Ultrasound-assessed lung aeration, oxygenation and respiratory care in neonatal bile acid pneumonia: A nested case-control study

Aim: Neonatal bile acid pneumonia (NBAP) occurs in neonates following obstetric cholestasis. We aimed to study the lung aeration and respiratory support of NBAP.Methods: Nested, case/control study enrolling age-matched neonates with NBAP, respiratory distress syndrome (RDS) or transient tachypnoea (TTN). Lung aeration and oxygenation were assessed with lung ultrasound score, oxygenation index and SpO(2)/FiO(2).Results: Nineteen, 22 and 25 neonates with NBAP, RDS and TTN, respectively were studied (mean gestational age = 33 (2.2) weeks, 30 (45.5%) males). Upon admission, RDS patients had the worst lung ultrasound score (p = 0.022) and oxygenation index (p = 0.001), while NBAP and TTN neonates had similar values. At the worst time-point, NBAP and RDS patients showed similar oxygenation index (NBAP: 4.6 [2], RDS: 5.7 [3]) and SpO(2)/FiO(2) (NBAP: 3.1 [1.1], RDS: 2.7 [1]) which were worse than those of TTN patients (oxygenation index: p = 0.015, SpO(2)/FiO(2): p = 0.001). RDS neonates needed the longest continuous positive airway pressure and highest mean airway pressure, but NBAP neonates needed invasive ventilation (26.3%, p = 0.01) and surfactant (31.6%, p = 0.003) more often than TTN patients who never needed these.Conclusion: NBAP was a mild disorder in the first hours of life but subsequently worsened and became similar to RDS.

Automated summary

The aim of this study was to investigate the lung aeration and respiratory support of neonatal bile acid pneumonia (NBAP). A case/control study was conducted on neonates with NBAP, respiratory distress syndrome (RDS) or transient tachypnoea (TTN). Lung ultrasound score, oxygenation index and SpO(2)/FiO(2) were used to assess lung aeration and oxygenation. The results showed that NBAP started as a mild disorder in the first hours of life but later worsened and became similar to RDS.