Dear all 

A little bit of brainstorming is needed. We had a term baby deliver SVD. No risk factors for sepsis. Cord around the neck at delivery noted. Baby at birth did not require any resuscitation and was with mum in the postnatal ward. Had a 25 ml feed. Asked to review by the neonatal team due to facial congestion and low temp. Temp was normal on the review but grunting and facial congestion was noted straight away brought to nicu at 8 hours of age due to oxygen requirement. Soon needed ventilating and curosurf. Post ventilation oxygen requirements came down to air. Blood gases were satisfactory. PH>7.25 BE and Lactate WNL. 

Noted to have abnormal movements at 11 hrs loaded with phenobarbitone and CFM was commenced. No further clinical or subclinical seizures. However the baby's facial congestion is so bad that the face looks purple (as if strangulated) in comparison to the body (which is probably normal colour but looks pale if you look at the face) Bloods including platelets, coagulation and hematocrit are normal. I don't know... could be my perception, it seems that the facial congestion is getting worse. Head scan is normal. No obvious stroke (but limited study). Mild periventricular flare.

Do I need to worry and investigate further???? but what ???? I'm thinking could there be a clot in the neck vessels? It might be just secondary to cord around the neck but wanted to share ...am I missing something! Your comments are appreciated.

 

 

 

 

 

 

 

 

 

 

 

Is there a history that the head was ”stuck” outside while the body was about to be delivered?

If yes, watchful waiting sounds good.

Cerebral sinovenous Thrombosis comes to mind. What do you mean by abnormal movements? Were you suspecting a seizure?

Thank you for your comments. @Stefan Johansson and @Francesco Cardona yes he had a probable seizure but no further seizures. CFM for 48 hours all satisfactory. Baby is now extubated and we are normalising his care. I think waiting and watching worked.  

Just to let you know baby's comgestion settled on its own ...waiting and watching was a good idea indeed. 

 

@Schumz thanks for closing the loop with those good news!