Infant Journal
for neonatal and paediatric healthcare professionals

A floppy baby with elevated right hemidiaphragm and large stomach bubble on chest radiograph: what’s the diagnosis?

A preterm neonate of 36 weeks’ gestation was born via emergency lower segment caesarean section, requiring respiratory support soon after birth. She was hypotonic from birth and was found to have a large gastric bubble and a raised right hemidiaphragm on X-ray. She reached full feeds through a nasogastric tube on day 3 of life but later developed severe gastro-oesophageal reflux with pulmonary aspiration. What is the likely diagnosis?

Fatimah Aliyu
ST6 Paediatric Trainee, York Teaching Hospital, NHS Foundation Trust,

Udoka Asoh
ST7 Paediatric Trainee, Neonatal Unit, Hull University Teaching Hospitals NHS Trust,

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nutrition; breast milk; late onset sepsis; necrotising enterocolitis
Key points
  1. FEED1 is the first large RCT to investigate whether infants born at 30+0 to 32+6weeks’ gestation will be able to milk feed fully from day 1.
  2. Full milk feeds from day 1 could ‘de-medicalise’ the care of preterm infants, help to avoid invasive procedures, reduce the length of their stay in neonatal units, encourage mothers to express milk, and support early breast milk feeding.

Also published in Infant:

Stoma associated morbidity in the preterm infant
Babies born prematurely are at risk of developing gastrointestinal complications that may require small bowel resection with or without stoma formation. The evidence base regarding the optimal initial surgical intervention and the subsequent timing of stoma closure is limited. To help inform the design of future randomised controlled trials investigating the optimal timing of stoma closure, we describe current practice and outcomes including stoma-related complications in a cohort of preterm infants who underwent stoma formation at the Royal Hospital for Children, Glasgow.