Wednesday, 24 December 2025

N LUS SCORE > 9-10 NEEDS SURFACTANT

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Lung Ultrasound (LUS) – RDS Score
Used mainly in neonates (especially preterm infants) to assess Respiratory Distress Syndrome (RDS) severity and guide respiratory management.


Purpose

  • Quantifies loss of lung aeration

  • Helps predict:

    • Need for surfactant

    • Need for mechanical ventilation

    • Disease severity and progression

  • Reduces reliance on chest X-ray


Lung Regions Examined

Most commonly:

  • 6-zone method (most used in neonatology):

    • Right anterior, right lateral, right posterior

    • Left anterior, left lateral, left posterior

(Some protocols use 8 or 12 zones, but scoring principles are the same.)


Scoring System (per zone)

Each lung zone is scored 0–3 based on ultrasound pattern:

ScoreUltrasound PatternMeaning
0A-lines present, normal lung slidingNormal aeration
1≥3 well-spaced B-linesMild interstitial syndrome
2Coalescent B-lines (“white lung”)Severe interstitial/alveolar disease
3Lung consolidation ± air bronchogramsComplete loss of aeration

Total LUS-RDS Score

  • Score per zone: 0–3

  • Total score (6 zones): 0–18


Interpretation (commonly used ranges)

Total ScoreInterpretation
0–4Normal / minimal disease
5–8Mild RDS
9–13Moderate RDS
14–18Severe RDS

Clinical Correlations

  • Higher scores correlate with:

    • Lower oxygenation

    • Higher CPAP/ventilation needs

    • Increased likelihood of surfactant therapy

  • Many studies show LUS score ≥9–10 predicts surfactant requirement


Advantages

  • Bedside, radiation-free

  • Repeatable for monitoring response

  • High inter-observer reliability when trained


Limitations

  • Operator-dependent

  • Interpretation may overlap with:

    • Transient tachypnea of newborn (TTN)

    • Pneumonia

    • Pulmonary edema


If you want, I can:

  • Share a quick scoring diagram

  • Compare LUS vs chest X-ray

  • Explain cutoffs for surfactant decision-making

  • Adapt this to adult ARDS scoring

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