Transient respiratory distress and difficulty passing a nasogastric tube in a newborn baby.

Abstract

A baby was born at 30 weeks and 5 days’ gestation, by emergency caesarean section after onset of labour. It was a twin pregnancy, with an antenatal history of polyhydramnios, but no risk factors for sepsis. Polyhydramnios is excess amniotic fluid in the amniotic sac during a pregnancy. The baby was the second twin and weighed 1160 g. On delivery the baby had irregular respirations, low saturations, and excessive secretions necessitating intermittent positive pressure ventilation. Ten minutes after the delivery she was intubated and given surfactant through an endotracheal tube. Soon after, her respiratory effort improved and she was extubated and managed with short term nasal continuous positive airway pressure (CPAP) before stepping down to self ventilation within hours. On examination the baby had a left pre-auricular skin tag, but was not dysmorphic. No limb abnormalities were found. Examination of the abdomen was unremarkable except for a single umbilical artery. Perineal examination showed a urethra and vagina and no patent anus. Three attempts at passing a nasogastric tube were unsuccessful and a radiograph showed it coiling in the upper oesophagus. A Replogle tube—used to suction excess saliva from the oesophagus—was placed before the baby was transferred to a surgical unit. A radiograph of the chest and abdomen was obtained (fig 1). Fig 1 Neonatal chest and abdominal radiograph 1. Describe the findings in the radiograph. 2. Which diagnoses are evident or suspected? 3. What further investigations should be performed and why? 4. How should this baby be managed …