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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
What are the most striking features on this X-ray?
Hyperinflation of the right lung, honeycomb appearance of the lung field, mediastinal shift to the left.
Right-sided tension pneumothorax with mediastinal shift to the left.
Bilateral ground-glass changes, worse on the right, with mediastinal shift to the left.
Collapse of the left lung causing mediastinal shift to the left. …
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.