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

transient vasospasm; ischaemia

Key points

The arterial spasm is a well-known complication of arterial catheterisation in neonates.
Transient peripheral vasospasm may occur in the preterm baby without any obvious precipitating factors.

Also published in Infant:

VOLUME 8/ISSUE 1, JANUARY 2012

Blood transfusion and necrotising enterocolitis: a review and survey into feeding practices during transfusion

Studies have identified a temporal association between packed red blood cell transfusion (PRBCT) and necrotising enterocolitis (NEC). Some researchers have suggested that stopping enteral feeds during a PRBCT may reduce the risk of NEC. A survey conducted by the authors in 2011 identified over a third of English neonatal units stopping or reducing feeds around the time of an elective blood transfusion in preterm infants. The evidence for the benefit of this practice is very limited.