Purpose or Case Report:
To evaluate the chest radiographic findings of respiratory distress syndrome in full-term and late preterm neonates.
Methods & Materials: A total of 1,308 consecutively obtained chest radiographs from 45 neonates (M:F = 32:13) with gestational ages between 36 and 40 weeks were retrospectively analyzed. Birth weights ranged from 1,610 g to 3,410 g (mean, 2,986 g). Apgar scores were 6–8 at 1 minute and 7–9 at 5 minutes. Surfactant therapy was administered according to clinical signs of RDS and arterial blood gas results. Neonates with congenital heart disease or underlying pulmonary disorders were excluded. Initial and follow-up chest radiographs (posteroanterior and lateral views) were reviewed to evaluate complications and pulmonary sequelae until complete recovery of respiratory symptoms.
Results: Initial chest radiographs demonstrated non-specific findings (n = 1, 2%), mild diffuse ground-glass opacities (GGO) with air bronchogram (n = 7, 16%), patchy opacities (n = 15, 33%), and linear atelectasis (n = 22, 49%). In 23 neonates (51%), follow-up radiographs obtained 1–25 hours after the initial study revealed GGO and progression of atelectasis, accompanied by delayed clinical manifestation of RDS, which consequently led to postponed surfactant administration. On subsequent follow-up imaging, additional findings included parahilar haziness (n = 3), costophrenic angle blunting (n = 13), pneumothorax (n = 20), and recurrent or resolving atelectasis until complete recovery (n = 40). Pulmonary sequelae such as bronchopulmonary dysplasia were identified in three cases.
The time to full recovery of respiratory symptoms and normalization of chest radiographs ranged from 2 to 61 days (mean ± SD, 11.5 ± 10.2 days).
Conclusions: Radiographic findings of RDS in term and late preterm neonates may differ from the typical pattern observed in preterm neonates. Persistent respiratory symptoms and abnormal initial radiographic findings warrant close observation and serial follow-up chest radiographs.