1. Learning objectives

â–º Understand the characteristics of the normal X-ray

â–º X-ray pictures of common neonatal respiratory morbidities

2. Normal neonatal X-ray

â–º Neonatal CXRs are all AP films taken in supine position

â–º The chest is more cylindrical and translucent

â–º Ribs more horizontal compared to children and adults

â–º Thymus is prominent and CT ratio can be up to 0.6

â–º Diaphragm is upto 6th rib anteriorly & 8th rib posteriorly

â–º More is hyperinflation and less is underaeration

3. Indications for X-ray

â–º For diagnosis of respiratory distress

â–º To check position of endotracheal tube, umbilical arterial
    and venous lines, and chest tubes

â–º To prove clinical suspicion of air leak

4. HMD

5. HMD

6. X-ray of HMD

7. Typical X-ray finding of RDS/ HMD

â–º Decreased lung volume

â–º Reticulogranular pattern

â–º Ground glass opacification

â–º Air bronchograms

â–º White out lungs

8. Pneumonia

â–º Patchy alveolar or interstitial infiltrates

â–º Consolidation is rarely seen in newborn

â–º Normal to increased lung volumes with areas of air trapping

9. MAS

11. TTNB

â–º Prominent hilum with streaky shadows
â–º Prominent interlobar fissures
â–º Small pleural effusion
â–º Mild cardiomegaly
â–º Normal to increased lung volume

12. Pneumothorax

â–º Pleural air with no or decreased lung markings (hyperlucent)
â–º Collapsed lung
â–º Shift of mediastinum to opposite side

13. Congenital Diaphragmatic Hernia

â–º Left hemithorax filled with cyst like loops of bowel
â–º Mediastinal shift to right side

14. Key messages

â–º Identification of RDS on x-ray will help us in correctly
    identifying newborn who needs surfactant

â–º Other respiratory disorders can be identified with the help
    of x-rays