Application of a modified lung ultrasound score in assessing the severity of neonatal pneumonia: a multicenter prospective study

Abstract

Objective: To evaluate a modified twelve-zone lung ultrasound (LUS) scoring system for diagnosing neonatal pneumonia and assessing disease severity. Methods: In this multicenter prospective study (January 2023–02tober 2024), 160 neonates with pneumonia underwent both LUS and chest X-ray. Diagnostic performance (AUC, sensitivity, specificity) was compared, and correlations between LUS indicators (B-lines, consolidation area, pleural line abnormalities) and clinical outcomes (respiratory distress scores, PaO2/FiO2 ratio) were analyzed using multivariate regression. Results: LUS demonstrated superior diagnostic accuracy to X-ray (AUC: 0.93 vs. 0.83; sensitivity 94.0 vs. 78.5%, specificity 88.5 vs. 78.5%, both P < 0.05). B-line reduction correlated with improved respiratory distress scores (r = 0.856, P < 0.001), and consolidation area reduction correlated with PaO2/FiO2 ratio improvement (r = 0.801, P < 0.001). Multivariate analysis identified B-line count (OR = 1.154), consolidation area (OR = 2.962), pleural line abnormalities (OR = 6.408), and CRP (OR = 1.102) as independent severity predictors (P < 0.05). Conclusions: The modified twelve-zone LUS system accurately diagnoses neonatal pneumonia, quantifies severity, and dynamically monitors treatment efficacy, offering a radiation-free alternative to X-ray for clinical practice.