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
deferred or delayed cord clamping; extreme preterm babies; intact cord stabilisation; optimal cord management; thermoregulation
Key points
  1. DCC should be provided to all preterm infants as a standard care at birth.
  2. Effective planning, team working and communication would facilitate the teams to provide DCC alongside stabilisation in extreme preterm infants.
  3. Use of simulation, quality improvement tools, regular teaching and training will

Also published in Infant:

VOLUME 15/ISSUE 2, MARCH 2019
The red hat pathway: reducing avoidable NNU admissions for hypoglycaemia
Although untreated neonatal hypoglycaemia may be a cause of long-term harm, anticipatory management of at-risk babies (eg with thermoregulation and feeding support) can prevent many unnecessary admissions. Staff at the NNU at Evelina London Children’s Hospital implemented the ‘red hat pathway’ to reduce the number of avoidable NNU admissions for hypoglycaemia by introducing the use of a red knitted hat for babies identified as at increased risk. The project demonstrates that many of these at-risk infants can be successfully managed on the postnatal ward and highlights how a simple intervention can have a significant impact on care delivery.

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