X-Rays and Babies (Or all the radiology you need to get you through the night in the ICN) Nick Mickas, MD Childrens Hospital & Research Center, Oakland January 12, 2009

Things you’re not born with… Endotracheal tube Radiographic landmarks are the thoracic inlet and the carina Optimal tube position is midway between the two Tube position varies with head position Chin down-tube moves in Chin up-tube moves out

Things you’re not born with… Umbilical catheters Important to visualize entire catheter to assure position Natural course of umbilical vein is straight from umbilicus through ductus venosus to IVC Umbilical artery dives into the iliac artery before ascending to the aorta Most of the time arch is to the patient’s left

Umbilical catheters… UVC tip should be above the liver to ensure not in the portal circulation UAC if low lying should be between the top of L3 (below renals) and below bottom of L4 UAC tip if high lying should be between T6 and T10 (out of the arch, above the mesenterics)

L3 L4

RDS

Pneumonia

(Meconium) Aspiration Syndrome

TTN

PIE

Pneumothorax

Pneumothorax and PIE

Pneumomediastinum

Pneumopericardium

Congenital Heart Disease

Congenital Diaphragmatic Hernia

Congenital Cystic Adenomatoid Malformation (CCAM)

Esophageal Atresia/TEF

Duodenal Atresia

Hirschsprung’s Disease

NEC/Pneumatosis Intestinalis

Pneumoperitoneum