The clinical value of screening chest radiography in the neonate with lung disease.

To examine the role of routine chest radiography in the management of the critically ill neonate with pulmonary disease, 41 term and preterm infants with lung diseases were prospectively evaluated. Seventy radiographs (35%) were obtained for clinical indications and 128 (65%) for prospective screening. Studies were compared with each infant's most recent previous study, if available. Every exam was designated Level I, if the radiograph identified a new finding that required clinical intervention; Level II, if an abnormality or interval change was observed that did not require immediate intervention; or Level III, if there was no interval change since the previous radiograph. Thirty-three (47%) indication radiographs and 63 (49%) screening radiographs showed significant changes since the previous study. Twenty-four (34%) of the indication radiographs and 42 (33%) of the screening radiographs had Level I abnormalities (P = NS). Nine (13%) of the indication radiographs and 21 (16%) of the screening radiographs had Level II abnormalities (P = NS). Results suggest that routine screening chest radiographic studies are an important adjunct of care in critically ill newborns with respiratory disease and may identify potential problems before they are reflected in a change in clinical status.