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Neonatal chest-Xray (CXR)s are commonly performed as a first line investigation for the evaluation of respiratory complications. Although lung area derived from CXRs correlates well with functional assessments of the neonatal lung, it is not currently utilised in clinical practice, partly due to the lack of reference ranges for CXR-derived lung area in healthy neonates. Advanced MR techniques now enable direct evaluation of both fetal pulmonary volume and area. This study therefore aims to generate reference ranges for pulmonary volume and area in uncomplicated pregnancies, evaluate the correlation between prenatal pulmonary volume and area, as well as to assess the agreement between antenatal MRI-derived and neonatal CXR-derived pulmonary area in a cohort of fetuses that delivered shortly after the antenatal MRI investigation. Fetal MRI datasets were retrospectively analysed from uncomplicated term pregnancies and a preterm cohort that delivered within 72 h of the fetal MRI. All examinations included T2 weighted single-shot turbo spin echo images in multiple planes. In-house pipelines were applied to correct for fetal motion using deformable slice-to-volume reconstruction. An MRI-derived lung area was manually segmented from the average intensity projection (AIP) images generated. Postnatal lung area in the preterm cohort was measured from neonatal CXRs within 24 h of delivery. Pearson correlation coefficient was used to correlate MRI-derived lung volume and area. A two-way absolute agreement was performed between the MRI-derived AIP lung area and CXR-derived lung area. Datasets from 180 controls and 10 preterm fetuses were suitable for analysis. Mean gestational age at MRI was 28.6 ± 4.2 weeks for controls and 28.7 ± 2.7 weeks for preterm neonates. MRI-derived lung area correlated strongly with lung volumes (p < 0.001). MRI-derived lung area had good agreement with the neonatal CXR-derived lung area in the preterm cohort [both lungs = 0.982]. MRI-derived pulmonary area correlates well with absolute pulmonary volume and there is good correlation between MRI-derived pulmonary area and postnatal CXR-derived lung area when delivery occurs within a few days of the MRI examination. This may indicate that fetal MRI derived lung area may prove to be useful reference ranges for pulmonary areas derived from CXRs obtained in the perinatal period. • Refrence ranges were derived from segmentation of fetal lung areas on AIP-MRI images and correlates with CXR-derived data in preterm infants • Fetal MRI-derived lung area correlated well with fetal MR pulmonary volume and postnatal CXR-lung area. This may prove to be a useful reference range for pulmonary areas derived from CXRs obtained in the perinatal period. • The findings suggest that fetal MRI measurements can serve as useful reference points for assessing lung area in high-risk neonatal CXRs. [ABSTRACT FROM AUTHOR]

Disparities in neonatal respiratory outcomes in prematurely-born infants might be partially explained by racial differences and the relationship of hypoxia and oxidative stress. To determine if Black, preterm infants were exposed more frequently to hypoxaemia compared to White infants and had a higher level of oxidative damage. Single-centre retrospective cohort study at King's College Hospital, London, UK between 2018 and 2021. Infants born before 32 completed weeks of gestational age. The median arterial oxygen saturation (SaO 2) over the first seven days was measured. The maximum carboxyhaemoglobin (COHb) level for the first three days was also recorded as an index of oxidative stress. Two thousand and sixty blood gases from 87 infants (38 Black) with a median (IQR) gestational age of 26.4 (24.6–28.3) weeks were analysed. The median (IQR) SaO 2 was not significantly different in Black [96.1 (95.2–96.8) %] compared to White infants [96.7 (95.6–97.7) %, p = 0.24]. The median (IQR) COHb was not significantly different in Black infants [1.9 (1.7–2.4) %] compared to White infants [1.9 (1.7–2.3) %, p = 0.77]. The highest COHb was significantly related to the median SaO 2 in all infants (r = −0.51, p < 0.001) and separately in Black (r = −0.50, p = 0.002) and White (r = −0.56, p < 0.001) infants. Preterm, Black infants were not exposed more frequently to hypoxaemia compared to White infants. Lower saturation levels were associated with higher maximum carboxyhaemoglobin levels indicating a higher risk of oxidative stress, irrespective of racial background. • We assessed hypoxia and oxidative stress in Black and White preterm infants. • Oxygen saturation and carboxyhaemoglobin (COHb) levels were measured. • Black and White infants had similar arterial oxygen saturation and COHb levels. • Lower oxygen saturation was associated with a higher risk of oxidative stress. [ABSTRACT FROM AUTHOR]