Aymen Eshene Posted March 3, 2018 Share Posted March 3, 2018 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 . 1 Link to comment Share on other sites More sharing options...
rehman_naveed Posted March 5, 2018 Share Posted March 5, 2018 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 3 Link to comment Share on other sites More sharing options...
Hamed Posted March 5, 2018 Share Posted March 5, 2018 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. Link to comment Share on other sites More sharing options...
tarek Posted March 5, 2018 Share Posted March 5, 2018 @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 Link to comment Share on other sites More sharing options...
rehman_naveed Posted March 6, 2018 Share Posted March 6, 2018 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 Link to comment Share on other sites More sharing options...
Hamed Posted March 6, 2018 Share Posted March 6, 2018 @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. Link to comment Share on other sites More sharing options...
tarek Posted March 6, 2018 Share Posted March 6, 2018 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 2 Link to comment Share on other sites More sharing options...
Aymen Eshene Posted March 6, 2018 Author Share Posted March 6, 2018 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 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 . 2 Link to comment Share on other sites More sharing options...
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now