Journal of pediatric surgery · 2026
Utility of neonatal chest X-ray in patients with prenatally diagnosed congenital lung malformations.
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Schwab Marisa E, Stottlemyre Rachael, Khan Faraz A
Аннотация
PURPOSE: In patients with congenital lung malformations (CLM), prenatal imaging is used to risk stratify patients and delineate algorithms for delivery planning and neonatal care. Most algorithms include a chest x-ray immediately after birth in all patients. This study sought to evaluate whether chest x-ray impacts clinical decision-making, ability to predict symptoms, and the decision to manage patients in the Neonatal Intensive Care Unit (NICU).
METHODS: A single center, retrospective cohort study was performed of patients diagnosed prenatally with a CLM (2015-2025). Maternal demographics, pre- and postnatal imaging, surgical details and outcomes were collected. Patients with symptoms at birth were compared to the asymptomatic cohort.
RESULTS: 124 patients were included, with a median peak Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of 0.79 (IQR 0.38-1.17). Only 15.3% received supplemental oxygen after birth (4% required mechanical ventilation). 72.3% were admitted to the NICU. 47.2% (50/106) had an abnormal x-ray, including 62% with a potential CLM and 38% with a clearly visible CLM. Of those with a clear CLM on x-ray, 84.2% (16/19) didn't have symptoms. The abnormal x-ray did not trigger further imaging or management changes. 13/19 patients with a clear CLM on x-ray were monitored in the NICU. X-ray sensitivity to detect symptomatic patients was 56.3% and specificity was 54.4%. Comparing the symptomatic and asymptomatic cohorts revealed no significant differences in the probability of an abnormal x-ray.
CONCLUSIONS: Chest x-rays have poor sensitivity and specificity in the initial evaluation of asymptomatic CLM patients and did not change clinical decision-making including whether the patient required NICU-level care.
METHODS: A single center, retrospective cohort study was performed of patients diagnosed prenatally with a CLM (2015-2025). Maternal demographics, pre- and postnatal imaging, surgical details and outcomes were collected. Patients with symptoms at birth were compared to the asymptomatic cohort.
RESULTS: 124 patients were included, with a median peak Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of 0.79 (IQR 0.38-1.17). Only 15.3% received supplemental oxygen after birth (4% required mechanical ventilation). 72.3% were admitted to the NICU. 47.2% (50/106) had an abnormal x-ray, including 62% with a potential CLM and 38% with a clearly visible CLM. Of those with a clear CLM on x-ray, 84.2% (16/19) didn't have symptoms. The abnormal x-ray did not trigger further imaging or management changes. 13/19 patients with a clear CLM on x-ray were monitored in the NICU. X-ray sensitivity to detect symptomatic patients was 56.3% and specificity was 54.4%. Comparing the symptomatic and asymptomatic cohorts revealed no significant differences in the probability of an abnormal x-ray.
CONCLUSIONS: Chest x-rays have poor sensitivity and specificity in the initial evaluation of asymptomatic CLM patients and did not change clinical decision-making including whether the patient required NICU-level care.