• Neonatal respiratory distress
• Total Anomalous Pulmonary Venous Drainage
• Post-operative pulmonary vein stenosis

A baby girl was born at 36+3 weeks gestation by emergency caesarean section due to maternal unstable blood sugars and fetal distress. Her mother was an insulin-controlled diabetic but otherwise had a normal, low-risk pregnancy. She was born in a good condition and did not require any resuscitation at birth. However, she was noted soon after to have respiratory distress and was admitted to the neonatal unit. On admission, her saturations fluctuated between 90% and 95% with limited improvement with high-flow nasal cannula oxygen with moderate subcostal recessions. She had normal heart sounds, good volume femoral pulses and normal four-limb blood pressure. There was a 1 cm liver edge palpable.

She was started on first-line antibiotics which were continued until negative cultures at 48 hours, and she tolerated weaning of her respiratory support. However, she then began to have intermittent desaturations to 60% and so respiratory support was re-escalated. The chest radiograph is shown in figure 1.