A 30-week preterm baby born by emergency caesarean section because of placenta praevia and antepartum haemorrhage was ventilated from birth and had repeated reintubations. By day 7 ventilation became difficult and on day 12 was transferred to a tertiary centre for escalation of ventilatory support. The transfer diagnosis was sepsis and pulmonary hypertension. Review of the chest x-rays (figures 1 and 2) shows pneumomediastinum not seen on previous …