Dynamics of the Ultrasound Pattern “Double Lung Point” in Newborns with Transient Tachypnea During Body Position Change: A Prospective Study

Relevance. Transient tachypnea of the newborn (TTN) is the leading cause of respiratory distress in the early neonatal period. Although lung ultrasound is widely used in TTN, the effect of body position on detecting the “double lung point” (DLР) pattern remains insufficiently studied.

Purpose — to evaluate the dynamics of the DLР pattern in newborns with TTN when changing body position.

Materials and methods. A prospective cohort study was conducted. Newborns with a gestational age of ≥35⁰ weeks, respiratory failure in the first 4 hours of life, and the need for CPAP therapy or mechanical ventilation were included. Lung ultrasound was performed twice: in the supine position (ultrasound-1) and 1 hour after the infant was placed in the prone position (ultrasound-2). The LUS score and DLР pattern recording were used. The primary endpoint was the change in the DLР detection rate and the dynamics of the LUS score. The study duration was from April to May 2025.

Results. The LBD pattern was detected in 85.7 % of patients with TTN. Over time, ultrasound-2 imaging showed a decrease in the lung ultrasound score across all examined areas (p < 0.001), as well as a decrease in the detection rate of DLР from 100 % to 76.7 % (p = 0.016). In all cases, while DLР persisted on ultrasound-2 imaging, a pattern inversion was observed, dependent on the infant’s body position.

Conclusion. Body position significantly influences lung ultrasound findings in TTN. These results emphasize the importance of considering patient positioning when performing lung ultrasound, highlighting the need for standardized protocols to improve diagnostic accuracy and optimization of respiratory therapy.

1. Stewart DL, Barfield WD; Committee on Fetus and Newborn. Updates on an at-risk population: Late-preterm and early-term infants. Pediatrics. 2019;144(5):e20192760. DOI: https://doi.org/10.1542/peds.2019-2760.

2. Kumar A, Bhat BV. Epidemiology of respiratory distress of newborns. The Indian Journal of Pediatrics. 1996;63(1):93–98. DOI: https://doi.org/10.1007/BF02823875.

3. Hooper SB, Te Pas AB, Kitchen MJ. Respiratory transition in the newborn: A three-phase process. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2016;101(3):F266–F271. DOI: https://doi.org/10.1136/archdischild-2013-305704.

4. Olver RE, Strang LB. Ion fluxes across the pulmonary epithelium and the secretion of lung liquid in the foetal lamb. The Journal of Physiology. 1974;241(2):327–357. DOI: https://doi.org/10.1113/jphysiol.1974.sp010659.

5. Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: A summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118(3):1207–1214. DOI: https://doi.org/10.1542/peds.2006-0018.

6. Kasap B, Duman N, Ozer E, Tatli M, Kumral A, Ozkan H. Transient tachypnea of the newborn: Predictive factor for prolonged tachypnea. Pediatrics International. 2008;50(1):81–84. DOI: https://doi.org/10.1111/j.1442-200X.2007.02535.x.

7. Shestak EV, Kovtun OP, Ksenofontova OL, Dodrov DS. Efficacy and safety of standardized protocol of CPAP therapy for full-term newborns in delivery room at transient tachypnea: Clinical trial with historical control. Current Pediatrics. 2022;21(4):282–292. (In Russ.). DOI: https://doi.org/10.15690/vsp.v21i4.2445.

8. Shestak EV, Kovtun OP, Mylarshikova EA, Nechaeva YuI. Efficacy and safety of a standardized CPAP protocol in the delivery room in late preterm infants with infectious and non-infectious lung diseases. General Reanimatology. 2024;20(5):44–54. (In Russ.). DOI: https://doi.org/10.15360/1813-9779-2024-5-44-54.

9. Shestak EV, Kovtun OP, Mylarshchikova EA, Nechaeva II. Retrospective analysis of diseases in a cohort of late preterm infants. Ural Medical Journal. 2024;23(6):7–17. (In Russ.). DOI: https://doi.org/10.52420/umj.23.6.7.

10. Sharma D, Farahbakhsh N. Role of chest ultrasound in neonatal lung disease: A review of current evidences. The Journal of Maternal-Fetal & Neonatal. 2019;32(2):310–316. DOI: https://doi.org/10.1080/14767058.2017.1376317.

11. Gao YQ, Qiu RX, Liu J, Zhang L, Ren XL, Qin SJ. Lung ultrasound completely replaced chest X-ray for diagnosing neonatal lung diseases: A 3-year clinical practice report from a neonatal intensive care unit in China. The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(18):3565–3572. DOI: https://doi.org/10.1080/14767058.2020.1830369.

12. Liu J, Chen XX, Li XW, Chen SW, Wang Y, Fu W. Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149(5):1269–1275. DOI: https://doi.org/10.1016/j.chest.2015.12.024.

13. Liu J, Wang Y, Fu W, Yang CS, Huang JJ. Diagnosis of neonatal transient tachypnea and its differentiation from respiratory distress syndrome using lung ultrasound. Medicine. 2014;93(27):e197. DOI: https://doi.org/10.1097/MD.0000000000000197.

14. Ismail R, El Raggal NM, Hegazy LA, Sakr HM, Eldafrawy OA, Farid YA. Lung ultrasound role in diagnosis of neonatal respiratory disorders: A prospective cross-sectional study. Children. 2023;10(1):173. DOI: https://doi.org/10.3390/children10010173.

15. Copetti R, Cattarossi L. The ‘double lung point’: An ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;91(3):203–209. DOI: https://doi.org/10.1159/000097454.

16. Vergine M, Copetti R, Brusa G, Cattarossi L. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology. 2014;106(2):87–93. DOI: https://doi.org/10.1159/000358227.

17. Singh Y, Dauengauer-Kirliene S, Yousef N. Setting the standards: Neonatal lung ultrasound in clinical practice. Diagnostics. 2024;14(13):1413. DOI: https://doi.org/10.3390/diagnostics14131413.

18. Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatrics. 2015;169(8):e151797. DOI: https://doi.org/10.1001/jamapediatrics.2015.1797.

19. Shestak EV, Kovtun OP, Starkov VYu. The assessment of the effectiveness of ultrasound and near-infrared spectroscopy of the lungs for the differential diagnosis of transient tachypnea of newborns and congenital pneumonia in children over 350 weeks of gestation. The prospective study. Russian Pediatric Journal. 2024; 5(4):182–191. (In Russ.). DOI: https://doi.org/10.15690/rpj.v5i4.2844.

20. Liu J, Liu F, Liu Y, Wang HW, Feng ZC. Lung ultrasonography for the diagnosis of severe neonatal pneumonia. Chest. 2014;146(2):383–388. DOI: https://doi.org/10.1378/chest.13-2852.

21. Li CS, Chu SM, Lien R, Mok TY, Hsu KH, Lai SH. Prospective investigation of serial ultrasound for transient tachypnea of the newborn. Pediatrics and Neonatology. 2021;62(1):64–69. DOI: https://doi.org/10.1016/j.pedneo.2020.09.002.

22. Ibrahim M, Omran A, AbdAllah NB, Ibrahim M, El-Sharkawy S. Lung ultrasound in early diagnosis of neonatal transient tachypnea and its differentiation from other causes of neonatal respiratory distress. Journal of Neonatal-Perinatal Medicine. 2018;11(3):281–287. DOI: https://doi.org/10.3233/NPM-181796.

23. Rachuri H, Oleti TP, Murki S, Subramanian S, Nethagani J. Diagnostic performance of point of care ultrasonography in identifying the etiology of respiratory distress in neonates. Indian Journal of Pediatrics. 2017;84(4):267–270. DOI: https://doi.org/10.1007/s12098-016-2288-7.

24. Grimaldi C, Michel F, Brévaut-Malaty V, Hassid S, Nicaise C, Puech B, et al. Thoracic ultrasound accuracy for the investigation of initial neonatal respiratory distress. Archives de Pediatrie. 2019;26(8):459–465. DOI: https://doi.org/10.1016/j.arcped.2019.09.009.

25. He L, Sun Y, Sheng W, Yao Q. Diagnostic performance of lung ultrasound for transient tachypnea of the newborn: A meta-analysis. PLoS One. 2021;16(3):e0248827. DOI: https://doi.org/10.1371/journal.pone.0248827.