Postextubation chest X-rays in neonates: a routine no longer necessary

To ascertain the incidence of postextubation atelectasis (PEA) in neonates, to delineate any objective differences between those infants with PEA and those without, and to see if any of those differences were predictive of the need for a postextubation chest X-ray (CXR).

This is a retrospective review of all infants ventilated in 1994. For each separate period of extubation the medical, physiotherapy and nursing notes were examined. Data were collected on birthweight, gestational age, duration of ventilation, age at extubation, ventilation requirements pre-extubation, pre- and postextubation arterial carbon dioxide tensions (PaCO2) and oxygen requirements, the number of episodes of bradycardia and apnoea, the pulse and respiratory rates pre- and postextubation, and the use of nasal continuous positive airway pressure (NCPAP). It was routine practice throughout 1994 for all ventilated babies to have a CXR 6 h postextubation. Each postextubation CXR was examined by one of the authors (MWD) for the presence of atelectasis and other diagnoses. PEA was defined as any atelectasis present on the postextubation CXR that was not present on the pre-extubation CXR.

The overall incidence of any PEA was 2.5% (6/236). In those babies with PEA, the increase in oxygen requirement at 1 and 6 h postextubation was higher (change in inspired oxygen (deltaFiO2) of 0.05 vs 0.015, P=0.043 and deltaFiO2 of 0.045 vs 0.0, P=0.033, respectively). There was a higher incidence of the need for NCPAP some time after extubation (2/4 vs 9/163, P<0.001). No infant with PEA required reintubation and ventilation.

In this nursery the incidence of PEA is low with no significant morbidity. Postextubation CXRs should be performed on only those infants who have an increase in oxygen requirement postextubation or become symptomatic with new or increasing respiratory distress, and to follow up atelectasis on the most recent pre-extubation CXR.