Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria

Joseph Matthew Rich; Lydia Jing Lin; Jonathan Luan Le; Justin Ryan Ching Abe; Amit Sura

doi:10.1186/s40748-024-00178-4

Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria

Matern Health Neonatol Perinatol. 2024 Apr 5;10(1):8. doi: 10.1186/s40748-024-00178-4.

Authors

Joseph Matthew Rich¹, Lydia Jing Lin², Jonathan Luan Le³, Justin Ryan Ching Abe⁴, Amit Sura⁵

Affiliations

¹ USC-Caltech MD/PhD Program, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, 90033, Los Angeles, CA, USA. jmrich@usc.edu.
² USC-Caltech MD/PhD Program, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, 90033, Los Angeles, CA, USA.
³ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
⁵ Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Abstract

Background: Chronic lung disease of prematurity (CLD) is the most prevalent complication of preterm birth and indicates an increased likelihood of long-term pulmonary complications. The accurate diagnosis of this condition is critical for long-term health management. Numerous definitions define CLD with different clinical parameters and radiology findings, making diagnosis of the disease ambiguous and potentially inaccurate.

Methods: 95 patients were identified for this study, as determined by the diagnosis or confirmation of CLD in the impression of the radiologist's report on chest x-ray. Pulmonary function and complications were recorded at multiple benchmark timeframes within each patient's first few months of life and used for determining eligibility under each definition.

Results: Each clinical definition of CLD had a high sensitivity for patients identified to have CLD by radiologists, correctly fitting over 90% of patients. Most patients included required invasive mechanical ventilation or positive pressure ventilation at 36 weeks postmenstrual age, indicating patients with radiographically confirmed CLD tended to have more severe disease. Radiologists tended to diagnose CLD before 36 weeks postmenstrual age, a timepoint used by multiple standard clinical definitions, with cases called earlier fitting under a larger percentage of definitions than those called later.

Conclusions: Radiologists tend to diagnose CLD in young patients with severe respiratory compromise, and can accurately diagnose the condition before developmental milestones for clinical definitions are met.

Keywords: Bronchopulmonary dysplasia; Chest x-ray; Chronic lung disease of prematurity; Definitions; Infant; Premature.