Atelectasis and lung changes in preterm neonates in the neonatal period: a blind radiological report and clinical findings

ABSTRACT Objective: To determine the occurrence and characteristics of atelectasis, opacities, hypolucency and pulmonary infiltrates observed on chest X-rays of preterm infants in a neonatal intensive care unit. Methods: This was a cross-sectional observational study. From August to December 2017, all chest radiographs of newborn infants were analyzed. The study included the chest radiographs of preterm neonates with gestational ages up to 36 weeks in the neonatal period that showed clear changes or suspected changes, which were confirmed after a radiologist’s report. Radiological changes were associated with possible predisposing factors. Results: During the study period, 450 radiographs were performed on preterm neonates, and 37 lung changes were identified and classified into 4 types: 12 (2.66%) changes were described as opacities, 11 (2.44%) were described as atelectasis, 10 (2.22%) were described as pulmonary infiltrate, and 4 (0.88%) were described as hypolucency. A higher occurrence of atelectasis was noted in the right lung (81.8%). Among the abnormal radiographs, 25 (67.6%) newborn infants were receiving invasive mechanical ventilation. Conclusion: Considering the radiological report, no significance was found for the observed changes. Atelectasis was not the most frequently observed change. The predisposing factors for these changes were extreme prematurity, low weight, male sex, a poorly positioned endotracheal tube and the use of invasive mechanical ventilation.

摘要
目的：明确新生儿重症监护病房（neonatal intensive care unit, NICU）早产婴儿胸部X线片中所观察到的肺不张（atelectasis）、肺部混浊（opacities）、肺透光度减低（hypolucency）及肺浸润（pulmonary infiltrates）的发生情况与特征。
方法：本研究为横断面观察性研究。2017年8月至12月期间，对所有新生儿胸部X线片进行分析。本研究纳入胎龄≤36周的新生儿期早产患儿的胸部X线片，此类影像需显示明确或疑似异常改变，且经放射科医师报告确认。同时将影像学异常改变与潜在易感因素进行关联分析。
结果：研究期间共完成早产患儿胸部X线检查450例次，其中37例存在肺部异常改变，分为4类：肺部混浊12例（占比2.66%），肺不张11例（占比2.44%），肺浸润10例（占比2.22%），肺透光度减低4例（占比0.88%）。右侧肺不张的发生率更高，占所有肺不张病例的81.8%。在异常胸部X线片对应的患儿中，25例（67.6%）接受了有创机械通气（invasive mechanical ventilation）。
结论：结合影像学报告分析，未发现上述异常改变存在统计学显著性差异。肺不张并非本次研究中最常见的影像学异常改变。此类肺部异常改变的易感因素包括极早早产、低出生体重、男性性别、气管导管（endotracheal tube）位置不当以及有创机械通气的应用。