# 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.

## Key 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.