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Unconventional management approach to a life-threatening neonatal respiratory condition
  1. Hannah Hilton,
  2. Aishin Lok,
  3. Chakrapani Vasudevan,
  4. Megan Dale
  1. Neonates, Bradford Royal Infirmary Neonatal Unit, Bradford, West Yorkshire, UK
  1. Correspondence to Dr Hannah Hilton, Neonates, Bradford Royal Infirmary Neonatal Unit, Bradford, West Yorkshire, UK; hannahvhilton{at}gmail.com

https://doi.org/10.1136/archdischild-2022-324837

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    A steroid-exposed 1100g infant of 27+3 weeks’ gestation was born by emergency caesarean section for maternal COVID-19 pneumonitis. He required ventilation and surfactant administration at birth but continued needing ventilatory support despite a further dose of surfactant and an unsuccessful trial on continuous positive airway pressure (CPAP). It became increasingly difficult to oxygenate and ventilate him adequately, and with progressively worsening chest X-ray changes (figure 1), he warranted transfer to the nearest neonatal intensive care unit (NICU) as per national guidelines.1 2

    Figure 1

    Chest X-ray taken on day 10 of life.

    Questions

    1. What are the most striking features on this X-ray?

      1. Hyperinflation of the right lung, honeycomb appearance of the lung field, mediastinal shift to the left.

      2. Right-sided tension pneumothorax with mediastinal shift to the left.

      3. Bilateral ground-glass changes, worse on the right, with mediastinal shift to the left.

      4. Collapse of the left lung causing mediastinal shift to the left. …

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    Footnotes

    • Contributors All authors were involved in patient care. All authors were involved in manuscript design and serial drafts, and all approved the final copy.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.