Table 1 Statements shared by panellists

A. Management of lung diseases in which the primary LUS manifestation is lung consolidation

1. If the diagnosis is respiratory distress syndrome (RDS) on LUS:

1.1. In the case of mild (grade I) RDS, noninvasive MV can be used firstly

1.2. Invasive MV should be strongly considered in cases of moderate (grade II) to severe (grade III) RDS

1.3. The severity degree of RDS can be scored on LUS according to the areas involved

4

4

0

A

2. If the diagnosis is mild (grade I) RDS on LUS, the invasive MV should be administered immediately if the lung condition worsens

4

4

1

B

3. In RDS treated with invasive MV, monitoring the lung changes by LUS every 2–4 h is necessary

4

4

1

B

4. If the diagnosis is severe meconium aspiration syndrome (MAS), severe pneumonia, or atelectasis on LUS, the bronchoalveolar lavage (BAL) using 0.9% NaCl (at the dosage of 1.0–2.0 ml/kg per time) should be performed before MV. Occasionally, diluted PS may be used for lavage at the same dosage

4

4

1.5

C

5. After BAL, the MV is not required if lung consolidation disappears on LUS; noninvasive MV should be provided if the extensive consolidation significantly decreases, while invasive MV should be provided if extensive consolidation shows no significant changes on LUS. However, if the diagnosis is pulmonary haemorrhage, the invasive MV therapy should directly instead of BLA

4

4

1

B

6. If LUS supports a diagnosis of mild MAS, pneumonia, or atelectasis, MV is generally unnecessary if the infant is clinically stable with normal spontaneous breath

4

4

0

A

B. Management of the lung in which the primary LUS manifestation is lung oedema

1. Lung oedema is a common pathological change in neonates with various diseases, including intrapulmonary and extrapulmonary diseases (e.g. heart disease, hypoproteinemia). However, when excluding extrapulmonary diseases, lung diseases with lung oedema as the primary LUS manifestation are TTN, especially in infants with dyspnoea shortly after birth

4

4

0

A

2. Noninvasive MV should be provided firstly if the LUS presents a confluent B-lines or compact B-lines pattern (white lung) because (according to studies on animal models) a baby would develop into type II respiratory failure

4

4

1

B

3. LUS can be used to estimate lung water content. Noninvasive respiratory support may be needed if the estimated lung water content is > 10–15 ml/kg, while indication for invasive MV may be needed with an estimated lung water content > 15–20 ml/kg

4

4

1

B

4. If the TTN was diagnosed on initial LUS, dynamic LUS observation is necessary until the TTN resolves. TTN can rarely result in secondary RDS due to the development of surfactant deficiency. In this case, LUS would be helpful with more timely identification and treatment of these changes

4

4

1

A

5. Less invasive PS administration (LISA) could be adopted if the diagnosis is grade I RDS on LUS. However, invasive MV treatment with PS administration should be adopted if the diagnosis was grade II-III RDS on LUS

4

4

0

A

C. Management of the condition of pneumothorax diagnosed on LUS

1. LUS allows pneumothorax to be identified and its degree determined

2. Whether and how PTX needs to be treated depends on the degree of dyspnoea of the patient

3. Since MV in a patient with an undrained pneumothorax might severely worsen the patient’s condition, pneumothorax drainage is required before MV is initiated

4. The MV is usually not required if LUS presented as mild pneumothorax

5. Invasive MV should be provided if moderate-severe pneumothorax is identified on LUS and the infant appears significant clinical distress. However, high-frequency oscillatory ventilation should be preferred

4

4

0

A

D. Use of LUS monitoring to guide the adjustment of ventilator parameters

1. The principle of guiding MV parameter adjustments for invasive or noninvasive treatment based on LUS imaging ensures that the lungs are fully expanded

4

4

0

A

2. Neonatal lung overexpansion can be detected effectively by LUS

2.1 Overlapping the median borders of the lungs (transternal transverse section) is an easy-to-detect, specific, and sensitive sign of excessive lung volume

2.2 In addition to overdistension, atelectrauma can be easily detected. The ventilator-induced lung injury is due to repetitive opening and closing of collapsed alveoli and small airways within atelectatic areas during MV

4

4

1

B

E. Use LUS to guide the weaning from MV

1. Weaning from invasive MV can be performed when lung consolidation disappears on LUS in patients initially presenting with consolidated lungs

4

4

1

A

2. Weaning from invasive MV should be considered when lung oedema shows signs of absorption when the confluent B-lines or compact B-lines become more sparse B-lines or AIS

3. The endotracheal tube can be removed directly when weaning from the ventilator without lowering the parameters (i.e. keeping the original ventilator parameters unchanged)

4. The need for noninvasive respiratory support after weaning from an invasive ventilator should be decided by patient’s gestational age, weight, and overall condition

4

4

1

A

F. Use LUS to guide exogenous neonatal PS application

1. Exogenous PS should be provided if the RDS is diagnosed by LUS including the mild (grade I) RDS, and the dosage of PS at 75–100 mg/kg per time is sufficient

4

4

0

96.80%

A

2. The BAL is necessary firstly when severe MAS, pneumonia, or atelectasis exists on LUS; the PS is not required if lung consolidation disappears or the size significantly decreases after BAL Otherwise, PS could be given to the patient.

3. The PS is also unnecessary if the diagnosis is TTN on LUS

4

4

1

84.30%

B