POSTEXTUBATION CHEST X-RAYS IN NEONATES - A ROUTINE NO LONGER NECESSARY

Objectives: 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 differ ences were predictive of the need for a postextubation chest X-ray (CX R). Methods: This is a retrospective review of all infants ventilated in 1994. For each separate period of extubation the medical, physiothe rapy and nursing notes were examined. Data were collected on birthweig ht, gestational age, duration of ventilation, age at extubation, venti lation requirements pre-extubation, pre-and postextubation arterial ca rbon dioxide tensions (PaCO2) and oxygen requirements, the number of e pisodes of bradycardia and apnoea, the pulse and respiratory rates pre -and postextubation, and the use of nasal continuous positive airway p ressure (NCPAP). It was routine practice throughout 1994 for all venti lated babies to have a CXR 6 h postextubation. Each postextubation CXR was examined by one of the authors (MWD) for the presence of atelecta sis and other diagnoses. PEA was defined as any atelectasis present on the postextubation CXR that was not present on the pre-extubation CXR . Results: 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 post extubation was higher (change in inspired oxygen (Delta FiO(2)) of 0.0 5 vs 0.015, P=0.043 and Delta FiO(2) of 0.045 vs 0.0, P=0.033, respect ively). There was a higher incidence of the need for NCPAP some time a fter extubation (2/4 vs 9/163, P<0.001). No infant with PEA required r eintubation and ventilation. Conclusions: In this nursery the incidenc e of PEA is low with no significant morbidity. Postextubation CXRs sho uld be performed on only those infants who have an increase in oxygen requirement postextubation or become symptomatic with new or increasin g respiratory distress, and to follow up atelectasis on the most recen t pre-extubation CXR.