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The appearance of "early" chest radiographs and the response to surfactant replacement therapy
G Dimitriou1, A Greenough, F J Giffin
1Department of Child Health, King's College Hospital, London, UK.
Insights
Early chest X-rays in premature infants do not predict surfactant therapy response. Post-treatment X-rays, however, correlate with improved lung function and outcomes for respiratory distress syndrome.
Area of Science:
- Neonatal Medicine
- Pediatric Radiology
- Respiratory Physiology
Background:
- Surfactant replacement therapy (SRT) is crucial for premature infants with respiratory distress syndrome.
- Chest radiographs are commonly used to guide SRT decisions.
- Predicting SRT response and patient outcomes remains a clinical challenge.
Purpose of the Study:
- To evaluate if early (pre-SRT) chest radiograph appearance predicts response to exogenous surfactant therapy.
- To determine the correlation between radiographic findings and functional residual capacity (FRC) and oxygenation (a/A ratio).
- To assess the predictive value of both early and post-SRT radiographs on infant outcomes.
Main Methods:
- 18 premature infants receiving synthetic surfactant (Exosurf) were studied.
- Chest radiographs were scored for lung volume, inflation, opacification, interstitial shadows, and air bronchograms before and after SRT.
- Functional residual capacity (FRC) and a/A ratio were measured concurrently.
Main Results:
- SRT improved radiograph scores, FRC, and a/A ratio, but changes in radiograph scores did not correlate with changes in FRC or a/A ratio.
- Only the post-SRT chest radiograph appearance significantly correlated with FRC, a/A ratio, and patient outcomes (mortality or oxygen dependency).
- Early chest radiograph appearance was a poor predictor of SRT response.
Conclusions:
- The appearance of a chest radiograph within 2 hours of birth is not a reliable predictor of response to surfactant replacement therapy.
- Post-SRT chest radiographs are more valuable in assessing treatment efficacy and predicting outcomes in premature infants.
- Radiographic assessment after surfactant administration is essential for managing respiratory distress syndrome.
Abstract:
We have assessed whether the appearance of the chest radiograph performed within the first 2 h of birth was predictive of the response to exogenous surfactant replacement therapy (SRT), as indicated by changes in sensitive indices of disease severity, that is lung volume (functional residual capacity (FRC)) and oxygenation (a/A ratio). 18 premature infants who received two doses of a synthetic surfactant (Exosurf) were studied. The appearances of chest radiographs taken prior to the first and immediately after the second dose of SRT were scored for lung volume, degree of inflation, presence of opacification, interstitial shadows and air bronchograms. At similar times, FRC was measured and the a/A ratio calculated. Although following SRT, the chest radiograph score decreased (p < 0.01) and the FRC (p < 0.01) and a/A ratio (ns) improved, there was no significant relationship between the change in chest radiograph score and either the change in FRC or a/A ratio. In addition, only the post-SRT chest radiograph appearance correlated significantly with the respective FRC, a/A ratio and outcome (death or oxygen dependency beyond 28 days). Although the appearance of an early chest radiograph is frequently used as an indicator of the need for SRT, these results demonstrate that, unlike the post-SRT radiograph, it is a poor predictor of the response to SRT and outcome.