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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transient vasospasm; ischaemia
Key points
  1. The arterial spasm is a well-known complication of arterial catheterisation in neonates.
  2. Transient peripheral vasospasm may occur in the preterm baby without any obvious precipitating factors.

Also published in Infant:

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.