Lung Ultrasound Scoring-Driven Precision: A Non-Invasive Paradigm for Optimal Surfactant Timing in Neonatal Meconium Aspiration Syndrome

Background Meconium aspiration syndrome (MAS) is a severe respiratory disease in neonates, and the timing of the application of pulmonary surfactant (PS) is still controversial. Lung ultrasound (LUS), as a non-invasive, highly sensitive and specific imaging technique, may provide a basis for the precise use of PS. Methods This study was a prospective observational study, and 218 MAS infants from two tertiary neonatal rescue centers were included. The LUS score (total score of 18 points, divided into 6 zones) was compared with traditional indicators (oxygenation index, oxygen concentration, etc.), and the ROC curve was used to analyze the predictive efficiency. Results When the LUS score threshold was 5.5 points (actually 6 points), the AUC for predicting the timing of PS use was 0.9886 (95% CI: 0.9967-1), with a sensitivity of 99% and a specificity of 98%, which was significantly better than the oxygenation index (AUC = 0.9673), oxygen concentration (AUC = 0.9527) and pH value (AUC = 0.9062). LUS is non-invasive and repeatable, and can reduce complications (such as PPHN) and hospital stay. Conclusion LUS score ≥ 6 is a reliable indicator for initiating PS treatment in children with MAS, which can optimize the timing of treatment and improve clinical prognosis.