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
abdominal injury; subcapsular haematoma of the liver; refractory hypotension; abdominal ultrasound
Key points
  1. Even without evidence of birth trauma, intra-abdominal bleeding must be suspected in a newborn infant with refractory hypotension.
  2. Early identification of the source of bleeding may improve the outcome.
  3. Ultrasonography is the best modality to diagnose intra-abdominal birth injuries and can be performed at the bedside.

Also published in Infant:

VOLUME 10/ISSUE 2, MARCH 2014
A preterm infant with progressive abdominal distension
This report describes the case of a preterm infant with progressive liver enlargement causing abdominal distension at a few weeks of age. The liver biochemistry was normal with Doppler ultrasonographic evidence of increased vascularity within the liver parenchyma. The diagnosis was infantile multifocal hepatic haemangiomas. The clinical management required input from a multidisciplinary team. The spectrum of clinical presentation, diagnostic pathway and management options is reviewed.

Read more...