Expanded versus classical assessments for identifying mandate for lung ultrasound-guided surfactant therapy in preterm neonates (EXCLAIM-LUS): a retrospective comparative study
In brief
Six-area lung ultrasound predicts surfactant need as accurately as larger scores
In a retrospective review of preterm infants up to 34 weeks with respiratory distress, four lung-ultrasound scoring protocols (6-area anterolateral, 6-area anterolateral-posterior, 10-area, and 12-area) all showed similar ability to identify those requiring surfactant (AUC 0.80-0.83). Because the simple 6-area method performed equally well, it may be the preferred choice for routine bedside decision-making, though prospective validation is still needed.
- Journal
- European journal of pediatrics (Q1)
- Published
- 21 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Chinmay Chetan, Shoham Majumder, Ravleen Kaur, Deepak Jaybhaye, Arshpuneet Kaur, Aninda Debnath, et al.
- PMID
- 42766165
- DOI
- 10.1007/s00431-026-07431-2
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 22 September 2026): Lung ultrasound scoring for surfactant therapy in preterm RDS
Abstract
UNLABELLED: Lung ultrasound (LUS) is increasingly used to guide surfactant therapy in preterm neonates with respiratory distress syndrome (RDS). To compare diagnostic performance of LUS scoring systems with various partitioning for predicting surfactant requirement in preterm neonates with RDS. Retrospective observational study. Preterm neonates (≤ 34 weeks) with RDS who underwent LUS within two hours of admission were included. Images were independently scored using four protocols: 6-area anterolateral (A/L), 6-area anterolateral-posterior (A/L/P), 10-area, and 12-area. All four scoring systems demonstrated good discrimination for surfactant requirement (AUC 0.800-0.831), with no statistically significant pairwise differences (all p ≥ 0.19). Decision curve analysis (DCA) confirmed positive net benefit for all protocols at threshold probabilities of 10-55%. CONCLUSIONS: All four LUS scoring systems demonstrated comparable performance. Classical 6-area anterolateral protocol may be considered a pragmatic choice given its simplicity and comparable performance for routine LUS-guided surfactant therapy in preterm RDS. WHAT IS KNOWN: • LUS predicts surfactant need in preterm RDS (AUC 0.84-0.97). • Multiple scoring systems with varying zone counts exist but direct comparative evidence is lacking. WHAT IS NEW: • All four protocols (6-area anterolateral, 6-area Anterolateroposterior, 10-area eLUS, and 12-area) show comparable diagnostic performance (AUC 0.800-0.831) with overlapping decision curve net benefit. • The 6-area anterolateral protocol achieves equivalent utility with the lowest procedural burden.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.