Urban Rosenqvist

1c 2 No 3 for an asphyxiated baby: a For a premature baby: b (prophylactic nCPAP)

Twin, w31+4, SGA 994g. Short time on ventilator/RDS and later CPAP. Now on HFNC. Now 6 weeks old. Since roughly 2 weeks age this girl has a patch of hypertrichosis in her scalp. This is surrounded by an area of slightly less hair. The patch has crusta-like borders so it feels like a scab. The dermatologist speculated a month ago of it being caused by the CPAP. It looks the same now after a month and I´m not familiar with wounds that has excessive hair growth in them? I´ve looked up "nevoid hypertrichosis" as an alternative diagnosis but of course a reaction after a wound is much more common... I have the parents consent to post the pics here Any ideas?

bimc Good point though. I will check for mislabeled/swapped probes in the future...

Thank you for your feedback! I am not alone 😊

I wonder if there are any more common states where you would find reversed pre- and postductal saturations? We see it sometimes and those children do not have serious congenital heart defects such as TGA. Right now I´m looking at one baby with 95% foot 86% right hand. Any experience on this?

Thanks for the pictures! I’ve seen the bottom picture before and that is the only picture of ”ectropion uveae” that looks similar to my findings, although a very mild variant. Mostly it looks like the upper pictures although not that extreme and not extending radially outwards onto the iris but only inwards, into the pupil.

Bumping this one... a very benign condition but for those interested Had antoher patient with these findings and I did som more digging on the topic.... It looks like it could be "Iris Flocculus/flocculi" I teamed up with the opthalmologist today to see that they would see what I saw and she did. They usually call it "epithelial cyst of the iris" and if it´s only on the margin of the pupil they dont check it further. If it´s bigger (like this one covering a third of the caudal part of the pupil) they have follow up checks. There are two Pictures showing iris flocculi in the link below In Figure 2 - A and B http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiKs4mUj5_fAhWjAxAIHVV5BB0Q5TV6BAgBEAs&url=http%3A%2F%2Fwww.apjo.org%2FApjo%2FdownPDF%2Fid%2F462.html&psig=AOvVaw2CHiN8-FCSrDAlRPpuCl_R&ust=1544869834309802 I also found an old article from 1998 where they describe the phenomenon "Flocculus neonatorum" - a self resolving benign nodular flocculus of the Iris in the newborn. https://journals.sagepub.com/doi/abs/10.1177/000992289803700509?journalCode=cpja and they estimate it to be as common as 1 out of 30 newborns so I´m surprised that so few examiners recognise these findings Finally I can sleep peacefully

An interested ENT specialist does ours within 1-2 days. As for the criterias for intervention we tend to go with: A subjective assessment of tounge tie-degree + continued feeding difficulties (even after midwife has observed and given breast feeding technique advice) and/or maternal painful nipples and/or poor weight gain. Honestly I think of it as mostly trial and error based on the factors above. We don´t use a scoring system. Those of you who do - does it help you in your decision and is this Hazelbaker scoring tool validated?

No problem @tarek

Thank you Stefan! This post was directed only to the Swedish members of this forum, thats why it was in swedish

Pediatric Week 2018 in Västerås, Sweden 23-26 April @ Aros congress center The neonatal part includes a Keynote lecture by Professor Lex Doyle, Australien, and the BPD-specialist Dr Edward Shepherd, US. View the preliminary program at www.barnveckan.se and follow on Instagram: barnveckan2018

Thank you!

@Stefan Johansson Yes, now the Freestyle Pro.

On the OT: The same here... To reduce pain we changed several years ago from heel lancing using a stationary meter to the mobile Freestyle Lite blood glucose meter. After that we had to deal with, and treat a lot more "hypoglycemias". After changing to another model of Freestyle we now see less hypoglycemias.

@Stefan Johansson Not yet a protocol on it... Did I understand you correctly - you mean milk/formula given by nasogastric tube driven by a "food pump" 24h a day? Because that´s what we are doing :-) Usually when the baby is admitted we try starting with normal bolus feeding but if the baby´s having difficulties in tolerating the given amount we switch to food infusion Sometimes they don´t tolerate 150ml/kg, sometimes they tolerate 220ml/kg or more. We set it to continous infusion (over 24h) and increase it until glucose levels are under control.

Stefan: We do that as well. We have no study on it but since roughly 2 years ago our need for intravenous infusion has dropped. After discussion with ALB hospital we learned that they are successful in preventing i.v. treatment when giving a supplement of oral Duocal (brand name - carbohydrates/fat) to breast milk.

Table2: Do you interpret the results that the use of intravenous infusion and bolus was not affected by the gel-intervention (p>0,05) but when it comes to admittance to NICU for hypoglycemia there was a benefit (p 0,03)? Anyone who has more information on this?

This is very interesting! Results of the study? Sorry, missed the link

Ectropion uvae according to the ophtalmologist. If you image-search the web for this I don´t think I find something that is spot on the appearance of my patients but I trust the opthalmologist...

Survey closed...

No other symptoms? Otherwise I would say that closure varies a lot from 3 to 18 months. If head shape does'nt suggest premature synostosis I would declare it as normal. /Urban

I will, if a get a picture!

They dont see it at all which I think implies that it's a dynamic process (also making me look like a fool ;)). Once though when it was so pronounced in one baby that I thought vision might get impaired the ophtalmologist acknowledged it and would do a follow up. Even then I got no clear explanation of it. I think it could be a normal finding caused by some developmental remnant (as your article points toward)? Next time I find it, I will do a follow up myself after 2 weeks before I consult an ophtalmologist. Thank you

In the maternity ward I sometimes come across babies with irregular pupillary shapes. Not like coloboma but the other way around - small black circles outline the pupil. Whenever I refer these findings to the ophtalmologist they don´t see it so I have´nt got a name for it. Does any of you have the same experience? Do you know what it is?