Chest Radiography Scores for Predicting the Severity of Respiratory Status in Newborns Weighing More Than 1,500 g.

Background Acute respiratory failure (ARF) may occur in neonates. Chest radiography is commonly used to evaluate the severity of ARF; however, the application of quantitative scales in clinical practice in neonatal intensive care units is uncommon. This study aimed to assess the usefulness of two semi-quantitative radiographical scales, the Brixia and radiographic assessment of lung edema (RALE) scores, in newborns weighing more than 1,500 g. Methods Newborns weighing > 1,500 g who received invasive respiratory support with arterial lines between January 2010 and October 2023 were enrolled in this study (n = 98; gestational age, 35.6 ± 3.1 weeks; birthweight, 2,321 ± 600 g). We investigated the correlation between the Brixia or RALE scores and the oxygen index (OI), alveolar-arterial oxygen gradient (A-aDO2), and ventilation index (VI). Furthermore, the cut-off points of the two radiographic scores for the prediction of these respiratory indices were determined. Results All respiratory indices correlated with the Brixia (OI: r = 0.71, p < 0.001; A-aDO2: r = 0.74, p < 0.001; VI: r = 0.56, p < 0.001) and RALE scores (OI: r = 0.78, p < 0.001; A-aDO2: r = 0.82, p < 0.001; VI: r = 0.60, p < 0.001). Additionally, the receiver operating characteristic curve showed that the radiographical scores had a statistically significant ability to predict respiratory index values. Conclusion Brixia and RALE scores are useful predictive markers of acute respiratory failure in infants weighing >1,500 g. These chest radiography scores may be good predictors of respiratory status and have wider clinical applications in neonatal care.