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, f.aliyu@nhs.net

Udoka Asoh
ST7 Paediatric Trainee, Neonatal Unit, Hull University Teaching Hospitals NHS Trust, u.asoh@nhs.net

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Keywords
less invasive surfactant administration (LISA); surfactant; respiratory distress syndrome; videolaryngoscope; bronchopulmonary dysplasia (BPD); premature
Key points
  1. Structured guidelines and training of medical staff are required to establish LISA as a routine procedure in the NNU.
  2. Videolaryngoscopy is a useful adjunct to the procedure.
  3. Further studies are required on the use of medications during the procedure.
  4. A robust system of data collection and analysis helps to guide improvements.