Abstract
OBJECTIVE: Meconium aspiration syndrome is a common cause of severe respiratory failure in term and post-term neonates. The timing for administering surfactant remains non-standardized. This study aimed to evaluate the predictive value of the lung ultrasound score for the need for surfactant therapy in infants with Meconium aspiration syndrome. METHOD: This prospective multicenter study enrolled 218 neonates with meconium aspiration syndrome. Lung ultrasound was performed within 30 min of admission using a six-zone scoring system (0-18). Surfactant was given based on oxygenation criteria (FiO₂ > 0.5 or OI > 8), with clinicians blinded to ultrasound findings. Predictive performance of the lung ultrasound score for surfactant need was assessed by ROC analysis and compared with traditional indices. Multivariable regression and decision curve analysis were performed. RESULTS: Lung ultrasound score demonstrated near-perfect diagnostic accuracy for predicting surfactant need: at the optimal cutoff of 6 points, AUC was 0.999 (95% CI, 0.997-1), with 100% sensitivity. Performance was superior to pH (AUC 0.906) and chest radiograph grade (AUC 0.539), and consistent across subgroups by respiratory support, gestational age, and presence of persistent pulmonary hypertension. Multivariable analysis identified lung ultrasound as an independent predictor of surfactant use. Decision curve analysis confirmed greater net clinical benefit for lung ultrasound-based strategies over a wide range of threshold probabilities. CONCLUSION: A lung ultrasound score of ≥ 6 exhibited near-perfect predictive capacity for guiding surfactant administration decisions (AUC 0.999). This technique provides rapid, non-invasive pulmonary morphological information, facilitating the identification of neonates meeting the criteria for surfactant therapy.