The significance of recurrent lung opacities in neonates on surfactant treatment for respiratory distress syndrome.
OBJECTIVE
To determine the significance of recurrent opacities in chest radiographs of neonates on surfactant therapy for respiratory distress syndrome (RDS) after an initial period of improvement.


METHODS
Serial pre-and post-surfactant chest radiographs on 94 preterm infants with RDS were analyzed and the pattern of chest radiographic response was classified as (a) clear, (b) recurrent opacities, and (c) no response. Their clinical characteristics were also recorded.


RESULTS
In 34 infants the RDS changes cleared within 3 days. 31 infants developed lung opacities within 10 days after an initial period of improvement. Twenty-nine infants failed to respond to the surfactant. The corresponding mean birth weights for the three groups were 1.74, 1.19, and 0.76 kg and the mean gestation ages 32.6, 27.7, and 25.4 weeks. The incidence of bronchopulmonary dysplasia (BPD) was highest among the slumping infants (72% vs. 50% in no responders, P<0.001)


CONCLUSIONS
The pattern of chest radiographic response is primarily affected by gestation age and birth weight. Recurrent lung opacity after an initial positive response to surfactant therapy may be caused by such factors as edema from barotrauma and patent ductus arteriosus. Infants with intraventricular hemorrhage may demonstrate neurogenic edema. Other contributory factors include pneumonia and abnormal consumption of surfactant. Recurrent lung opacities after surfactant may be a predictor of chronic lung disease in the preterm infant.
Odita
J C
JC
Department of Radiology, Louisiana State University Health Sciences Center, Shreveport 71130, USA. jodita@lsuhsc.edu
D001724:Birth Weight; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D011859:Radiography; D012008:Recurrence; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*
D011663:Pulmonary Surfactants