Comparison of lung ultrasonography and chest radiography in detecting neonatal respiratory distress as a composite clinical condition: a prospective cross-sectional diagnostic accuracy study at Muhimbili National Hospital
4 affiliations
- 1Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- 2Department of Radiology and Imaging, Mirembe National Mental Health Hospital, Dodoma, Tanzania
- 3Department of Radiology and Imaging, Muhimbili National Hospital, Dar es Salaam, Tanzania
- 4Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
Abstract
Background: Neonatal respiratory distress (RD) is a leading cause of neonatal morbidity and mortality. While chest radiography (CXR) is the traditional modality of diagnosis, lung ultrasound (LUS) has emerged as a bedside, radiation-free alternative for evaluating neonatal respiratory conditions.
Aim: To determine the diagnostic performance of lung ultrasonography (LUS) compared to chest radiography (CXR) in detecting neonatal respiratory distress (RD) as a composite clinical condition at Muhimbili National Hospital (MNH).
Methods: A prospective cross-sectional diagnostic accuracy study was conducted at Muhimbili National Hospital (MNH) between June and December 2022. A total of 179 neonates with clinical signs of respiratory distress were consecutively enrolled. All neonates underwent both LUS and CXR within 6 h. Demographic and clinical data were collected using a structured tool. Diagnostic performance was assessed for overall respiratory distress rather than individual disease etiologies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were calculated using a composite clinico-radiological reference standard. Agreement was assessed using Cohen’s kappa with 95% confidence intervals and significance set at p < 0.05.
Results: Among 179 neonates (mean gestational age: 32 ± 4 weeks; mean birth weight: 1,769 ± 856 g), LUS demonstrated high diagnostic performance in this setting, with higher sensitivity (95.1% vs. 90.3%), specificity (94.7% vs. 89.5%), positive predictive value (PPV) (96.1% vs. 92.1%), negative predictive value (NPV) (93.5% vs. 87.2%), and diagnostic accuracy (95% vs. 90%) compared to chest radiography (CXR). We observed almost perfect agreement between lung ultrasonography and the reference standard (κ = 0.898) and substantial agreement between lung ultrasonography and chest radiography (κ = 0.806).
Conclusion: Lung ultrasonography demonstrated high diagnostic performance in this setting for detecting neonatal respiratory distress as a composite clinical condition. However, interpretation should consider the use of a composite reference standard that included chest radiography, which may have introduced incorporation bias. Additionally, the composite outcome limits interpretation for individual respiratory conditions. Despite these limitations, LUS appears to be a useful adjunct imaging modality in resource-limited settings, where access to radiography may be constrained.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07345-w.
Related
- Diagnostic accuracy of point-of-care ultrasound and radiography for triage of laryngotracheal stenosis in resource-limited settings: a prospective study protocol
- Preoperative staging of gastric cancer: a prospective comparison of gastric filling ultrasonography and enhanced CT with implications for surgical decision-making
- Clinical Diagnosis Versus Plain Radiography for Diabetic Foot Osteomyelitis: A Prospective Study of Diagnostic Agreement in a Resource‐Limited Settings
- Diagnostic accuracy of cone beam computed tomography in the detection of furcation perforations: an in vitro comparison with periapical radiography and micro-computed tomography
- Intraoperative specimen ultrasonography for margin assessment in breast conserving surgery in comparison with specimen mammography
BibTeX
@article{dadi2026comparison,
title = {{Comparison of lung ultrasonography and chest radiography in detecting neonatal respiratory distress as a composite clinical condition: a prospective cross-sectional diagnostic accuracy study at Muhimbili National Hospital}},
author = {Hollo K. Dadi and Balowa Musa Baraka and Irene H. Mhalu and Martha Franklin Mkony},
journal = {BMC Pediatrics},
year = {2026},
month = aug,
doi = {10.1186/s12887-026-07345-w},
url = {https://doi.org/10.1186/s12887-026-07345-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Comparison of lung ultrasonography and chest radiography in detecting neonatal respiratory distress as a composite clinical condition: a prospective cross-sectional diagnostic accuracy study at Muhimbili National Hospital
AU - Hollo K. Dadi
AU - Balowa Musa Baraka
AU - Irene H. Mhalu
AU - Martha Franklin Mkony
PY - 2026
DA - 2026/08/10
JO - BMC Pediatrics
DO - 10.1186/s12887-026-07345-w
UR - https://doi.org/10.1186/s12887-026-07345-w
AB - Background: Neonatal respiratory distress (RD) is a leading cause of neonatal morbidity and mortality. While chest radiography (CXR) is the traditional modality of diagnosis, lung ultrasound (LUS) has emerged as a bedside, radiation-free alternative for evaluating neonatal respiratory conditions. Aim: To determine the diagnostic performance of lung ultrasonography (LUS) compared to chest radiography (CXR) in detecting neonatal respiratory distress (RD) as a composite clinical condition at Muhimbili National Hospital (MNH). Methods: A prospective cross-sectional diagnostic accuracy study was conducted at Muhimbili National Hospital (MNH) between June and December 2022. A total of 179 neonates with clinical signs of respiratory distress were consecutively enrolled. All neonates underwent both LUS and CXR within 6 h. Demographic and clinical data were collected using a structured tool. Diagnostic performance was assessed for overall respiratory distress rather than individual disease etiologies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were calculated using a composite clinico-radiological reference standard. Agreement was assessed using Cohen’s kappa with 95% confidence intervals and significance set at p < 0.05. Results: Among 179 neonates (mean gestational age: 32 ± 4 weeks; mean birth weight: 1,769 ± 856 g), LUS demonstrated high diagnostic performance in this setting, with higher sensitivity (95.1% vs. 90.3%), specificity (94.7% vs. 89.5%), positive predictive value (PPV) (96.1% vs. 92.1%), negative predictive value (NPV) (93.5% vs. 87.2%), and diagnostic accuracy (95% vs. 90%) compared to chest radiography (CXR). We observed almost perfect agreement between lung ultrasonography and the reference standard (κ = 0.898) and substantial agreement between lung ultrasonography and chest radiography (κ = 0.806). Conclusion: Lung ultrasonography demonstrated high diagnostic performance in this setting for detecting neonatal respiratory distress as a composite clinical condition. However, interpretation should consider the use of a composite reference standard that included chest radiography, which may have introduced incorporation bias. Additionally, the composite outcome limits interpretation for individual respiratory conditions. Despite these limitations, LUS appears to be a useful adjunct imaging modality in resource-limited settings, where access to radiography may be constrained. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07345-w.
SN - 1471-2431
ER -