Chest Radiography Scores for Predicting the Severity of Respiratory Status in Newborns Weighing More Than 1,500 g

TL;DR

This study shows that two chest X-ray scoring systems can predict the severity of breathing problems in newborns over 1,500 grams.

Contribution

The study evaluates the clinical utility of Brixia and RALE scores for predicting respiratory severity in neonates.

Findings

Brixia and RALE scores strongly correlated with key respiratory indices like OI, A-aDO2, and VI.

The scores showed significant predictive ability for respiratory status in newborns over 1,500 grams.

Both scores demonstrated high statistical significance in predicting acute respiratory failure.

Abstract

Background

Acute respiratory failure (ARF) may occur in neonates. Chest radiography is commonly used to evaluate the severity of ARF; however, the application of quantitative scales in clinical practice in neonatal intensive care units is uncommon. This study aimed to assess the usefulness of two semi-quantitative radiographical scales, the Brixia and radiographic assessment of lung edema (RALE) scores, in newborns weighing more than 1,500 g.

Methods

Newborns weighing > 1,500 g who received invasive respiratory support with arterial lines between January 2010 and October 2023 were enrolled in this study (n = 98; gestational age, 35.6 ± 3.1 weeks; birthweight, 2,321 ± 600 g). We investigated the correlation between the Brixia or RALE scores and the oxygen index (OI), alveolar-arterial oxygen gradient (A-aDO2), and ventilation index (VI). Furthermore, the cut-off points of the two radiographic scores for the prediction of these respiratory indices were determined.

Results

All respiratory indices correlated with the Brixia (OI: r = 0.71, p < 0.001; A-aDO2: r = 0.74, p < 0.001; VI: r = 0.56, p < 0.001) and RALE scores (OI: r = 0.78, p < 0.001; A-aDO2: r = 0.82, p < 0.001; VI: r = 0.60, p < 0.001). Additionally, the receiver operating characteristic curve showed that the radiographical scores had a statistically significant ability to predict respiratory index values.

Conclusion

Brixia and RALE scores are useful predictive markers of acute respiratory failure in infants weighing >1,500 g. These chest radiography scores may be good predictors of respiratory status and have wider clinical applications in neonatal care.

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