Clinical prediction of post-extubation 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 clinical deterioration, is a controversy in neonatal unit practice. This study tested the hypothesis that most cases of post-extubation radiological deterioration in the lungs could be detected by clinical assessment.


METHODS
A chest radiograph was performed at 8 h post-extubation in 100 episodes of extubation in 85 newborn infants ventilated for a variety of lung diseases. Each infant was assessed at the same time by a neonatologist blinded to the radiological findings, to determine whether a chest radiograph would have been requested based on clinical judgement. The infants were continuously monitored for their respiratory and oxygenation status before and after extubation.


RESULTS
Compared to 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 clinicians' assessment failed to detect most of the deterioration, with a sensitivity of only 21.7%. Systematic analysis of the infants' clinical parameters showed that the development of significant intercostal/subcostal retraction, and an increase in inspired oxygen concentration by > or = 7% after extubation, were the best predictors of post-extubation radiological deterioration (sensitivity 82.6%, specificity 62.3%, positive predictive value 39.6%, and negative predictive value 92.3%). Serial blood gas in contrast had little predictive value.


CONCLUSIONS
We conclude that most cases of radiological deterioration of the lungs after extubation are clinically predictable, provided the correct clinical criteria are used.
Fok
T F
TF
Department of Paediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin.
Kew
J
J
Loftus
W K
WK
Ng
P C
PC
Set
P A
PA
Wong
W
W
Cheung
K L
KL
D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D011237:Predictive Value of Tests; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging* / Q000209:etiology*; D011859:Radiography; D012121:Respiration, Artificial