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
procalcitonin; early onset sepsis; sepsis; early onset infection
Key points
  1. Decision making about antibiotic treatment should not rely on any single blood test.
  2. Procalcitonin (PCT) is a potentially useful adjunct to C-reactive protein (CRP) levels in term babies being treated for suspected early onset neonatal infection.
  3. Low PCT and CRP results should allow clinicians to be more confident in their decision to stop antibiotics in apparently well babies. 
  4. PCT results need to be interpreted according to the time they are taken due to physiological variations in PCT after birth.