 5 X-ray grade 4 respiratory distress syndrome neonatal pulmonary ultrasonography images. A–H: Representative images showing involvement of consolidation with bronchial inflation sign in each longitudinal area. The transverse scan confirms the existence of the above changes, with 6 points for each area and a total ultrasonography score of 36 points.

Figure 6 Scatter plot of the relationship between the respiratory distress syndrome neonatal ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray grade before and after treatment. A: Relationship between the pretreatment ultrasonography scores and respiratory distress scores; B: Relationship between the pretreatment ultrasonography score and oxygenation index; C: Relationship between the pretreatment ultrasonography scores and chest X-ray grade; D: Relationship between the ultrasonography scores and respiratory distress scores after treatment; E: Relationship between the ultrasonography scores and oxygenation index after treatment; F: Relationship between the post-treatment ultrasonography score and chest X-ray grade; the red circle in the figure represents the corresponding data of each sample indicator.

Figure 7 Receiver operating characteristic correlation of the pulmonary ultrasonography score with newborn respiratory distress syndrome severity. The green line is the receiver operating characteristic (ROC) of pulmonary X-ray grades I and II; the blue line is the ROC of pulmonary X-ray grades II and III; and the purple line is the ROC of pulmonary X-ray grades III and IV.