Neonates with Respiratory Distress (Viz., in case of RDS, TTN, MAS & So on):

1. CXR needs to be done at the time of NICU admission?

2. (Or) After 4-6hours of birth?

Which would be the ideal way of management?

I think it depends on the condition of baby. If baby is having respiratory distress or grunting. The it is worthy doing chest X ray. But , if baby is fine , no heart problem and with normal respiratory rate maintaining saturation well , then chest x ray can be delayed or even not indicated in NICU.

I AGREE THAT IT DEPENDS ON THE BABY'S CONDITION, ALSO THE SILVERMAN SCORE

AFAF KORRAA

Your answer is in your question itself. Baby with respiratory distress ( it means RR >60/min) needs immediate CXR to rule out that underlying cause which you mentioned as well as I add Pneumothorax. If the baby in respiratory distress has underlying pneumothorax intervention needs to be done urgently. delaying CXR 4-6hours later may aggravate things. By the way why you want to delay CXR after 4-6 hrs,

Thanks....

I just had an argument with my UK trained colleague, who says, in the center where he got training (UK) they ask for CXR after 4-6hours in case of RDS!!! Though I tried convincing, I could not...as I believe in immediate CXR in any case of respiratory distress....!

I'd like to add my approach to chest x-ray (not set in stone):

- immediate x-ray in infants who are compromised, severely ill, regardless of gestational age

- early x-ray in very/extremely preterm infants who have some resp distress but are otherwise stable (typically with 1-2 hours, or after intubation, i.e. one x-ray checks for tube position an lung pathology at the same time)

- x-ray after 4-6 hours in well (term) infants but only if their breathing problems persists more than 4-6 hours

add to that repeat x ary whenever baby becomes sick even if the first one is normal.

add to that repeat x ary whenever baby becomes sick even if the first one is normal.

Good point!

There is another practice in some unit about doing lateral chest/Abdo view inorder to count Vertebrae for confirmation of correct placement

of UVC/UAC? Is AP Chest Xray not enough for post UVC/UAC xray . Is it essential to do lateral chest/Abdo Xray inaddition to AP??

For UAC and UVC no need for lateral CXR, AP is enough. Whosoever is doing the lateral x ray is doing wrong and adding more x ray exposure un necesary. It means they will also be doing lateral CXR to confirm Endotracheal tube position as well. On PICC line insertion in lower limb u need lateral x ray as well to see if the tip in not in spinal vein

Rarely do we ever do Lateral X-ray for UVC and UAC confirmation...Most of the time the AP X-ray will suffice

Lateral X-rays are really useful in problematic pneumothox cases where despite ICT in situ we have persistent air collection. In such cases lateral X-ray in addition to AP views can help localize the track and tip of the ICT.

X-ray AP view is fair enough to look out for the position of UAC & UVC, which can be made out by tracing out their respective course.

Lateral view may be necessary only in cases of undue course of UVC/UAC, and of course academic purpose - teaching the fellows/trainees!