Yuksel et al used changes in the chest X-ray to identify a preterm infant with a history of respiratory distress syndrome (RDS) who may be at increased risk for chronic lung disease. The authors are from King's College Hospital in London.
Patient selection: preterm delivery with range 23 to 32 weeks
Timing of chest radiograph exam: 1 month of age
Parameters:
(1) thoracic volume
(2) degree of lung inflation
(3) opacification
(4) air bronchogram
(5) pulmonary interstitial emphysema
(6) interstitial changes (coarse shadows)
(7) cystic elements
(8) size of largest cyst (if cysts present)
|
Parameter |
Finding |
Points |
|
thoracic volume |
normal |
0 |
|
|
decreased |
1 |
|
|
increased |
2 |
|
degree of lung inflation |
normal |
0 |
|
|
underinflated |
1 |
|
|
overinflated |
2 |
|
opacifications |
none |
0 |
|
|
perihilar OR regional |
1 |
|
|
perihilar AND regional |
2 |
|
|
complete opacification |
3 |
|
air bronchogram |
absent |
0 |
|
|
present |
1 |
|
pulmonary interstitial emphysema |
absent |
0 |
|
|
present |
1 |
|
interstitial changes (coarse shadows) |
none |
0 |
|
|
present in 1 quadrant |
1 |
|
|
present in 2 quadrants |
2 |
|
|
present in 3 quadrants |
3 |
|
|
present in all 4 quadrants |
4 |
|
cystic element |
none |
0 |
|
|
single |
1 |
|
|
2 or more |
2 |
|
size of largest cyst |
none |
0 |
|
|
up to one third of ipsilateral lung field |
1 |
|
|
larger than one third of the ipsilateral lung field |
2 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• Infants who had greater respiratory distress after delivery had higher scores.
• Infants with higher scores tended to develop chronic respiratory problems.
• A score >= 4 was 88% sensitive and 54% specific for an elevated airway resistance.
Specialty: Pulmonology, Pedatrics
ICD-10: ,
