Abstract
Clinical Image A 690 g male infant delivered at 24+2 weeks had respiratory distress syndrome treated with Curosurf. Chest X-ray showed pulmonary interstitial emphysema (PIE) changes from day 5 onwards. On day 6 he suddenly developed desaturation with bradycardia, not responding to bagging. Auscultation revealed reduced air entry over right lung; endotracheal tube was changed for suspected blockage. Transient improvement noted. Then, the baby deteriorated again. Repeated auscultation showed markedly reduced air entry over right lung. Transillumination was positive. X-ray confirmed right tension pneumothorax but pneumoperitoneum was unexpected (Figure 1). The baby’s condition did not improve upon repeated chest tapping and required chest compression and Adrenaline. A chest drain was inserted and the baby then improved. Bowel perforation was once suspected but the infant improved so dramatically after chest drainage and milk feeding was subsequently established, ruling out bowel perforation.