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
therapeutic hypothermia; late preterm infant; mild encephalopathy; postnatal collapse; neonatal surgical condition
Key points
  1. A therapeutic ‘creep’ has been observed in which TH is offered beyond the accepted cooling criteria.
  2. Meticulous studies focusing on knowledge gaps are crucial to maximise the benefit of treatment in ‘grey case scenarios’.
  3. When evidence is limited, the decision to cool must be made by a team of experienced clinicians along with the parents.

Also published in Infant:

VOLUME 17/ISSUE 4, JULY 2021
Therapeutic hypothermia for neonatal encephalopathy: what’s new in BAPM’s latest framework for practice?
Since the British Association of Perinatal Medicine (BAPM) published its Position Statement on Therapeutic Hypothermia (TH) for Neonatal Encephalopathy in 2010, TH has become firmly established as the standard of care for all term infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). There is increasing evidence of its long-term benefits for these infants, as well as its cost-effectiveness.1 The new BAPM Framework published in November 2020 therefore expands upon the previous guidance and incorporates the most up-to-date evidence.

Read more...