BACKGROUND: Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. OBJECTIVE: The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. STUDY DESIGN: This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. RESULTS: A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. CONCLUSION: The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.

Althaia Xarxa Assistencial Universitària de Manresa Hospital de Sant Joan de Déu Manresa Spain

BCNatal Barcelona Center for Maternal Fetal and Neonatal Medicine Barcelona Spain

BCNatal Barcelona Center for Maternal Fetal and Neonatal Medicine IDIBAPS University of Barcelona Barcelona Spain

Clínica del Prado Medellín Antioquía Colombia

Department of Maternal Fetal Medicine KK Women's and Children's Hospital Singapore

Department of Obstetrics and Gynaecology Consorci Sanitari de Terrassa Terrassa Spain

Department of Obstetrics and Gynaecology University Hospitals Leuven and Academic Department of Development and Regeneration Organ System Cluster KU Leuven Leuven Belgium

Department of Obstetrics and Gynecology Sahlgrenska University Hospital Ostra Gothenburg University Gothenburg Sweden; Department of Genetics and Bioinformatics Area of Health Data and Digitalization Norwegian Institute of Public Health Oslo Norway

Department of Obstetrics and Gynecology University Hospital Hradec Kralove and Charles University Prague Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Department of Obstetrics and Gynecology University of Tennessee Health Science Center Memphis TN

Division of Fetal Maternal Medicine Department of Obstetrics and Gynecology University Hospital Puerta del Mar Cadiz Spain

Division of Maternal and Fetal Medicine University Hospital La Paz Madrid Spain

Division of Maternal Fetal Medicine Department of Obstetrics and Gynaecology University of Wisconsin Madison WI

Fernández Hospital Hyberabad India

Fetal Medicine Research Unit Children's and Women's Specialty Hospital of Queretaro Unidad de Investigación en Neurodesarrollo Instituto de Neurobiología UNAM Juriquilla Queretaro Mexico

Fetal Medicine Unit Clinic University Hospital Virgen de la Arrixaca Murcia Spain

Hospital Nostra Senyora de Meritxell Escaldes Engordany Andorra

Maternal Fetal Medicine Unit Department of Obstetrics and Gynaecology University Hospital of Granada Granada Spain

Maternal Fetal Medicine Unit Department of Obstetrics and Gynecology University of Chile Hospital Santiago de Chile Chile

Perinatology Research Branch Program for Perinatal Research and Obstetrics Division of Intramural Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD and Detroit MI; Center for Molecular Medicine and Genetics Wayne State University Detroit MI; Department of Obstetrics and Gynecology University of Michigan Ann Arbor MI; Department of Epidemiology and Biostatistics Michigan State University East Lansing MI

Perinatology Research Branch Program for Perinatal Research and Obstetrics Division of Intramural Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD and Detroit MI; Department of Obstetrics and Gynecology Wayne State University School of Medicine Wayne State University Detroit MI

Royal Prince Alfred Hospital Sydney University of Sydney Sydney New South Wales Australia

Transmural Biotech SL Barcelona Spain

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