The first chest radiograph in neonates exhibiting respiratory distress at birth.

The aim of the present study was to assess the diagnostic accuracy and clinical utility of the first anteroposterior chest radiograph taken within the first hours of life from 99 neonates admitted consecutively from the delivery room to the neonatal intensive care unit because of mild to moderate respiratory distress. Before the radiograph was taken, all necessary emergency life support measures were undertaken. These included intubation, if indicated, and placement of intravenous and intra-arterial cannulae and nasogastric tubes. Intratracheal surfactant was never, however, administered before the radiograph. We examined the agreement between the clinicians' and the pediatric radiologist's opinion regarding the pulmonary and cardiac findings in these radiographs. Seventy-four radiographs exhibited definite pulmonary or cardiac pathology. In 66 patients the initial assessment was in agreement with the radiologic reevaluation. Clinicians' and radiologist's diagnoses of respiratory distress syndrome (RDS) agreed in 95%, of pneumothoraces in 78%, but, ultimately, of transient tachypnea of the neonate (TTN) in only 48%. The benefits of having the chest radiographs reviewed by a consultant radiologist experienced in neonatology are evident. The first chest radiograph taken early during the course of the disease had the greatest impact in the care of neonates with mild respiratory distress. In such cases, potentially dangerous conditions (e.g., pneumothoraces) could be detected before severe clinical deterioration occurred.