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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
目的：在产前诊断为先天性肺畸形（CLM）的无症状儿童中，产后胸部X线（CXR）的临床意义尚不确定。我们评估了这些儿童产后使用CXR的理由。
方法：我们纳入了通过胸部计算机断层扫描血管造影或组织病理学分析证实的出生时无症状的CLM患者，接受了常规的产后CXR，并参与了我们的标准护理前瞻性结构化纵向随访计划。排除有主要相关疾病的儿童。主要结果是4周龄和6月龄时CXR结果对症状发展的阳性和阴性预测值（PPV和NPV）。其次，我们试图确定CXR结果是否与在初次观察性住院期间或产后住院时间延长期间接受额外诊断相关.
结果：在121名患者中，35例(29%)CXR未见异常，23例（19%）非特异性异常，和可能的CLM在63（52％）。CXR在4周和6个月时与症状发展相关的PPV分别为0.05和0.25。相应的NPV分别为0.96和0.91。在初始观察性住院期间，CXR发现与接受进一步诊断之间存在关联（p=.047）。其他诊断结果不影响临床管理。CXR结果与初始住院时间延长无关（p=0.40）。
结论：在产前诊断为CLM的无症状患者中，产后CXR的常规做法可以省略，因为CXR结果不影响后续的临床管理。
方法：我们纳入了通过胸部计算机断层扫描血管造影或组织病理学分析证实的出生时无症状的CLM患者，接受了常规的产后CXR，并参与了我们的标准护理前瞻性结构化纵向随访计划。排除有主要相关疾病的儿童。主要结果是4周龄和6月龄时CXR结果对症状发展的阳性和阴性预测值（PPV和NPV）。其次，我们试图确定CXR结果是否与在初次观察性住院期间或产后住院时间延长期间接受额外诊断相关.
结果：在121名患者中，35例(29%)CXR未见异常，23例（19%）非特异性异常，和可能的CLM在63（52％）。CXR在4周和6个月时与症状发展相关的PPV分别为0.05和0.25。相应的NPV分别为0.96和0.91。在初始观察性住院期间，CXR发现与接受进一步诊断之间存在关联（p=.047）。其他诊断结果不影响临床管理。CXR结果与初始住院时间延长无关（p=0.40）。
结论：在产前诊断为CLM的无症状患者中，产后CXR的常规做法可以省略，因为CXR结果不影响后续的临床管理。
