The neonatal respiratory exam: Have we lost our edge?

Abstract

In this volume of The Journal, Jensen et al make the simple but important observation that the high degree of inter-observer variability of a structured respiratory physical examination in the preterm infant precludes its use as an outcome measure for multicenter studies. How can this be? The respiratory exam of the neonate is one of the first things we learn as a medical student, pediatric resident, and neonatology fellow, and something we perform on each of our patients every day. The physician cohort in the study by Jensen et al included attending or senior fellow neonatologists and pulmonologists in large academic neonatal intensive care units. It seems unlikely that this was a group of physicians who had lost their edge, and probably indicates that there is even greater variability in the real world setting. Conceivably, the real problem is thatthe physical exam, at least in the neonatal population, is too blunt a tool to discern the subtle changes underlying the developing lungs of the premature baby. These findings almost certainly translate to daily practice in the neonatal intensive care unit, and should lead us to assume that our own examination is likely to tell us something different than the examination that a trainee or referring colleague describes over the telephone. Article page 87 ▶ Interobserver Reliability of the Respiratory Physical Examination in Premature Infants: A Multicenter StudyThe Journal of PediatricsVol. 178PreviewTo measure the inter-rater reliability of 7 visual and 3 auscultatory respiratory physical examination findings at 36-40 weeks' postmenstrual age in infants born less than 29 weeks' gestation. Physicians also estimated the probability that each infant would remain hospitalized for 3 months after the examination or be readmitted for a respiratory illness during that time. Full-Text PDF