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Aymen Eshene

Hemangioma ? Next steps ?

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Hello .

 

I would like to share with you these pictures for a term baby who was born in a good condition after uneventful pregnancy .

 

So , what to do next ? Imaging for head and abdomen ? 

 

( permition taken ) 

Thanks .

 

 

28511891_10215304639986287_1252713904_n.jpg

28535809_10215304639786282_1536664554_n.jpg

28535970_10215304640346296_78519718_n.jpg

28537189_10215304636266194_512732515_n.jpg

28537870_10215304639426273_154872549_n.jpg

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If baby is stable, just observe. Needs only CBC to rule out thrombocytopenia, Kasabach–Merritt syndrome.  In a resource limited NICU like yours ,I would just keep the baby in followup, no investigation except CBC. If thrombocytopenia, will tell you what to do. till then routine care.

Below is the link to have detail management of infantile hemangioma, not related to your case but overall review.

https://www.dovepress.com/current-perspectives-on-the-optimal-management-of-infantile-hemangioma-peer-reviewed-fulltext-article-PHMT#

keep posting, your cases are great learning case for all of us especially to guide someone in very limited resources

 

Naveed 

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Thanks for sharing your case Ayman.

As @rehman_naveed clearly recommended concerning CBC. Reassure the infant`s family, the size may increase in the first few months and is expected to decrease later on.

In similar cases in our unit we would consider propranolol after a normal cardiac examination and ECG, to be started in the NICU and if the infant tolerates it, will be D/C to home on oral propanolol and followed in outpatient.

Good luck.

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@Hamed

In the protocol that we had to start propranolol for hemangiomas we are not doing screening ECHO or ECG

We are just measuring BP and RBS after Ist dose and after each increment of the dose

@Aymen Eshene

Thanks for sharing such chalanging patients 

In the neoreviews october 2017 you will find a patient similar to your patient presented by Dr Jubara who will present the magic bullets of golden hour in the upcoming meeting

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Excellent @tarek. I wish I can attend the meeting but due to working condition, didn't get time to attend as golden hour remained my favourite topic especially how to manage time in putting UAC and UVC in that 60minutes especially when you are training juniors , time consumed in x ray, medication arrival etc. these are the rate limiting steps to achieve golden hour success, do let us know what he comment on these issues.

I am sharing the article you mentioned in above post for all reviewers.

@Aymen Eshene your patient will have a somewhat similar outcome, so please make sure to have proper follow up and to start propranolol at proper time.

Naveed 

e629.full.pdf

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@tarek & @rehman_naveed

Well, there is no clear national pre-screening guidelines for the use of propranolol. However, we do the following screening parameters:

Full clinical examination, CBC, electrolytes, urea and creatinine, bl glucose, T3, T4 and TSH, Abdominal ultrasound (in case of multiple lesions), cranial U/S, ECG and ECHO. In addition to photos of the hemangiomas and their diameters. 

I believe every unit will follow their own screening guideline until we have a clear statement. 

Agree with both of you, the Golden hour and the expected magic bullets of the golden hour will be a really nice subject talk. Unfortunately, I am not able to join the meeting also. Looking forward to hearing your feedback and the recommendations coming out of the meeting.

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:)

I think there is missunderstanding for what i said although its nice missunderstanding

I said in NEOREVIEWS OCTOBER 2017

there is a case presentation almost similar to the case of @Aymen Eshene

This case presentation by Dr Jubara who WILL present the magic pullets of golden hour in the upcoming meeting 

Hemangioma.pdf

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On 3/5/2018 at 3:15 AM, rehman_naveed said:

If baby is stable, just observe. Needs only CBC to rule out thrombocytopenia, Kasabach–Merritt syndrome.  In a resource limited NICU like yours ,I would just keep the baby in followup, no investigation except CBC. If thrombocytopenia, will tell you what to do. till then routine care.

Below is the link to have detail management of infantile hemangioma, not related to your case but overall review.

https://www.dovepress.com/current-perspectives-on-the-optimal-management-of-infantile-hemangioma-peer-reviewed-fulltext-article-PHMT#

keep posting, your cases are great learning case for all of us especially to guide someone in very limited resources

 

Naveed 

Thanks a lot for your help .

8 hours ago, tarek said:

:)

I think there is missunderstanding for what i said although its nice missunderstanding

I said in NEOREVIEWS OCTOBER 2017

there is a case presentation almost similar to the case of @Aymen Eshene

This case presentation by Dr Jubara who WILL present the magic pullets of golden hour in the upcoming meeting

I tried to upload it but but it is a big file so i will try to upload it as photos

Screenshot_2018-03-06-17-27-36.png

Screenshot_2018-03-06-17-27-40.png

Remaing 3 pages i uploaded in slack 

As not uploaded her

Thanks

@Stefan Johansson 

your article is of great help .

thanks for your time and support .

21 hours ago, Hamed said:

@tarek & @rehman_naveed

Well, there is no clear national pre-screening guidelines for the use of propranolol. However, we do the following screening parameters:

Full clinical examination, CBC, electrolytes, urea and creatinine, bl glucose, T3, T4 and TSH, Abdominal ultrasound (in case of multiple lesions), cranial U/S, ECG and ECHO. In addition to photos of the hemangiomas and their diameters. 

I believe every unit will follow their own screening guideline until we have a clear statement. 

Agree with both of you, the Golden hour and the expected magic bullets of the golden hour will be a really nice subject talk. Unfortunately, I am not able to join the meeting also. Looking forward to hearing your feedback and the recommendations coming out of the meeting.

Thank you for your very useful information .

Waiting for U/s results .

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