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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assessment; cognitive development; language development; parent report; neurodevelopmental outcomes
Key points
  1. The PARCA-R can be used to assess neurodevelopmental outcomes at 23.5 to 27.5 months of age.
  2. The questionnaire takes parents less than 15 minutes to complete.
  3. It produces separate norm-referenced scores for non-verbal cognition and language development.
  4. It can be used to identify developmental delay for all children in the general population.
  5. The PARCA-R is free to use and all available resources can be accessed online at