Value of routine postextubation chest X-ray on prognosis for neonates

Minerva Pediatr. 2014 Apr;66(2):105-10.

Abstract

Aim: The postextubation chest X-ray (CXR) is frequently taken in neonates who have undergone mechanical ventilation (MV); however, this is not an evidence-based practice. The aim of this paper was to assess the utility of routine post-extubation CXR on the prognosis for neonates who have undergone MV.

Methods: This is a retrospective cohort study comparing two periods of time. During the first period, the routine postextubation CXR was performed in neonates; during the second period, postextubation CXR was performed only in infants with any sign of clinical deterioration. Patients were continuously followed up to identify complications such as need for reintubation, length of hospital stay, and death.

Results: Twenty-nine vs. 33 patients were compared in the first and second periods, respectively. Throughout follow-up one patient died (in the routine CXR period) and there were 17 reintubations: 8 in the routine CXR group and 9 in the selective CXR group (P=1). However, in a multivariate Cox model (adjusted for birth weight, nasal continuous positive airway pressure [CPAP], bronchopulmonary dysplasia and duration of MV), the routine CXR was associated with an acceleration of discharge after extubation (Hazard Ratio: 1.86, 95% CI: 1.02-3.38). On the other hand, birthweight, nasal-CPAP and duration of MV were strong predictors of hospital stay after extubation.

Conclusion: Although it may help accelerate hospital discharge, the utility of routine CXR on prognosis is uncertain. Consequently, it is required to conduct studies of greater magnitude in order to assess the relevance of this procedure.

Publication types

  • Comparative Study

MeSH terms

  • Airway Extubation*
  • Cohort Studies
  • Continuous Positive Airway Pressure
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Intubation, Intratracheal
  • Length of Stay
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Atelectasis / diagnostic imaging*
  • Pulmonary Atelectasis / therapy
  • Radiography, Thoracic*
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Newborn / diagnostic imaging*
  • Respiratory Distress Syndrome, Newborn / therapy
  • Retrospective Studies
  • Risk Factors