The coexistence of pneumonia and the idiopathic respiratory distress syndrome in neonates

The chest radiographs of 54 neonates dying within 48 hours of birth have been analysed. All cases had evidence of the classical idiopathic respiratory distress syndrome. Nineteen cases were complicated by pneumonia, five of these probably being of intra-uterine origin. Five other cases were complicated by other lung pathology. A good correlation was obtained between the radiological analysis and the histological findings. Almost all (23/24) cases with an uncomplicated reticulo-granular pattern showed no pneumonia at post-mortem. Minor variations in this pattern indicated the presence of complicating consolidation in about half the cases, while complete opacity of the lungs commonly (6/8) was due to complicating pneumonia. All cases (9/9) with atypical appearances were found to have pneumonia. It is concluded that more precise information in the diagnosis of pneumonia complicating RDS can be obtained from the chest radiograph than has previously been appreciated. It is suggested that chest radiographs should be obtained at regular intervals in the management of babies with RDS.