Rare and unexpected complication after a malpositioned nasogastric tube in a neonate

Description

A full-term newborn boy was admitted to the high dependency unit at the age of 4 hours with signs of respiratory distress, tachypnoea and recession with low oxygen saturation. There was no perinatal history of concerns; delivery was normal and uneventful, but the mother was colonised with Group B streptococcus.

A plan was made on admission for a chest X-ray, a nasogastric tube (NGT) insertion and antibiotics. NGT was placed by a senior neonatal nurse without incident, followed by chest X-ray primarily looking for respiratory causes of the respiratory distress. This however revealed that the NGT was malposed into the right main bronchus (figure 1). There were no signs of choking or cough at the time of insertion. NGT was then pulled out and a new one reinserted in a satisfactory position and confirmed on a repeat chest X-ray (figure 2). A right-sided small and...

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