Utility of routine daily chest radiographs in ventilated newborns in intensive care units of Children's Hospital, Cairo University

ABSTRACT

The aim of this study was to assess the frequency of new abnormalities on routine chest radiographs of ventilated, preterm and full term infants during the acute stage of their illness; thus determining whether the interventions performed, were based on the routine portable morning CXR or not. It also aimed to identify patient subgroups for whom routine CXR is most useful. Seventeen preterm [group 1] and twelve full term [group 2] infants were recruited from the neonatal intensive care unit of Children's Hospital Cairo University. They were identified who had at least three daily routine chest radio graphs. The appearance of their subsequent radio graphs was compared to that obtained on the 1[st] day of ventilator sup port. The development of new abnormalities [malposition of the endotracheal or nasogastric tube, lobar collapse or consolidation, pleural effusion, pulmonary edema, etc.] was also noted. When the result of the routine chest radiograph led to an intervention; it was recorded. The third group [3] comprises ten ventilated sick full term infants who were not routinely radio graphed [i.e. only when clinically indicated] in order to determine the routine versus non-routine chest radiography protocol. [Premature newborns being at high risk of cardiopulmonary complications couldn't be included in that arm of the study]. The results revealed that a total of 107 radio graphs were examined from 39 infants. New changes were present on 26 [76.4%] of the 34 radio graphs taken on the 2[nd] or 3[rd] day[s] of ventilation of the seventeen ventilated preterms. In ventilated full term infants, new changes were present in 16 of 24 [66.6%] radiographs taken on the 2[nd] or 3[rd] day[s] of ventilation. In group [3] new abnormalities were detected only in 4/20 [20%] of the examined CXRs. The commonest problems were lung collapse and consolidation with the highest incidence among preterm infants. There was a significant relation between the results of routinely done CXRs and the interventional modifications [P value 0.012] although they didn't seem to influence the outcome or the duration of ventilation or hospital stay. Routine daily chest radiographs in mechanically ventilated, preterm infants during the acute stage of their respiratory illness can yield new information important in patient care. New abnormalities have been demonstrated in almost the majority radio graphs examined, thus highlighting the importance of routine daily radiography for this high risk group that can be of value in further management