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
paracetamol; therapeutic drug level; patent ductus arteriosus
Key points
  1. Lower cumulative doses of IV paracetamol may be equally efficacious to higher daily cumulative doses while assuring a better safety profile.
  2. Our review casts doubt on the therapeutic drug concentration of paracetamol as a marker of its safety or efficacy.
  3. Well-designed multicentre RCTs allowing exploration of predictive kinetic behaviour of paracetamol are needed to establish its safety and efficacy over NSAIDs.

Also published in Infant:

VOLUME 2/ISSUE 5, SEPTEMBER 2006
Postoperative care of neonates
This article deals with the care of the surgical neonate in the postoperative period. This is a time for physiological optimisation following the major stress of a surgical insult. For the surgical neonate particular vigilance is required with attention paid to pain and analgesia, temperature, apnoea and fluids, electrolytes and nutrition.

Read more...