Postnatal chest X-ray in children with asymptomatic congenital lung malformations

Abstract

Objective: The clinical implications of a postnatal chest X-ray (CXR) in asymptomatic children with a prenatally diagnosed congenital lung malformation (CLM) are uncertain. We assessed the justification for the postnatal use of CXR in these children.

Methods: We included patients with CLM confirmed through chest computed tomography angiography or histopathological analysis who were asymptomatic at birth, underwent routine postnatal CXR, and participated in our standard of care prospective structured longitudinal follow-up program. Children with major associated morbidities were excluded. Primary outcomes were the positive and negative predictive values (PPV and NPV) of CXR findings for symptom development at 4 weeks and 6 months of age. Secondarily, we sought to establish whether CXR findings were associated with undergoing additional diagnostics during the initial observational hospital stay or prolonged postnatal hospital admission.

Results: Among 121 included patients, CXR showed no abnormalities in 35 (29%), nonspecific abnormalities in 23 (19%), and probable CLM in 63 (52%). The PPV of CXR in relation to symptom development at 4 weeks and 6 months was 0.05 and 0.25, respectively. Corresponding NPVs were 0.96 and 0.91. An association was identified between CXR findings and undergoing further diagnostics during the initial observational hospital stay (p = .047). Additional diagnostic findings did not influence clinical management. CXR findings were not associated with prolonged initial hospital stay (p = .40).

Conclusion: The routine practice of postnatal CXR in asymptomatic patients with prenatally diagnosed CLM can be omitted, as CXR findings do not influence subsequent clinical management.

Keywords: congenital abnormalities; diagnostic imaging; lung disease; radiography; respiratory system abnormalities.

Figure 1

Flowchart of patient inclusion. CLM, congenital lung malformation, CTA, computed tomography angiography. ᵃMajor associated morbidities: cardiac (N = 3), chromosomal (N = 3), nonchromosomal syndromes (N = 2), anorectal malformation (N = 1), esophageal atresia (N = 1), congenital diaphragmatic hernia (N = 1), hepatic arteriovenous malformation (N = 1), filamin A deficiency (N = 1).