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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ventilation; pressure-support; preterm ventilation; weaning
Key points
  1. The conventional method to wean ventilation has been to reduce pressure and/or rate on SIMV or switch to SIMV from assist-control ventilation.
  2. PSV is a flow-cycled mode of ventilation that is being used with increasing frequency due to strong physiological rationale.
  3. PSV can be used in isolation or combined with SIMV and VG modes to aid extubation in preterm infants.

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Facial paralysis in Haddad syndrome: a case report of Ondine-Hirschsprung’s syndrome with a novel clinical feature
Haddad syndrome is a rare congenital disease that results in an autonomic nervous system dysfunction leading to respiratory failure due to loss of vagal input. In this article we report the case of a newborn male with central hypoventilation syndrome and Hirschsprung’s disease who presented with a facial paralysis – a new clinical presentation in Haddad syndrome. As this disease is not common, we describe the process in which the multidisciplinary team approached the patient and discuss the clinical and genetic aspects, aetiology and treatment.