1. Learning objectives

► Understand the characteristics of the normal X-ray

► X-ray pictures of common neonatal respiratory morbidities

2. Normal neonatal X-ray

► Neonatal CXRs are all AP films taken in supine position

► The chest is more cylindrical and translucent

► Ribs more horizontal compared to children and adults

► Thymus is prominent and CT ratio can be up to 0.6

► Diaphragm is upto 6th rib anteriorly & 8th rib posteriorly

► More is hyperinflation and less is underaeration

3. Indications for X-ray

► For diagnosis of respiratory distress

► To check position of endotracheal tube, umbilical arterial
    and venous lines, and chest tubes

► To prove clinical suspicion of air leak

4. HMD

5. HMD

6. X-ray of HMD

7. Typical X-ray finding of RDS/ HMD

► Decreased lung volume

► Reticulogranular pattern

► Ground glass opacification

► Air bronchograms

► White out lungs

8. Pneumonia

► Patchy alveolar or interstitial infiltrates

► Consolidation is rarely seen in newborn

► Normal to increased lung volumes with areas of air trapping

9. MAS

11. TTNB

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

12. Pneumothorax

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

13. Congenital Diaphragmatic Hernia

► Left hemithorax filled with cyst like loops of bowel
► Mediastinal shift to right side

14. Key messages

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

► Other respiratory disorders can be identified with the help
    of x-rays