In neonates, how effective is lung ultrasonography in directing chest physiotherapy intervention when compared to the combination of chest x-ray and auscultation?

Objective Evaluate the impact of lung ultrasound (LUS) compared to current chest physiotherapy (CPT) outcome measures on clinical decision-making in the Neonatal Intensive Care Unit (NICU). Design and Setting Single-centre prospective observational study at the NICU, Mater Mothers Hospital (MMH), Brisbane. Participants Infants admitted to the NICU who had had a chest x-ray (CXR) within the preceding 24hours. Infants were excluded if LUS was not possible, were expected to be discharged from MMH in less than 24hours or had a plan for redirection of care. Interventions Infants were assessed using CXR and auscultation by a physiotherapist, who recorded a diagnosis and intervention plan. An examiner blinded to the initial assessment then performed a LUS assessment. After receiving the LUS results, the initial physiotherapist recorded a re-evaluated intervention plan. Main outcome measures The primary outcome was the net reclassification improvement (NRI), which quantified how frequently physiotherapy diagnosis and treatment was reclassified after LUS. Secondary outcomes included diagnostic concordance between CXR/auscultation and LUS, and physiotherapist confidence in diagnoses. Results From 30 included episodes, NRI was -41% (SE 0.38; 95% CI -116% to 33%), indicating that LUS did not significantly result in reclassification of physiotherapy diagnosis and treatment. Diagnostic concordance was moderate at 0.595 (p