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Related Concept Videos

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Related Experiment Video

Updated: Sep 8, 2025

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
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Diaphragm Position on Chest Radiograph to Estimate Lung Volume in Neonates.

Sophia I Dahm1,2,3, Arun Sett1,4,5, Emma F Gunn1,3

  • 1Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

JAMA Pediatrics
|July 21, 2025
PubMed
Summary
This summary is machine-generated.

Diaphragm position on infant chest radiographs lacks precision for guiding lung aeration in the neonatal intensive care unit (NICU). This common practice, used in respiratory support, needs re-evaluation due to weak associations with actual lung volumes.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Radiology
  • Respiratory Physiology

Background:

  • Chest radiographs are standard for guiding lung aeration in neonatal intensive care units (NICUs).
  • Current guidelines recommend using chest radiographs for respiratory support in infants.
  • The validity of using diaphragm position on radiographs to assess lung aeration has not been established.

Purpose of the Study:

  • To determine the association between infant diaphragm position on chest radiographs and aerated lung volume measured by computed tomography (CT).
  • To evaluate the reliability of radiographic diaphragm position for assessing lung volumes in neonates.

Main Methods:

  • Retrospective cross-sectional study of 218 infants without congenital lung pathology.
  • Computed tomography (CT) was used to calculate lung volume via semiautomated segmentation.
  • Diaphragm position was standardized and measured against posterior rib count; CT analysis was blinded.

Main Results:

  • A weak association was found between diaphragm position and total lung volume (Kendall τ = 0.23).
  • Similar weak associations were observed when analyzing by hemithorax, consolidation, apex-diaphragm distance, and Hounsfield units.
  • The diaphragm position on chest radiographs showed limited precision in reflecting infant lung volumes.

Conclusions:

  • Diaphragm position on infant chest radiographs has insufficient precision to reliably assess aerated lung volume.
  • This finding challenges the long-standing practice in neonatal intensive care units (NICUs).
  • Clinical practice for guiding respiratory support in infants may require alternative or supplementary methods.