lmlang

Hello: Very interesting case. Not seen personally in my practice but considering the differential for boney lesions in the newborn I would agree that this may very well be osteofibrousdysplasia. There have only been a few case reports in the literature of this lesion in a newborn. Perhaps an open biopsy will be necessary to confirm a diagnosis and better direct future care. Good luck. Please give us some follow up when more information becomes available. Les Lang Neonatologist USA

Marello: I would agree with Dr. Deshpande. It is understandable that a serious infection like meningitis in the first twin would worry any of us regarding the risks to the other twin. One might worry if this is a particularly virulent strain of GBS or could the twins both of some immunodeficiency making them more susceptible to infection. However, the most likely scenario is that the first twin, being premature and colonized, was unlucky enough to become infected (most likely through the usual portals). If the other twin is asymptomatic the acceptable approach would be to watch her closely at home. Perhaps a thorough discussion with the family regarding what to watch for would be the most beneficial, and then work up and treat if she shows any signs or symptoms of possible infection. Good luck. Les Lang Neonatologist USA

Hello Naveed: I am new to these forums but would like to respond to your question. I assume by "Golden Hour" you refer to the care given during the first hour (or hours) of life. Your question is quite broad as this care encompasses so many considerations and possible interventions. It also very likely will vary with just how premature an infant is. However, I think your question is extraordinarily important since having a protocol for these interventions is likely to guarantee a better outcome, assuming the protocol is well thought out and evidence based. I would like to refer you to a document which is available on line at www.yorkshireneonet.org.uk/guidelines_folder/GoldenHour.htm . It was published by Bradford Teaching Hospitals in the past several years and is an excellent starting point for many NICUs. It can serve as a template and then could be modified to suit the needs and abilities of each unit. Perhaps questions regarding specific interventions could then be addressed through this forum. I hope that helps.