Predictive Value of Lung Ultrasound Combined With Serum ANGPL4 Levels for NICU Admission Needs in Late Preterm and Term Neonates With Respiratory Distress In The Transion Period

Predictive Value of Lung Ultrasound Combined With Serum ANGPL4 Levels for NICU Admission Needs in Late Preterm and Term Neonates With Respiratory Distress In The Transion Period

The aim of this study is to evaluate the validity of point-of-care lung ultrasound (POC-LUS) and serum ANGPL4 levels for predicting NICU admission needs in late preterm and full-term neonates with respiratory distress shortly after birth in the transition period.

Given its concordance with conventional x-ray, lung ultrasound (LU) has become an attractive diagnostic tool in neonatal settings, with its validation against a wide range of imaging techniques and excellent inter-observer agreement. LU is currently used for diagnosing several neonatal respiratory morbidities and has been proposed for predicting further interventions, such as the need for surfactant treatment or mechanical ventilation in preterm infants. The routine adoption of point-of-care LU in the NICU is still experiencing some limitations. However, the implementation of routine LU in the NICU would further optimize the management of newborns with, or at risk of, respiratory morbidities. Lung ultrasound alone may not be sufficient to fully assess the severity and prognosis of neonatal respiratory distress, so it is particularly important to explore the combined use of other biomarkers. In this area, angiopoietin-like protein 4 (ANGPTL4) has gradually attracted attention. ANGPTL4, first discovered in 2000 as a member of the angiopoietin-like protein subfamily, whose expression can be prominently induced under ischemic and hypoxic conditions, participating in various physiological effects, including lipid metabolism, wound healing, and vascular injury.Therefore, serum ANGPTL4 may be an underlying biomarker for the diagnosis and prognosis of neonatal respiratory distress syndrome

This study will include 80 late preterm and term neonates (≥34 gestional weeks) who will show any clinical signs of respiratory distress in the delivery room or within 30 minutes after birth.

The exclusion criteria:

1. Preterm neonates with gestional age <34 weeks.
2. Neonates with antenatal diagnosis of congenital anomalies of the lungs or thoracic cage.
3. Neonates with antenatal diagnosis of congenital heart disease.
4. Neonates with antenatal diagnosis of other major congenital anomalies or chromsomal abnormality.
5. Neonates born with severe perinatal asphyxia.
6. Neonates born with severe apnea requiring intubation in the delitery room.