Topics

Thank you

We don't measure breastfeeding volumes in infants given iv fluids or enteral NG tube feeds, but we make some assumptions. During the first 1-2 days of life, we don't take colostrum volumes into account at all, especially if the infant is just make some attempts to breastfeed. Later and when on NG tube feeds, we make a pragmatic plan and reduce the NG tube volumes with a reasonable volume. "Reasonable" in terms of ml? For a term infants with vigorous breastfeeding attempts we may reduce NG tube volumes withs with 1/3 per day (i.e. aim to take the NG tube out within 3 days). For a preterm infants, we usually reduce the NG tube feeds with 5-10 ml/feed after a good breast feeding attempt in preterm infants.  

how can we estimate and subtract breastfeeding volume in a newborn taking intravenous fluid ?

This could be an isolated localized hair overgrowth. However, it can be associated with neuroectodermal anomalies. CPAP has no relation to the hair tuft. Hair collar sign has been described. Below are some references. References 1. Commens C, Rogers M, Kan A. Heterotropic brain tissue presenting as bald cysts with a collar of hypertrophic hair: the ‘hair collar’ sign. Arch Dermatol. 1989;125(9):1253–1256 2. Drolet BA, Clowry L Jr, McTigue MK, Esterly NB. The hair collar sign: marker for cranial dysraphism. Pediatrics. 1995;96(2 pt 1):309–313 3. Stevens CA, Galen W. The hair collar sign. Am J Med Genet A. 2008;146A(4):484–487 4. Held I, Rose C, Hamm H, Fölster-Holst R. The hair collar sign: a possible indication of cranial dysraphism. J Dtsch Dermatol Ges. 2011;9(2):136–138 5. Bessis D, Bigorre M,Malissen N, et al;Groupe de Recherche Clinique en Dermatologie Pédiatrique. The scalp hair collar and tuft signs: a retrospective multicenter study of 78 patients with a systematic review of the literature. J Am Acad Dermatol. 2017;76(3):478–487 6. Harrington BC. The hair collar sign as a marker for neural tube defects. Pediatr Dermatol. 2007;24(2):138–140   An additional reference   Alexander K.C. Leung and Benjamin Barankin. Visual Diagnosis: A Ring of Long, Dark, Coarse Hair on the Scalp of a 5-month-old Girl. Pediatrics in Review July 2018, 39 (7) e31-e32; DOI: https://doi.org/10.1542/pir.2017-0094

Strange if nothing was seen from the start? Else I agree on that having nevioid lesions, lipomas or hemangiomas centrally etc one should rule out CNS-defects.