Anna Moscow

Dear collegues! Do anyone have an experience of treating nonates with congenital inherited trombophilia, caused by homozigote mutations (PAI-gene-mutation, methylenetetrahydrofolatreductase - gene-mutation). Now we have such a baby with problems, caused by both hyper- and hypocoagulation at the same time (this baby experienced peripheral lower extremity vene trombosis and had a large clinically-silent tromb in left atrium shortly after birth, nearly at the same time - gastric hemorrage). This baby was treated for suspected neonatal infection with one course of antibiotics. We suggest that coagulation problems were provoced by infection. Both parents have verifyed trombophilic mutations. Now (2 weeks later) trombosis resolved, but future management still seems unclear !!?

Dear Stephan and all! I apologise for a long silence about the clinical case of laryngomalacia. To our regret, the situation haven`t resolve yet: this baby is still intubated and spontaneously breathing through ETT. Additional examination (MRI etc) showed more severe brain abnormalities,than we suspected before, and bilateral blindness. So the prognosis seems to be poor. In Russia there`s a difficulty with performing laryngopexia on routine basis. Two days ago we transferred baby to a special clinic. As I know, they are going to perform tracheostomy.

Hi, Stephan and all the members! In our unit we ran across the case of congenital laryngomalacia, associated with minor brain abnormalities (cariotype 46XX). This baby required intubation immediately after birth because of stridor, then was ventilated for 18 days. Several attempts to extubate the baby within 72 hours after birth failed. Our surgeons performed laryngotracheoscopy and the diagnosis of laryngomalacia was established. They recommended 14-day course of prednisolone 1 mg/kg/day for larynx maturation and then repeated extubation. Now baby is 1 month old, spontaneously breathing through ETT. We tried 2 attempts of extub on nCPAP mode, but severe stridor signs occurred and reintubation was needed. The questions are: 1) do steroids really maturate the laryngeal cartilages? If yes what do the indications for repeated course look like? 2) what kind of respiratory support is preferable for this baby? What are the criteria for tracheostomy? 3) If someone had such an experience, what are the possible outcomes? Thanks for all of you.