Neonatal Chest Imaging

Part of the Medical Radiology book series (MEDRAD)


Neonatal lung disease is a common problem with potential for significant morbidity and mortality. Chest radiographs remain the most important imaging tool for investigation of these diseases. Many of these diseases can have a similar appearance on radiographs, but differentiation can be often be achieved by noting differentiating and sometimes subtle imaging findings, and taking into consideration pertinent clinical information such as the gestational age and perinatal history. As these patients are often critically ill, radiographs also need to be evaluated for adequate positioning of the support tubes and catheters. Many complications of these diseases, such as air leak related to mechanical ventilation, can also be assessed with radiographs. This chapter will describe and illustrate the imaging findings of diseases of the neonatal lung and complications of their management.


Inferior Vena Cava Respiratory Distress Syndrome Bronchopulmonary Dysplasia Meconium Aspiration Syndrome Meconium Aspiration Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ablow RC, Driscoll SG, Effmann EL et al (1976) A comparison of early-onset group B steptococcal neonatal infection and the respiratory-distress syndrome of the newborn. N Engl J Med 294(2):65–70PubMedCrossRefGoogle Scholar
  2. Agrons GA, Courtney SE, Stocker JT et al (2005) From the archives of the AFIP: lung disease in premature neonates: radiologic-pathologic correlation. Radiographics 25(4):1047–1073PubMedCrossRefGoogle Scholar
  3. Aherne W, Dawkins MJ (1964) The removal of fluid from the pulmonary airways after birth in the rabbit, and the effect on this of prematurity and pre-natal hypoxia. Biol Neonatal 7:214–229CrossRefGoogle Scholar
  4. Anadkat JS, Kuzniewicz MW, Chaudhari BP et al (2012) Increased risk for respiratory distress among white, male, late preterm and term infants. J Perinatol 32(10):780–785PubMedCentralPubMedCrossRefGoogle Scholar
  5. Bancalari E, Claure N, Sosenko IR (2003) Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 8(1):63–71PubMedCrossRefGoogle Scholar
  6. Barker PM, Olver RE (2002) Invited review: clearance of lung liquid during the perinatal period. J Appl Physiol 93(4):1542–1548PubMedGoogle Scholar
  7. Beligere N, Rao R (2008) Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol 28(Suppl 3):S93–S101PubMedCrossRefGoogle Scholar
  8. Birnkrant DJ, Picone C, Markowitz W et al (2006) Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol 41(10):978–984PubMedCrossRefGoogle Scholar
  9. Bland RD, Hansen TN, Haberkern CM et al (1982) Lung fluid balance in lambs before and after birth. J Appl Physiol 53(4):992–1004PubMedGoogle Scholar
  10. Clausson B, Cnattingius S, Axelsson O (1999) Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 94(5 Pt 1):758–762PubMedCrossRefGoogle Scholar
  11. Cleary GM, Wiswell TE (1998) Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 45(3):511–529PubMedCrossRefGoogle Scholar
  12. Cleveland RH (1995) A radiologic update on medical diseases of the newborn chest. Pediatr Radiol 25(8):631–637PubMedCrossRefGoogle Scholar
  13. Crowley P, Chalmers I, Keirse MJ (1990) The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 97(1):11–25PubMedCrossRefGoogle Scholar
  14. Dargaville PA (2012) Respiratory support in meconium aspiration syndrome: a practical guide. Int J Pediatr 2012:965159PubMedCentralPubMedGoogle Scholar
  15. Dargaville PA, Copnell B, Australian et al (2006) The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 117(5):1712–1721Google Scholar
  16. Dargaville PA, South M, McDougall PN (2001) Surfactant and surfactant inhibitors in meconium aspiration syndrome. J Pediatr 138(1):113–115PubMedCrossRefGoogle Scholar
  17. Dennehy PH (1987) Respiratory infections in the newborn. Clin Perinatol 14(3):667–682PubMedGoogle Scholar
  18. Dinger J, Schwarze R, Rupprecht E (1997) Radiological changes after therapeutic use of surfactant in infants with respiratory distress syndrome. Pediatr Radiol 27(1):26–31PubMedCrossRefGoogle Scholar
  19. Donnelly LF, Lucaya J, Ozelame V et al (2003) CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study. AJR Am J Roentgenol 180(4):1129–1133PubMedCrossRefGoogle Scholar
  20. Garenne M, Ronsmans C, Campbell H (1992) The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries. World Health Stat Q 45(2–3):180–191PubMedGoogle Scholar
  21. Garite TJ, Rumney PJ, Briggs GG et al (1992) A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks’ gestation. Am J Obstet Gynecol 166(2):646–651PubMedCrossRefGoogle Scholar
  22. Gooding CA, Gregory GA (1971) Roentgenographic analysis of meconium aspiration of the newborn. Radiology 100(1):131–140PubMedCrossRefGoogle Scholar
  23. Greenough A, Morley C, Roberton N (1992). Acute respiratory diseases in the newborn. In: Roberton N (ed) Textbook of Neonatology. Churchill Livingstone, London, pp 385–504Google Scholar
  24. Hammerschlag MR (1994) Chlamydia trachomatis in children. Pediatr Ann 23(7):349–353PubMedCrossRefGoogle Scholar
  25. Han BK, Suh YL, Yoon HK (2001) Thymic ultrasound. I. Intrathymic anatomy in infants. Pediatr Radiol 31(7):474–479PubMedCrossRefGoogle Scholar
  26. Haney PJ, Bohlman M, Sun CC (1984) Radiographic findings in neonatal pneumonia. AJR Am J Roentgenol 143(1):23–26PubMedCrossRefGoogle Scholar
  27. Hibbard JU, Wilkins I, Sun L et al (2010) Respiratory morbidity in late preterm births. JAMA 304(4):419–425PubMedCrossRefGoogle Scholar
  28. Humphreys PW, Normand IC, Reynolds EO et al (1967) Pulmonary lymph flow and the uptake of liquid from the lungs of the lamb at the start of breathing. J Physiol 193(1):1–29PubMedCentralPubMedGoogle Scholar
  29. Husain AN, Siddiqui NH, Stocker JT (1998) Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia. Hum Pathol 29(7):710–717PubMedCrossRefGoogle Scholar
  30. Janssen DJ, Carnielli VP, Cogo P et al (2006) Surfactant phosphatidylcholine metabolism in neonates with meconium aspiration syndrome. J Pediatr 149(5):634–639PubMedCrossRefGoogle Scholar
  31. Jeffery HE, Moses Lahra M (1998) Eight-year outcome of universal screening and intrapartum antibiotics for maternal group B streptococcal carriers. Pediatrics 101(1):E2PubMedCrossRefGoogle Scholar
  32. Jobe AH, Bancalari E (2001). Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729 Google Scholar
  33. Kotecha S, Hodge R, Schaber JA et al (2004) Pulmonary Ureaplasma urealyticum is associated with the development of acute lung inflammation and chronic lung disease in preterm infants. Pediatr Res 55(1):61–68PubMedCrossRefGoogle Scholar
  34. Kuhns LR, Poznanski AK (1971) Endotracheal tube position in the infant. J Pediatr 78(6):991–996PubMedCrossRefGoogle Scholar
  35. Lawson EE, Brown ER, Torday JS et al (1978) The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep. Am Rev Respir Dis 118(6):1023–1026PubMedGoogle Scholar
  36. Leonidas JC, Hall RT, Beatty EC et al (1977) Radiographic findings in early onset neonatal group b streptococcal septicemia. Pediatrics 59 Suppl(6 Pt 2):1006–1011Google Scholar
  37. Liggins GC, Howie RN (1972) A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 50(4):515–525PubMedGoogle Scholar
  38. Matthews TG, Warshaw JB (1979) Relevance of the gestational age distribution of meconium passage in utero. Pediatrics 64(1):30–31PubMedGoogle Scholar
  39. Mokrohisky ST, Levine RL, Blumhagen JD et al (1978) Low positioning of umbilical-artery catheters increases associated complications in newborn infants. N Engl J Med 299(11):561–564PubMedCrossRefGoogle Scholar
  40. Moskowitz PS, Griscom NT (1976) The medial pneumothorax. Radiology 120(1):143–147PubMedCrossRefGoogle Scholar
  41. Northway WH Jr, Rosan RC (1968) Radiographic features of pulmonary oxygen toxicity in the newborn: bronchopulmonary dysplasia. Radiology 91(1):49–58PubMedCrossRefGoogle Scholar
  42. Northway WH Jr, Rosan RC, Porter DY (1967) Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 276(7):357–368PubMedCrossRefGoogle Scholar
  43. Oppenheim C, Mamou-Mani T, Sayegh N et al (1994) Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae. AJR Am J Roentgenol 163(1):169–172PubMedCrossRefGoogle Scholar
  44. Persson B, Hanson U (1998) Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 21(Suppl 2):B79–B84PubMedGoogle Scholar
  45. Plenat F, Vert P, Didier F et al (1978) Pulmonary interstitial emphysema. Clin Perinatol 5(2):351–375PubMedGoogle Scholar
  46. Ramachandrappa A, Jain L (2008) Elective cesarean section: its impact on neonatal respiratory outcome. Clin Perinatol 35(2):373–393, viiGoogle Scholar
  47. Sapin E, Gumpert L, Bonnard A et al (2000) Iatrogenic pharyngoesophageal perforation in premature infants. Eur J Pediatr Surg 10(2):83–87PubMedCrossRefGoogle Scholar
  48. Schatz M, Zeiger RS, Hoffman CP et al (1991) Increased transient tachypnea of the newborn in infants of asthmatic mothers. Am J Dis Child 145(2):156–158PubMedGoogle Scholar
  49. Singh BS, Clark RH, Powers RJ et al (2009) Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol 29(7):497–503PubMedCrossRefGoogle Scholar
  50. Slama M, Andre C, Huon C et al (1999) Radiological analysis of hyaline membrane disease after exogenous surfactant treatment. Pediatr Radiol 29(1):56–60PubMedCrossRefGoogle Scholar
  51. Stocker J (1992). The respiratory tract. In: Stocker J, Dehner LP (eds) Pediatric pathology. Lippincott, Philadelphia, pp 505–573Google Scholar
  52. Stocker JT (1986) Pathologic features of long-standing “healed” bronchopulmonary dysplasia: a study of 28 3- to 40-month-old infants. Hum Pathol 17(9):943–961PubMedCrossRefGoogle Scholar
  53. Stoll BJ, Hansen NI, Bell EF et al (2010) Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics 126(3):443–456PubMedCentralPubMedCrossRefGoogle Scholar
  54. Stoll BJ, Hansen NI, Higgins RD et al (2005) Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002–2003. Pediatr Infect Dis J 24(7):635–639PubMedCrossRefGoogle Scholar
  55. Suresh GK, Soll RF (2005) Overview of surfactant replacement trials. J Perinatol 25(Suppl 2):S40–S44PubMedCrossRefGoogle Scholar
  56. Swaminathan S, Quinn J, Stabile MW et al (1989) Long-term pulmonary sequelae of meconium aspiration syndrome. J Pediatr 114(3):356–361PubMedCrossRefGoogle Scholar
  57. Swarnam K, Soraisham AS, Sivanandan S (2012) Advances in the management of meconium aspiration syndrome. Int J Pediatr 2012:359571PubMedCentralPubMedGoogle Scholar
  58. Swischuk LE (1970) Transient respiratory distress of the newborn (TRDN). A temporary disturbance of a normal phenomenon. Am J Roentgenol Radium Ther Nucl Med 108(3):557–563PubMedCrossRefGoogle Scholar
  59. Swischuk LE, John SD (1996) Immature lung problems: can our nomenclature be more specific? AJR Am J Roentgenol 166(4):917–918PubMedCrossRefGoogle Scholar
  60. Swischuk LE, Shetty BP, John SD (1996) The lungs in immature infants: how important is surfactant therapy in preventing chronic lung problems? Pediatr Radiol 26(8):508–511PubMedCrossRefGoogle Scholar
  61. Thibeault DW, Lachman RS, Laul VR et al (1973) Pulmonary interstitial emphysema, pneumomediastinum, and pneumothorax. Occurrence in the newborn infant. Am J Dis Child 126(5):611–614PubMedCrossRefGoogle Scholar
  62. Tutdibi E, Gries K, Bucheler M et al (2010) Impact of labor on outcomes in transient tachypnea of the newborn: population-based study. Pediatrics 125(3):e577–e583PubMedCrossRefGoogle Scholar
  63. Usta IM, Mercer BM, Sibai BM (1995) Risk factors for meconium aspiration syndrome. Obstet Gynecol 86(2):230–234PubMedCrossRefGoogle Scholar
  64. van Houten J, Long W, Mullett M et al (1992) Pulmonary hemorrhage in premature infants after treatment with synthetic surfactant: an autopsy evaluation. The american exosurf neonatal study group I, and the Canadian exosurf neonatal study group. J Pediatr 120(2 Pt 2):S40–S44PubMedCrossRefGoogle Scholar
  65. Wesenberg RL, Graven SN, McCabe EB (1971) Radiological findings in wet-lung disease. Radiology 98(1):69–74PubMedCrossRefGoogle Scholar
  66. Wiswell TE, Tuggle JM, Turner BS (1990) Meconium aspiration syndrome: have we made a difference? Pediatrics 85(5):715–721PubMedGoogle Scholar
  67. Yoder BA, Kirsch EA, Barth WH et al (2002) Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol 99(5 Pt 1):731–739PubMedCrossRefGoogle Scholar
  68. Yuksel B, Greenough A, Gamsu HR (1993) Neonatal meconium aspiration syndrome and respiratory morbidity during infancy. Pediatr Pulmonol 16(6):358–361PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Radiology, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA

Personalised recommendations