Upper Gastrointestinal Tract Mass and Respiratory Failure in a Newborn

Prenatal History:

• A 20-year-old primigravida female who has chronic hypertension, oligohydramnios, and maternal class B diabetes

• Nonreactive rapid plasma reagin, negative hepatitis B surface antigen, and presence of rubella antibodies; culture for group B Streptococcus (GBS) not performed

Birth History and Presentation:

• Infant delivered via cesarean section at 29 weeks’ gestation, weighing 1,030 g

• Apgar scores of 6 and 8 at 1 and 5 minutes, respectively; infant required oxygen and positive pressure ventilation in the delivery room and oral suction

• The patient was started on nasal continuous positive airway pressure in the neonatal intensive care unit at 7 cm H₂O and 27% Fio₂, with placement of a nasogastric tube and received antibiotics because of prematurity, respiratory distress, and unknown maternal GBS status

• Three hours after birth, the baby’s respiratory condition deteriorated, necessitating intubation and placement on a conventional ventilator

• The baby’s respiratory condition worsened on the second postnatal day, and chest radiography revealed an abnormal air-filled structure in the superior mediastinum (see Fig. 1)

Case Progression:

The infant was switched to high-frequency jet ventilation on postnatal day three. Her respiratory condition improved, …