Respiratory distress after ductus arteriosus ligation – Question

Abstract

A 31+2 weeks gestational age, birthweight 1,490 g female was born after an emergency C-section due to abruptio placenta. The Apgar score was 4/8/8, needing positive pressure followed by nasal continuous airway positive pressure (NCPAP). One dose of poractant alfa was administered in the first hour of life. On day 4 (D4) of life, the 2D-echocardiogram performed due to a systolic murmur showed the presence of a hemodynamically significant patent ductus arteriosus. After two cycles of intravenous ibuprofen in standard doses (three doses per cycle: first dose 10 mg/kg/day once a day, followed by two doses of 5 mg/kg/day once a day), the ductus arteriosus (DA) remained significant. The DA was surgically ligated on D12, successfully. On D3 postoperative, she was extubated to NCPAP, maintaining mild respiratory distress. During a progressive increase of enteral feeding, she presented with increased work of breathing and maintenance of oxygen supply, despite a normal chest X-ray. On D25 of life, the chest X-ray revealed an elevation of the left diaphragm. • What is your diagnosis? • Would you perform any complementary test to confirm the suspected diagnosis? • What do you expect to observe on physical examination? • What approach and outcome are suggested for this patient?

Keywords

• diaphragmatic paralysis
• patent ductus arteriosus
• respiratory distress
• preterm