Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.
Pediatr Pulmonol. 2024 Dec;59(12):3333-3339. doi: 10.1002/ppul.27201. Epub 2024 Aug 7.
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.
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.
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).
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.
对于出生时无症状且产前诊断为先天性肺畸形（CLM）的儿童，其产后胸部 X 光（CXR）的临床意义尚不确定。我们评估了这些儿童产后使用 CXR 的合理性。
我们纳入了通过胸部计算机断层血管造影或组织病理学分析确诊为 CLM 的患者，这些患者在出生时无症状，接受了常规的产后 CXR，并参加了我们标准的前瞻性结构化纵向随访计划。排除有主要合并症的患儿。主要结局是 CXR 结果在 4 周和 6 个月时出现症状的阳性预测值（PPV）和阴性预测值（NPV）。其次，我们试图确定 CXR 结果是否与在初始观察性住院期间或延长的产后住院期间进行额外诊断相关。
在 121 例纳入的患者中，35 例（29%）的 CXR 未见异常，23 例（19%）显示非特异性异常，63 例（52%）提示可能为 CLM。CXR 与 4 周和 6 个月时出现症状的 PPV 分别为 0.05 和 0.25，相应的 NPV 分别为 0.96 和 0.91。CXR 结果与在初始观察性住院期间进行进一步诊断之间存在关联（p=0.047）。进一步的诊断发现并未影响临床管理。CXR 结果与初始住院时间延长无关（p=0.40）。
对于产前诊断为 CLM 的无症状患儿，可省略常规的产后 CXR，因为 CXR 结果不会影响后续的临床管理。
