Prediction of neonatal respiratory morbidity in fetuses of diabetic mothers by quantitative ultrasound lung texture analysis

Abstract

Introduction: Poor glycemic control during pregnancy is associated with increased maternal and neonatal morbidity and mortality, as well as consequences in childhood and adult life. Patients with diabetes in pregnancy are at increased risk of preterm birth. In addition to prematurity, diabetes is an independent risk factor for neonatal respiratory morbidity. These risks are greater in patients with pre-gestational diabetes and gestational diabetes who require the use of medication. Neonatal respiratory morbidity due to respiratory distress syndrome or transient tachypnea of the newborn is the most common complications of late prematurity (between 34 and 36 6 / 7weeks) and the early term (<39 weeks). In this context, a noninvasive method to predict the risk of neonatal respiratory morbidity in these fetuses could be of great help in assisting the obstetrician in the decision on the use of corticosteroids to accelerate pulmonary maturity and in the planning of the most appropriate time for delivery. A software named quantitative ultrasound fetal lung maturity analysis (quantusFLM ") was developed combining several extractors of ultrasound image textures and computer algorithms to blindly predict the risk of neonatal respiratory morbidity. A multicenter study published in 2017 concluded that: the software has a similar accuracy to amniotic fluid testing to predict respiratory morbidity with the advantage of being noninvasive and that studies in specific populations such as diabetic pregnant women should be performed.Objectives: This study aims to evaluate the performance of quantitative ultrasonographic analysis of fetal lung texture to predict neonatal respiratory morbidity in preterm or late term deliveries in fetuses of pre-gestational or gestational diabetic mothers requiring medication.Methods: Observational prospective cohort study. Diabetic pregnant women (pre-gestational or on medication) and pregnant women without comorbidities (control group) will be included between 34 and 38 6/7 weeks. Ultrasonography for quantitative analysis of lung texture should be performed up to 48 hours before delivery. Ultrasonographic images will be obtained through a detailed protocol (axial section of the fetal chest at the 4-chamber level). The results obtained after the analysis are divided into two categories: low or high risk of neonatal respiratory morbidity. The main clinical outcome of the study is the presence of neonatal respiratory morbidity including respiratory distress syndrome and transient tachypnea of the newborn.Key words: pulmonary texture analysis, diabetes in gestation, fetal lung maturity, neonatal respiratory morbidity, lung maturity prediction, ultrasonography. (AU)