Chest X-ray child

Pathology

Age:

When evaluating the chest x-ray in children, it is important to differentiate between preterm infants, full-term infants and older children. Depending on the category, certain pathology is more likely; see figure 16 (the clinical features are discussed later in the module). The request for a chest x-ray should therefore include the following important information: the gestational age of the child at birth, the current age of the child, the treatment the child has received and the nature of the symptoms.

Preterm infants are categorised as follows: moderate to late preterm = infants born between 32-37 weeks of their projected due date; very preterm = infants born at less than 32 weeks of their projected due date; extremely preterm = infants born at less than 28 weeks of their projected due date. In the Netherlands, the minimum gestational age at which life-sustaining interventions will be attempted is 24 weeks. This is related to the maturity of the lungs. From 24 weeks onwards, the type 2 alveolar epithelial cells start to produce surfactant and the alveoli will increasingly develop. The lung maturity of the foetus continues to improve up until full term; in the Netherlands, lung maturity is regarded as reasonable at approximately 32 weeks’ gestation. Before 32 weeks, more surfactant-related pathology is to be expected.