CHEST RADIOGRAPH ABNORMALITIES IN VERY-LOW-BIRTH-WEIGHT SURVIVORS OF CHRONIC NEONATAL LUNG-DISEASE

Objective: To determine whether the neonatal chest radiograph (CXR) at 28 days in very low birthweight (VLBW) infants who develop chronic ne onatal lung disease (CNLD) predicts oxygen therapy duration or CXR abn ormalities in early childhood. Also, to assess the inter-observer reli ability of the radiologists scoring the CXR. Methodology: Clinically w ell survivors of CNLD (n = 46) had neonatal CXR scored (mean age 28.5 days) and compared with current CXR (mean age 40 months). The CXR were scored independently and 'blindly' by two paediatric radiologists usi ng a standardized scoring system (range 0-10). Results: There was no c orrelation between neonatal CXR scores and current CXR scores for eith er radiologist. There was no association between CXR severity scores a nd duration of oxygen therapy for either neonatal or current CXR. Radi ologist A scored the current CXR significantly more abnormal than radi ologist B [medians (range): 3 (1-6) vs 1 (0-5), P<0.001] with reasonab le correlation (r = 0.593, P<0.005) but worse than chance agreement (k appa = - 0.034). The median scores for the neonatal CXR were similar [ 1.5 (0-8) vs 2 (0-8), P = 0.789] and again there was good correlation (r = 0.760, P<0.0005) although poor individual agreement (kappa = 0.24 3) between radiologists. Conclusions: Follow-up CXR abnormalities in V LBW infants with CNLD are usually minor and are not predictive of the duration of oxygen therapy that will be required nor of the CXR appear ance in early childhood. Considerable inter-observer variation exists in the interpretation of the CXR in CNLD.