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Updated: Jun 28, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Chest radiographic thoracic areas and respiratory outcomes in infants with anterior abdominal wall defects
Allan Jenkinson1, Mirna Krishnan2, Mark Davenport3
1Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
Infants with abdominal wall defects like gastroschisis and exomphalos show reduced chest size, indicating abnormal lung growth. Lower chest areas in exomphalos correlate with worse respiratory outcomes, suggesting prognostic value.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Pulmonary Medicine
Background:
- Anterior abdominal wall defects (AWD) such as gastroschisis and exomphalos are associated with pulmonary complications in newborns.
- Assessing antenatal lung development is crucial for predicting respiratory outcomes in these infants.
Purpose of the Study:
- To compare chest radiographic thoracic areas (CRTAs) on day one between infants with exomphalos and gastroschisis.
- To determine if CRTA differences correlate with outcome severity and abnormal antenatal lung growth.
- To evaluate CRTA as a potential prognostic indicator for pulmonary complications.
Main Methods:
- Retrospective review of infants with exomphalos or gastroschisis (2004-2023) and term newborn controls.
- Analysis of chest radiographs on day one to measure the highest chest radiographic thoracic area (CRTA).
- Comparison of CRTAs between defect groups and controls, adjusted for birthweight.
Main Results:
- Infants with gastroschisis had lower gestational age and birthweight compared to exomphalos and controls.
- CRTAs were significantly lower in both exomphalos and gastroschisis infants compared to controls.
- Median CRTA corrected for birthweight was lower in exomphalos infants than gastroschisis infants.
- A CRTA threshold predicted bronchopulmonary dysplasia (BPD) in exomphalos infants with 81% sensitivity and 71% specificity.
Conclusions:
- Lower CRTAs in infants with gastroschisis and exomphalos suggest abnormal antenatal lung development.
- Exomphalos infants exhibited smaller CRTAs and poorer respiratory outcomes, highlighting CRTA's potential as a prognostic tool.
- CRTA measurement may aid in predicting respiratory severity in neonates with anterior abdominal wall defects.
Objectives:
Infants with anterior abdominal wall defects (AWD) can suffer from pulmonary complications. Our aims were to determine if the chest radiographic thoracic areas (CRTAs) on day one differed between infants with exomphalos or gastroschisis, whether this related to differing severity of outcomes and if they were lower than those of controls indicating abnormal antenatal lung growth.
Methods:
A review of infants with exomphalos or gastroschisis born between January 2004 and January 2023 was conducted. The control group was term, newborn infants ventilated for poor respiratory drive at birth. Chest radiographs on day one were analysed and the highest CRTA in the first 24 h after birth for each infant included in the analysis.
Results:
The 127 infants with gastroschisis had a lower gestational age and birthweight than the 62 exomphalos infants and 130 controls (all p<0.001) The CRTAs of the controls were greater than the CRTAs of the exomphalos and the gastroschisis infants (p = 0.001). The median CRTA corrected for birthweight was lower in the exomphalos infants [688, IQR 568-875 mm2/kg] than the gastroschisis infants [813, IQE 695-915 mm2/kg] No gastroschisis infant developed bronchopulmonary dysplasia (BPD). A CRTA of 1759 mm2 had a sensitivity of 81 % and specificity of 71 % in predicting BPD in infants with exomphalos.
Conclusions:
Infants with gastroschisis or exomphalos had lower CRTAs than controls suggesting both groups had abnormal antenatal lung development. The CRTA was lower in the exomphalos infants who also had worse respiratory outcomes, hence CRTA assessment may a useful prognostic aid.
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