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

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.