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The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit
Thesis (MMed)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867613865560244224 |
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| access_status_str | Open Access |
| author | Johaar, Rizqah |
| author2 | Holgate, Sandi |
| author_browse | Holgate, Sandi Johaar, Rizqah |
| author_facet | Holgate, Sandi Johaar, Rizqah |
| author_sort | Johaar, Rizqah |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/127166 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:42:55.322Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/127166 The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit Johaar, Rizqah Holgate, Sandi Hassan, Haseena Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. Respiratory distress syndrome Respiratory therapy for newborn infants Pulmonary surfactant Chest -- Radiography UCTD Thesis (MMed)--Stellenbosch University, 2023. ENGLISH SUMMARY: Introduction: Respiratory distress (RD) is the most common reason for admission into a neonatal unit and current guidelines recommend non-invasive ventilation (NIV) such as high flow nasal cannula (HFNC) or nasal continuous positive airway pressure (nCPAP) as the preferred method of support. Respiratory distress syndrome (RDS), a common cause of RD, is predominantly seen in premature neonates with the risk increasing with decreasing gestational age. If commenced early, nCPAP can reduce the need for surfactant replacement in 50% of cases of RDS, however, if surfactant is needed, administration within 2 hours is recommended. The use of nCPAP has changed the classic radiographic features of RDS thus the usefulness of the CXR in very low birth weight (VLBW, ≤ 1500 g) neonates was explored. Methods: The management of inborn VLBW neonates with RD at Tygerberg Hospital, Cape Town, South Africa (1 January 2019 - 31 December 2019) was analysed retrospectively. Timing of the CXR, clinician reported CXR findings and the need for, and timing of surfactant administration was described. Main results: Of the 617 included VLBW neonates, 75 % (463/617) had a CXR done and 30 % (189/617) required surfactant. Significantly more neonates requiring a fraction of inspired oxygen (Fi02) > 0.30, or with grade III/IV RDS, received surfactant compared to those needing a Fi02 < 0.3 (74 vs 14 %) or with grade I/II RDS (78 vs 19 %). Neonates waited a median of 3 hours and 19 minutes (interquartile range [IQR] = 2 hours 31 minutes – 4 hours 46 minutes) for their initial CXR to be done. The median time to surfactant replacement therapy (SRT) was 4 hours 43 minutes (IQR = 2 hours 30 minutes – 11 hours 30 minutes), with 43 % receiving their first dose of surfactant after 6 hours of age. Those that did not have a CXR were more likely to get their surfactant in under 2 hours after birth (P = < 0.001). No additional pathology, e.g. pneumothorax, was detected on the initial CXR. Conclusion: Surfactant administration was delayed beyond 2 hours in neonates where CXR was performed. Clinical criteria, such as FiO2 requirement, seemed as useful as CXR in predicting who would need surfactant. No additional pathology was detected by CXR, suggesting it would be safe to omit x-rays in these neonates on admission and beneficial in optimizing timing of SRT and reducing radiation exposure. AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar. Masters 2023-03-04T14:08:33Z 2023-05-18T07:07:43Z 2023-03-04T14:08:33Z 2023-05-18T07:07:43Z 2023-01 Thesis http://hdl.handle.net/10019.1/127166 en_ZA Stellenbosch University 51 pages ; includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Respiratory distress syndrome Respiratory therapy for newborn infants Pulmonary surfactant Chest -- Radiography UCTD Johaar, Rizqah The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title | The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title_full | The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title_fullStr | The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title_full_unstemmed | The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title_short | The contribution of the initial chest X-ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| title_sort | contribution of the initial chest x ray to the management of very low birth weight neonates admitted with respiratory distress in a resource limited tertiary hospital neonatal unit |
| topic | Respiratory distress syndrome Respiratory therapy for newborn infants Pulmonary surfactant Chest -- Radiography UCTD |
| url | http://hdl.handle.net/10019.1/127166 |
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