CLINICAL-PREDICTION OF POSTEXTUBATION RADIOLOGICAL CHANGES OF THE CHEST IN NEWBORN-INFANTS

Objective: Whether a chest radiograph should be performed routinely in all infants after extubation, or selectively only in those with clini cal deterioration, is a controversy in neonatal unit practice. This st udy tested the hypothesis that most cases of post-extubation radiologi cal deterioration in the lungs could be detected by clinical assessmen t. Methods: A chest radiograph was performed at 8 h post-extubation in 100 episodes of extubation in 85 newborn infants ventilated for a var iety of lung diseases. Each infant was assessed at the same time by a neonatologist blinded to the radiological findings, to determine wheth er a chest radiograph would have been requested based on clinical judg ement. The infants were continuously monitored for their respiratory a nd oxygenation status before and after extubation. Results: Compared t o the pre-extubation chest radiographs, 23 of the 100 post-extubation chest radiographs showed either deterioration of the pre-existing lung pathologies or appearance of significant new pathologies. The clinici ans' assessment failed to detect most of the deterioration, with a sen sitivity of only 21.7%. Systematic analysis of the infants' clinical p arameters showed that the development of significant intercostal/subco stal retraction, and an increase in inspired oxygen concentration by g reater than or equal to 7% after extubation, were the best predictors of post-extubation radiological deterioration (sensitivity 82.6%, spec ificity 62.3%, positive predictive value 39.6%, and negative predictiv e value 92.3%). Serial blood gas in contrast had little predictive val ue. Conclusion: We conclude that most cases of radiological deteriorat ion of the lungs after extubation are clinically predictable, provided the correct clinical criteria are used.