LAUSR

A full- term male infant was born in a tertiary care centre following spontaneous vaginal delivery. The labour was complicated by chorioamnionitis. The infant was born vigorous and neonatal resuscitation was uneventful, with Apgar scores of 5 and 8 at 1 and 5 min, respectively. At 10 min of life the infant developed increased work of breathing in the form of grunting and subcostal retractions. He was started on continuous positive airway pressure (CPAP) set at positive end expiratory pressure 5 cm H 2 O via a T- piece face mask. CPAP was discontinued after 3 min due to lack of any significant improvement. Because of the persistence of respiratory symptoms, the infant was admitted to the intensive care unit (ICU). On admission to the ICU his respiratory distress had improved. Cardiovascular examina-tion showed muffled heart sounds with capillary refill time of 3 s, a heart rate of 158 beats/min, blood pressure (BP) 55/26(38) mmHg and normal femoral/brachial pulses. Initial capillary expiration) and tricuspid inflows (>40% drop in tricuspid peak E- wave in expiration in comparison to inspiration), variation in ventricular output during the respiratory cycle (>10% drop in peak velocity seen in the aorta in inspiration and >10% increase in the peak velocity seen in the pulmonary outflow in inspiration), inferior vena cava collapsibility (<50% during respiration) and paradoxical movement of the interventricular septum during diastole. 4 Partial disappearance of the cardiac image during systole and comet tail artefacts emerging from the pericardium are more specific echocardiographic signs for pneumopericardium. 5 Serial monitoring with echocardiography for development of collapsibility of cardiac cavities, starting with the right atrium followed by the right ventricle and left atrium, a worsening trend in the respiratory variation across the inflow and outflow valves and increasing distension of the inferior vena cava will indicate echocardiographic progression towards cardiac tamponade.