Greenough et al developed a simple score for grading chest radiographs of premature infants. The score can help to identify an infant at increased risk for chronic lung disease (CLD). The authors are from King's College Hospital and St. George's Hospital in London.
Chronic lung disease (CLD, or bronchopulmonary dysplasia) was defined as oxygen dependency occurring at 1 or both of the following:
(1) more than 36 weeks after conception (post-conceptual age, PCA) OR
(2) more than 28 days after delivery
Patient selection: pre-term infants
Type of chest X-ray: supine
Timing of chest X-ray: 1 month of age
Parameters:
(1) number of posterior ends of the ribs visible above the diaphragm (as a metric for lung expansion)
(2) number of lung zones (quadrants) showing fibrosis or interstitial shadowing (linear or nodular densities in the lung not due to an anatomical structure)
(3) number of cysts (lucent intraparenchymal lesions with margins that are well-circumscribed
|
Parameter |
Finding |
Points |
|
number of posterior rib ends visible above the diaphragm |
<= 13 |
0 |
|
|
14, 15 or 16 |
1 |
|
|
>= 17 |
2 |
|
number of lung zones showing fibrosis or interstitial shadows |
0 |
0 |
|
|
1 |
1 |
|
|
2 |
2 |
|
|
3 |
3 |
|
|
4 (all 4 quadrants) |
4 |
|
cysts |
none |
0 |
|
|
few and small |
1 |
|
|
multiple and large |
2 |
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• An elevated score is associated with oxygen dependency at 28 days and an abnormal airway resistance at 6 months of age.
• A score of 4 or more correlated with CLD. A score of 3 showed overlap between infants with and without CLD. A score of 2 was infrequently associated with CLD.
Specialty: Pulmonology, Pedatrics
ICD-10: ,
