The Value of a Modified Chest-X ray Scoring System Combined with Clinical Variables in Early Prediction ofBronchopulmonary Dysplasia in Very Preterm Infants

Objective Bronchopulmonary dysplasia (BPD) is often accompanied by specific Chest-X ray patterns even in the early or evolving stages before the diagnosis is established. We aim to assess Chest-X ray's predictive value for BPD in preterm infants less than 32 weeks gestation. Method This is a retrospective, single-center study, including preterm infants born at less than 32 weeks gestation in our NICU from 2019 to 2024. We collected their clinical information during the maternal, birth and early postnatal periods. A chest X-ray scoring system was introduced based on the appearance of reduction in transparency, interstitial lesions, solid lesions and cystic vesicle. Risk factors were selected through univariable analyses. Prediction model was established through logistic regression and assessed by the AUC. The cut-off value of chest X-ray score was determined. Result A total of 747 infants was enrolled. The mean gestational age was 29.4 ± 1.6 weeks and mean birth weight was 1392 ± 313 g. The incidence of BPD was 22.4%. Univariable analysis and logistic regression showed gestational age, birth weight, mechanical ventilation mode, and chest X-ray score on day 7 postnatal age were associated with BPD, with adjusted odds ratios of 1.4 (95%CI: 1.2–1.7), 1.3 (95%CI: 1.1–1.4), 2.8 (95%CI: 2.0-3.8) and 1.8 (95%CI: 1.4–2.3), respectively. The AUC of the combination of the factors was 0.872 (95%CI: 0.843–0.902). The cut-off value of chest X-ray score was 3 with a sensitivity of 80% and specificity of 81%. Conclusion Predictive factors for the development of BPD were lower gestational age, lower birth weight, higher respiratory support mode, and higher chest X-ray score on day 7 postnatal age. A chest X-ray score ≥ 3 was a good predictor of BPD.