Lung Ultrasound for Neonatal Respiratory Distress in a Resource-Limited County Hospital: A pilot study

Background Lung ultrasound (LUS) is increasingly used as a radiation-free alternative to chest X-ray (CXR) for diagnosing neonatal respiratory distress syndrome (RDS). However, evidence regarding its feasibility and clinical utility in resource-limited county hospitals remains limited. Methods This prospective pilot observational study enrolled neonates with respiratory distress within 24 hours of birth in a county-level maternal and child health hospital. All infants underwent bedside LUS and CXR. LUS was performed using a standardized six-zone scanning protocol with a total score ranging from 0 to 18. Diagnostic performance of LUS for RDS was assessed using receiver operating characteristic (ROC) curve analysis. Factors associated with patient transfer were also analyzed. Results A total of 34 neonates were included, of whom 17 (50%) were diagnosed with RDS. LUS scores were significantly higher in the RDS group than in the non-RDS group (median 10.0 vs. 5.0, P < 0.001). LUS demonstrated high diagnostic accuracy for RDS, with an area under the ROC curve of 0.912. An optimal cut-off score of 9.0 yielded a sensitivity of 70.6% and a specificity of 94.1%. Notably, LUS scores were not significantly associated with patient transfer decisions (P > 0.05). Within the RDS group, 64.7% of neonates were successfully managed locally despite elevated LUS scores. Conclusions Bedside LUS is a feasible and accurate diagnostic tool for neonatal RDS in resource-limited county hospitals. Its primary clinical value lies in establishing a definitive diagnosis rather than directly guiding transfer decisions, supporting safe local management of selected neonates based on overall clinical assessment.