What has happened to cause this abrupt change in appearance?
The patient has been started on ECMO (the clue is that ECMO catheters are now present, in the right IJV and CCA). Generalized lung parenchymal opacification is common following commencement of ECMO in a neonate, and is thought to be due to the changes in pulmonary haemodynamics and the abrupt decrease in ventilator settings.
What are some of the indications for ECMO in a neonate?
Severe respiratory failure from such causes as meconium aspiration, primary pulmonary hypertension, severe congenital heart disease or congenital diaphragmatic hernia.
What potential complications of ECMO should neonates be monitored for?
All patients on ECMO are anticoagulated and at risk of haemorrhage. In particular, intracranial haemorrhage should be screened for with cranial ultrasound. Chest complications are relatively common, and include pneumothorax, pleural effusions and migration of the catheters.
The patient's x-rays remained relatively unchanged for 4 days. On day 5 the CXR looked like this...