Am J Perinatol
DOI: 10.1055/a-1905-5467
Original Article

Utility of Postnatal Chest X-Ray in Newborns for the Evaluation of Prenatally Suspected Congenital Pulmonary Airway Malformation: A Single-Center Experience

1   Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
Toby D. Yanowitz
1   Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
Paul Waltz
2   Division of Pediatric Surgery, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
Kalyani Vats
1   Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
› Author Affiliations
Funding None.


Objective The aim of the study is to assess the necessity of chest X-ray (CXR) during the newborn hospitalization for all patients with prenatally suspected congenital pulmonary airway malformation (CPAM).

Study Design This is a retrospective chart review of all infants delivered with prenatally suspected CPAM at our high-risk delivery hospital from January 2013 through April 2020 (n = 44). Nonparametric tests assessed the association between postnatal CXR findings, prescribed follow-up timeline, and neonatal outcomes.

Results Mean follow-up period recommended was 6.4 weeks regardless of CXR findings in the neonatal period (p = 0.81). Additionally, patients who required respiratory support at or after birth were not more likely to have a lesion identified on chest X-ray (odds ratio [OR] = 0.72, 95% confidence interval [CI], 0.18–2.64, p = 0.71).

Conclusion Neonatal hospital course and future follow-up plan of patients with prenatally suspected CPAM were not altered by information from the CXR obtained in the immediate neonatal period, suggesting that this CXR may not be necessary in the asymptomatic patient.

Key Points

  • Immediate postnatal X-ray of prenatally diagnosed CPAM does not alter planned follow-up interval.

  • Immediate postnatal X-ray does not alter surgical plan for CPAM.

  • Postnatal X-ray is not absolutely required for asymptomatic newborns with CPAM.

Authors' Contributions

L.E.J. contributed to the conceptualization and realization, data collection and organization, statistical analyses, and writing of the manuscript. T.D.Y. contributed to the statistical analyses and critical review of the manuscript. K.V. contributed to the conceptualization and realization, and writing of the manuscript. P.W. contributed to critical review of the manuscript. All authors reviewed the manuscript for important intellectual contents and approved the final version. All authors agree to be accountable for all aspects of the work.

Publication History

Received: 29 March 2022

Accepted: 05 July 2022

Accepted Manuscript online:
20 July 2022

Article published online:
29 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Kantor N, Wayne C, Nasr A. Symptom development in originally asymptomatic CPAM diagnosed prenatally: a systematic review. Pediatr Surg Int 2018; 34 (06) 613-620
  • 2 Stocker LJ, Wellesley DG, Stanton MP, Parasuraman R, Howe DT. The increasing incidence of foetal echogenic congenital lung malformations: an observational study. Prenat Diagn 2015; 35 (02) 148-153
  • 3 Lau CT, Kan A, Shek N, Tam P, Wong KK. Is congenital pulmonary airway malformation really a rare disease? Result of a prospective registry with universal antenatal screening program. Pediatr Surg Int 2017; 33 (01) 105-108
  • 4 Hardee S, Tuzovic L, Silva CT, Cowles RA, Copel J, Morotti RA. Congenital cystic lung lesions: evolution from in-utero detection to pathology diagnosis-a multidisciplinary approach. Pediatr Dev Pathol 2017; 20 (05) 403-410
  • 5 Beksac MS, Fadiloglu E, Tanacan A. et al. Outcomes of cases of prenatally-diagnosed congenital pulmonary airway malformation. Rev Bras Ginecol Obstet 2019; 41 (11) 654-659
  • 6 Crombleholme TM, Coleman B, Hedrick H. et al. Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg 2002; 37 (03) 331-338
  • 7 Leblanc C, Baron M, Desselas E. et al. Congenital pulmonary airway malformations: state-of-the-art review for pediatrician's use. Eur J Pediatr 2017; 176 (12) 1559-1571
  • 8 Cavoretto P, Molina F, Poggi S, Davenport M, Nicolaides KH. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol 2008; 32 (06) 769-783
  • 9 Kunisaki SM, Saito JM, Fallat ME. et al; Midwest Pediatric Surgery Consortium. Development of a multi-institutional registry for children with operative congenital lung malformations. J Pediatr Surg 2020; 55 (07) 1313-1318
  • 10 Stanton M, Davenport M. Management of congenital lung lesions. Early Hum Dev 2006; 82 (05) 289-295
  • 11 Parikh DH, Rasiah SV. Congenital lung lesions: postnatal management and outcome. Semin Pediatr Surg 2015; 24 (04) 160-167
  • 12 Sauvat F, Michel JL, Benachi A, Emond S, Revillon Y. Management of asymptomatic neonatal cystic adenomatoid malformations. J Pediatr Surg 2003; 38 (04) 548-552
  • 13 Downard CD, Calkins CM, Williams RF. et al. Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee. Pediatr Surg Int 2017; 33 (09) 939-953
  • 14 Ruchonnet-Metrailler I, Leroy-Terquem E, Stirnemann J. et al. Neonatal outcomes of prenatally diagnosed congenital pulmonary malformations. Pediatrics 2014; 133 (05) e1285-e1291
  • 15 Ng C, Stanwell J, Burge DM, Stanton MP. Conservative management of antenatally diagnosed cystic lung malformations. Arch Dis Child 2014; 99 (05) 432-437
  • 16 Stanton M, Njere I, Ade-Ajayi N, Patel S, Davenport M. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg 2009; 44 (05) 1027-1033
  • 17 Adams S, Jobson M, Sangnawakij P. et al. Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections. J Pediatr Surg 2017; 52 (02) 247-251
  • 18 Casagrande A, Pederiva F. Association between congenital lung malformations and lung tumors in children and adults: a systematic review. J Thorac Oncol 2016; 11 (11) 1837-1845
  • 19 Makhija Z, Moir CR, Allen MS. et al. Surgical management of congenital cystic lung malformations in older patients. Ann Thorac Surg 2011; 91 (05) 1568-1573 , discussion 1573
  • 20 Stanton M. The argument for a non-operative approach to asymptomatic lung lesions. Semin Pediatr Surg 2015; 24 (04) 183-186
  • 21 Kapralik J, Wayne C, Chan E, Nasr A. Surgical versus conservative management of congenital pulmonary airway malformation in children: A systematic review and meta-analysis. J Pediatr Surg 2016; 51 (03) 508-512
  • 22 Sullivan KJ, Li M, Haworth S. et al. Optimal age for elective surgery of asymptomatic congenital pulmonary airway malformation: a meta-analysis. Pediatr Surg Int 2017; 33 (06) 665-675
  • 23 Eber E. Antenatal diagnosis of congenital thoracic malformations: early surgery, late surgery, or no surgery?. Semin Respir Crit Care Med 2007; 28 (03) 355-366
  • 24 Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology: the impact of new epidemiological data. Br J Radiol 2012; 85 (1020): e1316-e1317
  • 25 Schulze-Rath R, Hammer GP, Blettner M. Are pre- or postnatal diagnostic X-rays a risk factor for childhood cancer? A systematic review. Radiat Environ Biophys 2008; 47 (03) 301-312