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Chest radiograph appearance at 24 h of age--prediction of chronic oxygen dependency
F Giffin1, A Greenough, J Karani
1Department of Child Health, King's College Hospital, London, UK.
Insights
A chest radiograph score at 24 hours can predict chronic oxygen dependence in premature infants. This early imaging assessment helps identify high-risk neonates for timely intervention.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Medical Imaging
Background:
- Chronic oxygen dependence affects premature infants, with immaturity, male sex, and low birth weight being key risk factors.
- Previous research established a chest radiograph scoring system at 1 month for predicting oxygen dependency at 36 weeks post-conceptional age (PCA).
Purpose of the Study:
- To evaluate the predictive value of a chest radiograph scoring system applied at 24 hours of age for chronic oxygen dependency.
- To determine if this early imaging score adds predictive value to existing demographic and ventilatory data.
Main Methods:
- A cohort of 50 infants with birth weights under 1200g, ventilated from birth, were studied.
- Chest radiographs were scored at 24 hours of age, with data on gestational age, birth weight, sex, and ventilatory requirements collected.
- Univariate and stepwise regression analyses were used to assess associations with oxygen dependency at 28 days and 36 weeks PCA.
Main Results:
- High chest radiograph scores at 24 hours predicted oxygen dependency at 28 days, independent of gestational age, birth weight, sex, and ventilatory requirements.
- A chest radiograph score >5 at 24 hours increased the likelihood of 28-day oxygen dependency fourfold.
- Oxygen dependency at 28 days and 36 weeks PCA was associated with low gestational age, male sex, high ventilatory needs, and high chest radiograph scores.
Conclusions:
- Chest radiograph appearance at 24 hours of age can serve as an early criterion for identifying infants at high risk of chronic oxygen dependence.
- Implementing interventional strategies based on early chest radiograph findings may help reduce chronic oxygen use in neonates.
Abstract:
Chronic oxygen dependence is associated with immaturity, male sex and low birthweight, but amongst that high risk group further criteria are necessary to predict those most at risk. We previously developed a chest radiograph scoring system which, when used at 1 month of age, proved useful in predicting chronic oxygen dependency at 36 weeks post-conceptional age (PCA). We have now assessed whether the scoring system, if applied at 24 h of age, added predictive value to readily available demographic and ventilatory data. 50 infants, birthweight less than 1200 g and ventilated from birth, were examined. They had a median gestational age of 27 weeks (range 23-34), birthweight of 886 g (range 470-1172) and chest radiograph score of 7 (range 2-13). Univariate analysis revealed that oxygen dependency at 28 days and 36 weeks PCA was significantly associated with low gestational age, male sex and high ventilatory requirements, in addition to a high chest radiograph score. Stepwise regression analysis, however, demonstrated that a high chest radiograph score predicted oxygen dependence at 28 days, independent of immaturity, low birthweight, male sex and high ventilatory requirements. A chest radiograph score of more than 5 rendered an infant four times more likely to be oxygen dependent at 28 days than those with lower scores. We conclude the chest radiograph appearance at 24 h of age could be used as a criterion to institute interventional strategies aimed at reducing chronic oxygen dependence.