title: Early radiologic evidence of severe respiratory distress syndrome as a predictor of nasal continuous positive airway pressure failure in extremely low birth weight newborns.
abstract: OBJECTIVE
  To determine whether early radiologic evidence of severe respiratory distress syndrome (RDS) is predictive of nasal continuous positive airway pressure (CPAP) failure in extremely low birth weight (ELBW) infants during the first 72 h of age.
  
  
  METHODS
  Retrospective analysis of 235 consecutively inborn ELBW infants who received initial support with CPAP. CPAP success (n=151) and CPAP failure (n=84) groups were designated according to outcome within the first 72 h of age. We assessed the ability of radiologic evidence of severe RDS in the initial chest radiograph, alone and in combination with other variables available in the first hours of life, to predict CPAP failure.
  
  
  RESULTS
  Severe RDS had a positive predictive value (PPV) of 0.81 (95% confidence interval (CI) 0.64, 0.92) for CPAP failure. The combination of severe RDS and gestational age (GA) ⩽ 26 weeks had a PPV of 0.92 (95% CI 0.68, 0.96).
  
  
  CONCLUSIONS
  Early radiologic evidence of severe RDS is predictive of CPAP failure, especially in infants with GA ⩽ 26 weeks.
authors.affiliation: Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: T
authors.initials: T
authors.lastname: Tagliaferro
authors.affiliation: Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bateman
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ruzal-Shapiro
authors.affiliation: Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Polin
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology; D062071:Infant, Extremely Premature / Q000502:physiology; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology