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Session: Birth & Neonates
Session starts: Thursday 24 January, 13:30
Presentation starts: 14:30
Room: Lecture room 558

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Gert Weijers (MUSIC, Radboud University Medical Center, Nijmegen)
Freke Wilmink (Perinatology, Radboud University Medical Center, Nijmegen)
Frank van der Bussche (Perinatology, Radboud University Medical Center, Nijmegen)
Chris de Korte (MUSIC, Radboud University Medical Center, Nijmegen)

Abstract:
Neonatal Respiratory Morbidity (NRM) is highly associated with fetal lung in-maturity and associated with late premature (34+0-36+6) or early term (37+0-38+6) delivery of the newborn. The risk at NRM and the maternal capacity and risks must be balanced against each other in the decision making concerning an elective delivery. Currently, lung maturity is hard to assess, and not feasible using non-invasive tools. Therefore a noninvasive diagnostic tool is highly warrant to support this decision making. Since ultrasound is non-invasive and already widely used in gynaecology, three Voluson ultrasound machines (GE Healthcare, 1x E8 and 2x E10, using RM6C transducer bandwidth: 1-7MHz) were used to image the fetal lung, using fixed and calibrated imaging preset. The calibrations were performed using a Tissue Mimicking Phantom (TMP) and included: optimal zoom-setting for fully speckle sampling; beam-profile correction estimation; scaling of all texture parameters relative to the TMP used, and to scale US parameters from one to another machine. Three independent conventional ultrasound images of the fetal thorax (four chamber view) of 45 babies from singleton pregnant women were acquired (gestational age range: 20-39 weeks). The CAUS software (Weijers, Wanten et al. 2016) was used to estimate the mean echo level, residual attenuation coefficient (RAC), and 2D parametric texture images of the axial (AX) and lateral (LAT) speckle size [mm] and amplitudes (_max) [dB]. All parameters were calculated after manual annotation of the lung parenchyma, and correlated to gestation age in order to search for US parameters able to predict the gestational and thus stage the long-ripeness. Highly significant correlations for all texture entropy parameters (AX; AX_max; LAT; LAT_max: R = .56**; .66**; .62**; .51** respectively) with gestational age were found. Also the RAC (R=-.38**) and the lung area (R=0.75**) correlated well with gestational age. These results indicate the potential of NIMPUS for fetal lung ripeness staging. Further research including, addition of NRM scores of the newborns and performing multiparametric logistics regression analysis, have to be conducted to obtain cut-off values required for predictive values estimation for NIMPUS. REFERENCE: Weijers, G., G. Wanten, J. M. Thijssen, M. van der Graaf and C. L. de Korte (2016). "Quantitative Ultrasound for Staging of Hepatic Steatosis in Patients on Home Parenteral Nutrition Validated with Magnetic Resonance Spectroscopy: A Feasibility Study." Ultrasound Med Biol 42(3): 637-644.