Role of Chest in Respiratory Distress of Neonates

Abstract

Introduction: The initial diagnosis of an infant with respiratory distress is crucial as life-saving measures can be started immediately. Despite all the improved diagnostic modalities out there, a roentgenogram of the chest is still considered the most reliable diagnostic tool to establish respiratory distress. The aim of this study was to assess and evaluate the role of chest X-ray (CXR) in neonatal respiratory distress.Materials and methods: This study was a prospective correlational hospital-based study done in 300 neonates in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. The neonates who were clinically diagnosed having respiratory distress were evaluated using chest radiograph. In all these patients, the chest radiography findings were noted and correlated with clinical findings.Results: Transient tachypnea of the newborn (TTNB) was the most common cause of respiratory distress (35.7%). Chest radiography had the highest sensitivity and specificity in pneumothorax (PTX), tracheoesophageal fistula, lobar emphysema, and diaphragmatic hernia (100%). Followed by pneumonia, radiography had 81.2% sensitivity and 86.5% specificity; for hyaline membrane disease (HMD), sensitivity and specificity were 80 and 89% respectively; for meconium aspiration syndrome (MAS), sensitivity was 60.5 and specificity was 81.7%; and for TTNB, sensitivity was 36.4% and specificity was 96%. Overall diagnostic accuracy was 59.7%, i.e., the final clinical diagnosis confirmed by CXR.Conclusion: A chest radiograph has high sensitivity for congenital diaphragmatic hernia (CDH), PTX, congenital lobar emphysema, tracheoesophageal fistula, pneumonia, and HMD and low sensitivity for TTNB. To sum up, a plain chest radiograph is an indispensable tool in neonates with respiratory distress, but as with any diagnostic modality, it has its own limitations.