Background: Respiratory distress in the neonatal period can be classified according to cause in abnormalities primarily affecting circulation or development of the thorax and aeration. In neonates the system which is majorly affected is the respiratory and the cardiovascular system, though for differential diagnosis abnormalities of chest wall, tracheobrochial tress, diaphragm and neuromuscular diseases also must be considered. The most effective and commonly used imaging modality in investigation of neonatal respiratory distress syndrome is Chest Radiography. The aim of this study was to assess and evaluate the role of chest X-ray in neonatal respiratory distress.1 Materials and methods: A prospective observational study was conducted in rural tertiary care center. A chest radiograph of 150 neonates were taken in anteroposterior view who came with chief complaint of respiratory distress. In all these patients, the chest radiography findings were noted and correlated with clinical findings. Results: Transient tachypnea of newborn is the most commonest cause of respiratory distress in neonates. Transient tachypnea of the newborn (TTNB) was the most common cause of respiratory distress (35.7%). Chest radiography had the highest sensitivity and specificity in pneu-mothorax (PTX), tracheoesophageal fistula, lobar emphysema, and diaphragmatic hernia (100%). Followed by pneumonia, radiography had 81.2% sensitivity and 86.5% specificity; for hyaline membrane disease (HMD), sensitivity and specificity were 80 and 89% respectively; for meconium aspiration syndrome (MAS), sensitivity was 60.5 and specificity was 81.7%; and for TTNB, sensitivity was 36.4% and specificity was 96%. Overall diagnostic accuracy was 59.7%, i.e., the final clinical diagnosis confirmed by CXR. Conclusion: A chest radiograph has high sensitivity for congenital diaphragmatic hernia (CDH), PTX, congenital lobar emphysema, tracheoesophageal fistula, pneumonia, and HMD and low sensitivity for TTNB. To sum up, a plain chest radiograph is an indispensable tool in neonates with respiratory distress, but as with any diagnostic modality, it has its own limitations.2

Keywords: Chest X-ray; Respiratory distress of newborn.