A radiological perspective of assessing neonatal respiratory distress syndrome

Background: The causes of respiratory distress in the neonatal period can be classified into abnormalities primarily affecting aeration, circulation or development of the thorax. Conditions of the lungs and cardiovascular system account for the majority but abnormalities of the tracheobronchial tree, chest wall, diaphragm, and a variety of neuromuscular diseases must also be considered in the differential diagnosis. Chest radiography is the most valuable imaging modality in the investigation of neonatal respiratory disorders. Within 48 – 72 hours, the most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X-ray. Materials and methods: This was a prospective observational study that was conducted in rural tertiary care center. Anteroposterior chest radiograph in supine position of (59) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, in my study 32.20% diagnosed with transient tachyponea; 20.3% diagnosed with hyaline membrane disease; 16.94% diagnosed with congenital neonatal pneumonia; 11.86% diagnosed with meconium aspiration syndrome; 1.96% diagnosed with aspiration syndrome; 5.08% diagnosed with cardiac causes; 3.38 % diagnosed with trachea-oesophageal fistula; 3.38% diagnosed with congenital diaphragmatic hernia; 1.69% diagnosed with idiopathic persistent pulmonary hypertension; 1.69% diagnosed with eventeration of diapghram; 1.69% diagnosed with pneumoperitoneum, presented to radiology department with respiratory distress. Conclusion: Chest radiography is essential in neonates with acute respiratory distress to exclude structural abnormalities such as congenital diaphragmatic hernia or congenital lobar emphysema. One should remember that any sign of post–natal respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible. Finally chest radiograph should be read by an expert radiologist.