PP-241. Congenital adrenal hyperplasia: An endocrine disorder with neonatal onset — Case report

Premature male, 33 weeks gestation. Caesarean due to intrauterine growth restriction and cardiotopography with poor variability. Apgar 8/ 10. Birthweight 1335 g. On day 2 he showed worsening respiratory distress and increasingoxygen requirements. The chest radiograph (CXR) showed complete opacity of the left hemithorax. There was oedema at the left clavicle and shoulder and bleeding at the site of the Peripherally Inserted Central Catheter (PICC), which was withdrawn. He required mechanical ventilation for two days. A chest drain was placed, with outflow of serous fluid, compatible with parenteral nutrition solution: glucose159 mg/dl (serumglucose139 mg/dl), protein<0.2 g/dl, amylase <3 UI/L, albumin <0.2 g/dl, erythrocyte 982/uL; cells 4/uL. CXR after drainage: lungs well expanded. From day 5 to 19, spontaneous breathing in air. Increasing respiratory distress on day 19. CXR showed elevated left hemidiaphragmwith left lung collapse. Abdominal ultrasound showed a subcostal spleen. Thoracic magnetic resonance imaging showed diaphragmatic eventration as a cause of the collapsed left lung. Doppler ultrasound of the subclavian vein showed no changes. From day 22 he demonstrated worsening respiratory distress and increasing oxygen requirements. On day 37 a laparascopic plicature was performed. The procedure findings revealed a congenital cause to the diaphragmatic eventration.