TY - JOUR T1 - Neonate with persisting respiratory distress after resolution of pneumothorax JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 152 LP - 154 DO - 10.1136/archdischild-2019-317882 VL - 106 IS - 3 AU - Sagarika Ray Y1 - 2021/06/01 UR - http://ep.bmj.com/content/106/3/152.abstract N2 - ­A preterm baby boy was born in good condition at 31+5 weeks gestation with a birth weight of 1956 g, following a precipitous labour with no prolonged rupture of membranes and no opportunity for administration of antenatal steroids to mother. Following admission to the neonatal unit, he developed respiratory distress and was commenced on nasal continuous positive airway pressure (CPAP) of 6 cm of water. At 24 hours of age, he developed a left-sided tension pneumothorax (figure 1), requiring endotracheal intubation and insertion of a chest drain. He received two doses of surfactant and was extubated onto CPAP on day 3. There was reaccumulation of the pneumothorax on day 4, which was subsequently drained. He remained self-ventilating in air in the second week of life. From day 15 to day 30, he required humidified high flow nasal cannula oxygen (fractional inspired oxygen up to 0.4), in view of marked subcostal and intercostal recession, intolerance to handling and a compensated respiratory acidosis on capillary blood gases. Figure 2 is the chest radiograph undertaken in the third week of life.Figure 1 Chest radiograph (supine anteroposterior) on day 1.Figure 2 Chest radiograph (supine anteroposterior) in week 3.QuestionsWhat is the most likely diagnosis in this case?Congenital pulmonary airway malformation (CPAM)Respiratory distress syndromePulmonary interstitial emphysema (PIE)PneumatocoeleCongenital diaphragmatic herniaWhich of the following is not an effective option for treatment of this condition?Corticosteroid therapyLateral decubitus with affected side downHigh frequency oscillatory ventilation (HFOV)Selective main bronchial intubation of contralateral lung (which is not affected)Chest physiotherapyWhich of the following statements is false about this condition?Complications can include other air leak syndromesMost neonates presenting with this condition have been mechanically ventilatedDiagnosis is usually made on a chest radiographSurfactant therapy has been associated with an increase in this conditionAir embolism can be a fatal complicationQuestions Answers can be found on page 2 ER -