# Application of a modified lung ultrasound score in assessing the severity of neonatal pneumonia: a multicenter prospective study

## TL;DR

A modified lung ultrasound scoring system accurately diagnoses and assesses severity of neonatal pneumonia better than X-rays, with no radiation risk.

## Contribution

A modified twelve-zone lung ultrasound score was developed and validated for neonatal pneumonia diagnosis and severity assessment.

## Key findings

- LUS had higher diagnostic accuracy than X-ray (AUC 0.93 vs. 0.83).
- B-line count and consolidation area were strong predictors of pneumonia severity.
- LUS indicators correlated with clinical outcomes like respiratory distress and PaO2/FiO2 ratio.

## Abstract

To evaluate a modified twelve-zone lung ultrasound (LUS) scoring system for diagnosing neonatal pneumonia and assessing disease severity.

In this multicenter prospective study (January 2023–02tober 2024), 160 neonates with pneumonia underwent both LUS and chest X-ray. Diagnostic performance (AUC, sensitivity, specificity) was compared, and correlations between LUS indicators (B-lines, consolidation area, pleural line abnormalities) and clinical outcomes (respiratory distress scores, PaO2/FiO2 ratio) were analyzed using multivariate regression.

LUS demonstrated superior diagnostic accuracy to X-ray (AUC: 0.93 vs. 0.83; sensitivity 94.0 vs. 78.5%, specificity 88.5 vs. 78.5%, both P < 0.05). B-line reduction correlated with improved respiratory distress scores (r = 0.856, P < 0.001), and consolidation area reduction correlated with PaO2/FiO2 ratio improvement (r = 0.801, P < 0.001). Multivariate analysis identified B-line count (OR = 1.154), consolidation area (OR = 2.962), pleural line abnormalities (OR = 6.408), and CRP (OR = 1.102) as independent severity predictors (P < 0.05).

The modified twelve-zone LUS system accurately diagnoses neonatal pneumonia, quantifies severity, and dynamically monitors treatment efficacy, offering a radiation-free alternative to X-ray for clinical practice.