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Temkar S, Ramachandar H, Shah A, Manimaran PS. Valsalva retinopathy in a child on non-invasive ventilation: exploring the possible mechanisms. BMJ Case Rep 2024; 17:e258149. [PMID: 38565227 PMCID: PMC10989105 DOI: 10.1136/bcr-2023-258149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Shreyas Temkar
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, Puducherry, India
| | - Hemanth Ramachandar
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, Puducherry, India
| | - Aahan Shah
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, Puducherry, India
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2
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Thakur K, Sehgal A, Goel B, Chaudhary M. Autosomal recessive ALOX12B gene and consecutive collodion baby. BMJ Case Rep 2024; 17:e257608. [PMID: 38514164 PMCID: PMC10961509 DOI: 10.1136/bcr-2023-257608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Autosomal recessive congenital ichthyosis is a type of inherited ichthyosis which is a rare cluster of genetic disorders leading to defective keratinisation. The combined prevalence for lamellar ichthyosis and congenital ichthyosiform erythroderma is almost 1 per 200 000-300 000 people. Among all the mutations in this gene, missense and frameshift mutations are most common which account for 80% of the cases. Our patient had a mutation in R-type arachidonate 12-lipoxygenase gene (ALOX12B, OMIM*603741).
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Affiliation(s)
| | - Alka Sehgal
- Obstetrics and Gynecology, GMCH, Chandigarh, India
| | - Bharti Goel
- Obstetrics and Gynecology, GMCH, Chandigarh, India
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3
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Chung BHY, Yeow SLS, Chan JCK, Lee M. Simpson-Golabi-Behmel syndrome type 1 with normal birth parameters. BMJ Case Rep 2024; 17:e247864. [PMID: 38442972 DOI: 10.1136/bcr-2021-247864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A newborn baby born at 34 weeks and 5 days gestation was admitted for prematurity, dysmorphic features and congenital heart defects. Antenatal scan at 21 weeks showed a large-for-gestational-age foetus with a large abdominal circumference and liver, ventricular septal defect, right prominent renal pelvis and echogenic bowel. Antenatal genetic tests for overgrowth syndromes were negative. The mother had early onset pre-eclampsia. After birth, an overgrowth syndrome was still suspected despite the baby having normal birth parameters. Raw data of the trio whole exome sequencing from the amniocentesis sample were manually inspected. Hemizygous exon 7 deletion in the GPC3 gene was found, and a postnatal diagnosis of Simpson-Golabi-Behmel syndrome, a rare overgrowth syndrome, was made. This case report discusses the significance of antenatal findings, an atypical presentation of a rare syndrome and the obstacles of diagnostic genetic testing.
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Affiliation(s)
- Brian Hon Yin Chung
- Paediatrics & Adolescent Medicine, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | | | | | - Mianne Lee
- The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
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4
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Costa IS, Vala B, Costa S, Henriques R. Rare cause of jaundice in a term newborn. BMJ Case Rep 2024; 17:e258661. [PMID: 38355207 PMCID: PMC10868289 DOI: 10.1136/bcr-2023-258661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Neonatal jaundice is a frequently observed occurrence in full-term newborns and typically manifests between 48 and 96 hours following birth. Early-onset jaundice is primarily induced by pathological factors, namely sepsis, hemolysis and an excessive accumulation of bilirubin resulting from the breakdown of red blood cells.We present a case involving a full-term newborn with an uneventful perinatal history, who exhibited jaundice within the initial day of life and was subsequently admitted to the neonatal intensive care unit to commence intensive phototherapy. Initial screenings for sepsis and blood group incompatibility yielded negative results. However, despite 6 hours of phototherapy, the bilirubin levels did not decrease, prompting an investigation into central nervous system haemorrhage, which uncovered the presence of a haemorrhagic stroke.After a worsening in neurological status with neonatal crisis and need for phenobarbital, a life-saving craniotomy was performed. Clinical evolution was good with no additional crisis detected after the early neonatal period and improvement in motor function at 2-month-old follow-up.
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Affiliation(s)
- Inês Silva Costa
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Pediatrics Department, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Beatriz Vala
- Pediatrics Department, Centro Hospitalar Leiria EPE, Pousos, Portugal
| | - Sofia Costa
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Raquel Henriques
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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5
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Sankannaavr A, Puttalinga D, Bagalkot PS. Subsequent development of Kawasaki disease following acute human adenovirus infection among siblings. BMJ Case Rep 2024; 17:e257257. [PMID: 38272517 PMCID: PMC10826485 DOI: 10.1136/bcr-2023-257257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
We report a middle-childhood girl presented with high-grade fever and headache for 4 days. Following this, the child developed mucocutaneous symptoms. She had a notable family history of autoimmune disease. Tests revealed increased inflammatory markers. On the sixth day of illness, a two-dimensonal echocardiogram showed an enlarged coronary artery, diagnosed as incomplete Kawasaki disease (KD) and treated with IVIG and aspirin.Within a week, her younger sibling, an early-childhood girl presented with features of viral prodrome, developed mucocutaneous lesions and subcutaneous oedema of limbs. Her investigations also showed elevated inflammatory markers and echocardiographic changes, diagnosed as incomplete KD.The subsequent development of KD in siblings, both showing initial viral symptoms and a family history of autoimmune disease, led to the suspicion of a potential viral trigger. This was confirmed through viral PCR studies for human adenovirus (type 3). These cases highlight an unusual occurrence of KD developing in siblings following acute adenoviral infection.
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Affiliation(s)
- Ashwini Sankannaavr
- Paediatrics, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Divyashree Puttalinga
- Paediatrics, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Praveen S Bagalkot
- Paediatrics, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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6
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Yeh LLY, Haak T, Ten Hove FL, Rhemrev SJ. Male adolescent with cardiac rupture after blunt thoracic trauma. BMJ Case Rep 2024; 17:e256042. [PMID: 38216168 PMCID: PMC10806948 DOI: 10.1136/bcr-2023-256042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Blunt cardiac injury, including a rupture of the atria or ventricle, is most commonly caused by motor vehicle collisions and falls from great heights. A rupture of a cardiac chamber is an extremely rare diagnosis with a high mortality rate. The best chance at survival can only be accomplished with timely intervention.To raise awareness of this potentially life-threatening injury, we describe the case of a male adolescent with cardiac rupture after blunt thoracic trauma. While the focused assessment with sonography in trauma (FAST) examination was negative, an additional CT showed pericardial effusion. During the operation a rupture of the right ventricle was observed.Even though the physical recovery of our patient is remarkable, the traumatic event still affects his mental well-being and activities in daily life. This case emphasises the need of a multidisciplinary approach to achieve the best possible physical and psychological recovery in multitrauma patients.
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Affiliation(s)
- Lin-Lin Yessica Yeh
- Department of General Surgery, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | - Timo Haak
- Department of General Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - F Laura Ten Hove
- Department of Radiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Steven J Rhemrev
- Department of General Surgery, Haaglanden Medisch Centrum, Den Haag, The Netherlands
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7
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Zeman K, Cullen T, Atkin KL, Armstrong RK. Delayed presentation of a malpositioned central venous access device (CVAD) in a neonate. BMJ Case Rep 2024; 17:e255685. [PMID: 38195186 PMCID: PMC10806968 DOI: 10.1136/bcr-2023-255685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Kiah Zeman
- Neonatal Intensive Care Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Terry Cullen
- Neonatal Intensive Care Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Karen L Atkin
- Radiology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ruth K Armstrong
- Neonatal Intensive Care Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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8
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Shima T, Kinjo T, Park S, Sonoda M. Perinatal clinical course of Vici syndrome associated with novel EPG5 variants: unique cardiac changes and difficulty with foetal diagnosis. BMJ Case Rep 2024; 17:e255847. [PMID: 38182173 PMCID: PMC10773411 DOI: 10.1136/bcr-2023-255847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Vici syndrome is a genetic disorder involving autophagy dysfunction caused by biallelic pathogenic variants in ectopic P-granules 5 autophagy tethering factor (EPG5). We report the perinatal clinical course of a neonate with Vici syndrome with a unique cardiac presentation. Foetal ultrasonography (US) detected right ventricular hypertrophy, hypoplastic left ventricle and narrowing of the foramen ovale, which were alleviated after birth. Agenesis of the corpus callosum and cerebellar hypoplasia were missed antenatally. After delivery, the patient was clinically diagnosed with Vici syndrome and two novel pathogenic mutations were detected in EPG5 The T-cell receptor repertoire was selectively skewed in the Vβ2 family. Immunological prophylaxis and tube feeding were introduced. Early diagnosis helps parents accept their child's prognosis and decide on a care plan. However, US has limited potential to detect clinical phenotypes associated with Vici syndrome. Foetal MRI may detect the characteristic abnormalities and contribute to antenatal diagnosis.
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Affiliation(s)
- Takashi Shima
- Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Tadamune Kinjo
- Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Sungyeon Park
- Department of Hematology, Infection, and Immunology, Fukuoka Children's Hospital, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
| | - Motoshi Sonoda
- Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University Hospital, Fukuoka, Japan
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9
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Liggett CJ, Zven SE, Schulz EV, Stark CM. Massive fetomaternal haemorrhage warranting novel use of tandem isovolumetric partial exchange transfusion and therapeutic hypothermia. BMJ Case Rep 2023; 16:e256634. [PMID: 38160023 PMCID: PMC10759016 DOI: 10.1136/bcr-2023-256634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
A newborn male infant was pale, hypotonic, and had respiratory distress after delivery. Venous cord blood gas revealed a severe metabolic acidosis. His initial examination was consistent with moderate encephalopathy and laboratory testing uncovered severe congenital anaemia (haematocrit 0.127 L/L). He met the clinical criteria for therapeutic hypothermia (TH) and required red blood cell transfusions, but due to the severity of his anaemia, an exchange transfusion was favoured to prevent transfusion-associated circulatory overload. There are no previous reports of these procedures completed in tandem, but the benefits were perceived to outweigh the risks. During the 72 hours of TH, the infant received an isovolumetric partial exchange transfusion and tolerated both treatments without any adverse clinical events.Kleihauer-Betke testing detected a massive chronic fetomaternal haemorrhage with 475 mL (164 mL/kg) of blood. A brain MRI completed prior to discharge was normal. At 6 months of age, he is growing and developing normally.
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Affiliation(s)
- Connor J Liggett
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sidney E Zven
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth V Schulz
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Christopher M Stark
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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10
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Raets M, Dirix M, Hütten MC. Cerebral near-infrared spectroscopy for early recognition of impending cardiac tamponade in a preterm neonate. BMJ Case Rep 2023; 16:e256014. [PMID: 38087490 PMCID: PMC10728941 DOI: 10.1136/bcr-2023-256014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheter (UVC) placement in neonates. Mortality rates are high; therefore, early diagnosis is important. We present a case of a preterm infant with a UVC in situ who underwent a laparotomy on the first day of life for pneumoperitoneum secondary to meconium ileus. The operation was uneventful; however, 2 hours after surgery, the patient developed cardiac tamponade, requiring resuscitation and pericardiocentesis. In retrospect, near-infrared spectroscopy (NIRS) showed a gradual decline in cerebral oxygenation (crSO2) in the 30 min prior to the cardiac arrest, while other vital signs were within normal ranges. Our case demonstrates that cerebral NIRS monitoring can serve as an additional clinical marker for early recognition of impending cardiac tamponade.
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Affiliation(s)
- Marlou Raets
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Marc Dirix
- Surgery, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Matthias Christian Hütten
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
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11
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Rawat J, Singh S, Tyagi N, Pant N. Retrieval of a retained umbilical vein catheter at 6 months. BMJ Case Rep 2023; 16:e254380. [PMID: 37963667 PMCID: PMC10649496 DOI: 10.1136/bcr-2022-254380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Umbilical venous catheterisation is carried out for the care of neonates who have very low birth weight and are critically ill. It is uncommon for catheter fragments to become fractured and retained. Here, we describe a case of a retained fractured umbilical vein catheter in an infant. An endovascular procedure to retrieve a catheter is the usual management option when the catheter has been accidentally cut and has moved proximally into a major vessel or inside the heart. It is rare to need open exploration and retrieval.
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Affiliation(s)
- Jiledar Rawat
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nirpex Tyagi
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nitin Pant
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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12
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Naik P, Anne RP, Mathai SS, Pai N. Neonatal perforated appendicitis: a presentation of necrotising enterocolitis? BMJ Case Rep 2023; 16:e257097. [PMID: 37945278 PMCID: PMC10649705 DOI: 10.1136/bcr-2023-257097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
In this case report, we present a late preterm growth-restricted neonate who developed signs of feeding intolerance on the second day of life, which progressed to frank peritonitis with perforation by the end of the second week of life. As necrotising enterocolitis was considered the most likely diagnosis, a glove drain was placed in the flanks. The neonate did not improve, and surgical exploration was done after medical stabilisation. On exploration, the neonate was found to have appendicular perforation and an appendicectomy was performed. During surgery, the rest of the gut was noted to be healthy. Histopathological examination of the appendix showed transmural inflammation, focal infarction and perforation. The postoperative period was uneventful, and the neonate showed rapid improvement and reached full enteral feeding in the next 5 days. Antibiotic therapy promptly resolved bacterial peritonitis, and the neonate was discharged successfully.
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Affiliation(s)
- Prathit Naik
- Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Rajendra Prasad Anne
- Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Sheila Samanta Mathai
- Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Nitin Pai
- Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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13
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Lim AM, Yap TL, Kong JY. Incarcerated hernia with ileal perforation in an extreme preterm infant. BMJ Case Rep 2023; 16:e257640. [PMID: 37914168 PMCID: PMC10626876 DOI: 10.1136/bcr-2023-257640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
We describe a case of a premature 24 weeks gestation infant who presented with clinical lability and abdominal distention with initial concerns of necrotising enterocolitis. On further examination, a right inguinal hernia was noted and serial abdominal X-rays showed bowel loop dilatation with intramural air and no perforation. However, the hernia was recurrent and later found to be not reducible. He underwent right groin exploration. Intraoperatively, distal ileal perforation was noted and he was found to have an additional five sites of perforation. He had a stoma sited at the left iliac fossa as well as primary anastomosis at the site of the second to fifth perforations. He had a stormy postoperative period but is currently doing well. Although obstructed hernias are rare in the initial course of an extreme preterm infant, it should not be missed as a cause of intestinal obstruction and early surgical opinion should be sought.
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Affiliation(s)
- Alicia May Lim
- Neonatology, KK Women's and Children's Hospital, Singapore
| | - Te-Lu Yap
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Juin Yee Kong
- Neonatology, KK Women's and Children's Hospital, Singapore
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14
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Eckel F, Klebermass-Schrehof K, Bago-Horvath Z, Farr A. Successful delayed interval delivery of a triplet pregnancy using conservative management. BMJ Case Rep 2023; 16:e254705. [PMID: 37714554 PMCID: PMC10510915 DOI: 10.1136/bcr-2023-254705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Preterm birth is a significant cause of perinatal morbidity and mortality, especially in multiple pregnancies. Delayed interval delivery can prolong pregnancy for the remaining fetus(es) in an imminent stillbirth or extremely preterm birth of the first fetus, improving the lastborn's outcomes. We present a case of delayed interval delivery of a triplet pregnancy following preterm prelabour rupture of membranes and progressive cervical insufficiency. Following vaginal delivery of the first fetus at 24+1 gestational weeks, the patient received antibiotics and tocolysis. Cerclage was not conducted as the mother had a vaginal infection. A 15-day delivery interval for the second and third fetuses was achieved. The firstborn required mechanical ventilation and inotropic support, while the others only required continuous positive airway pressure. There is no consensus on the best way to perform delayed interval delivery. We achieved a complications-free interval of 15 days with conservative management in a triplet pregnancy.
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Affiliation(s)
- Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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15
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Schim van der Loeff I, Tsilifis C, Abdelhafiz K, Williams EJ. Recurrent group B stretococcus infection in an extremely premature infant: as a preterm neonate, infant and toddler. BMJ Case Rep 2023; 16:e255216. [PMID: 37507127 PMCID: PMC10387633 DOI: 10.1136/bcr-2023-255216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
We report five discrete episodes of group B streptococcus (GBS) bacteraemia in an extremely premature infant, extending into early childhood. The first four episodes occurred during infancy despite appropriate treatment. Breastmilk was positive for group B streptococcal 16S DNA by polymerase chain reaction. The fifth episode occurred at 17 months of age, shortly after stopping antimicrobial prophylaxis.Radiological investigations did not identify a focus for recurrence of GBS bacteraemia, and immunological investigations and targeted whole genome sequencing yielded only transient hypogammaglobulinaemia of infancy, which resolved.This case highlights invasive GBS infection as a cause of infant morbidity. Premature infants are at particular risk of invasive as well as recurrent disease. GBS is typically a sensitive organism and each episode of GBS in our patient was effectively treated with penicillin. The role of breastmilk in recurrent GBS is controversial; in this case infant and mother isolated identical GBS serotypes and were concurrently treated with rifampicin.
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Affiliation(s)
- Ina Schim van der Loeff
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christo Tsilifis
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Khalid Abdelhafiz
- Neonatalogy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eleri J Williams
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
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16
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Kulkarni V, Sundaram V, Sameeksha TH. Overwhelming orbital cellulitis in a neonate. BMJ Case Rep 2023; 16:e252390. [PMID: 37491125 PMCID: PMC10373664 DOI: 10.1136/bcr-2022-252390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
This article discusses a rare ophthalmic manifestation of neonatal bacterial infection and its management, including surgical drainage. The case discussed is that of a neonate who presented with rapidly progressing ophthalmic symptoms suggestive of orbital cellulitis. The neonate also had extensive intracranial involvement and had spread to contiguous structures causing a temporal lobe abscess. As there was no local injury, a haematogenous spread was strongly considered. With blood culture and pus culture yielding the growth of Staphylococcus aureus, systemic antibiotics and surgical interventions were required to successfully manage the neonate. Through this case report, we emphasise that orbital infections are grave in neonates and may culminate into devastating intracranial complications; hence, it necessitates appropriate medical and surgical interventions right from hospital admission.
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Affiliation(s)
- Venu Kulkarni
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Venkataseshan Sundaram
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Carter R, Yakir M, Ryu J, Weiss K. Congenital CMV associated with diaphragm dysfunction: a rare cause of tachypnoea. BMJ Case Rep 2023; 16:e247959. [PMID: 37474144 PMCID: PMC10357725 DOI: 10.1136/bcr-2021-247959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
A late preterm infant with intrauterine growth restriction developed respiratory distress, tachypnoea and hypoxia after birth, requiring supplemental oxygen. Chest radiographs demonstrated persistent elevation of the right hemidiaphragm. Chest ultrasound initially demonstrated symmetrical bilateral diaphragm motion, but subsequent ultrasounds showed asymmetrical excursion with weaker movement of the right hemidiaphragm. Placental pathology demonstrated chronic infectious villitis secondary to cytomegalovirus (CMV), and subsequent CMV testing on the infant was positive. The infant was microcephalic and head imaging revealed intracranial calcifications, consistent with congenital CMV infection.CMV is the most common congenital infection and has a wide array of clinical manifestations. This report highlights the rarely described association between congenital CMV infection and respiratory distress due to underlying diaphragm dysfunction. In neonates with respiratory distress and features of congenital CMV infection, clinicians should have a high index of suspicion for diaphragm dysfunction.
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Affiliation(s)
- Rebecca Carter
- Pediatrics, UC San Diego, La Jolla, California, USA
- Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Maayan Yakir
- Pediatrics, UC San Diego, La Jolla, California, USA
| | - Julie Ryu
- Pediatrics, Division of Pediatric Pulmonary Medicine, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Katherine Weiss
- Pediatrics, UC San Diego, La Jolla, California, USA
- Pediatrics, Division of Neonatology, Rady Children's Hospital San Diego, San Diego, California, USA
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18
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Matsuo K, Asada D, Aoki H, Kayatani F. Successful bailout stenting for critical aortic coarctation in a premature baby weighing 590 g. BMJ Case Rep 2023; 16:16/6/e255215. [PMID: 37295815 DOI: 10.1136/bcr-2023-255215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Severe aortic coarctation (CoA) is a critical congenital heart disease that requires surgery as the first-line treatment in neonates. However, in very small premature infants, aortic arch repair has a relatively high mortality and morbidity rate. Bailout stenting is an alternative method that can be performed safely and effectively with low morbidity.We present a case of severe CoA in a premature baby, a monochorionic twin with selective intrauterine growth restriction. The patient was born at 31 weeks of gestation with a birth weight of 570 g. Seven days following her birth, she experienced anuria due to critical neonatal isthmic CoA. She underwent a stent implantation procedure at term neonatal, weighing 590 g. She had good dilatation of the coarcted segment with no complications. Follow-up at infancy showed no CoA recurrence. This is the world's smallest case of stenting for CoA.
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Affiliation(s)
- Kumiyo Matsuo
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Dai Asada
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Hisaaki Aoki
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Futoshi Kayatani
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
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19
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Jamal M, Ateeque K, Quddusi MBK, Qamar FN. Life-threatening complication: the development of necrotising fasciitis in a preterm neonate with omphalitis. BMJ Case Rep 2023; 16:16/5/e251116. [PMID: 37142286 PMCID: PMC10163410 DOI: 10.1136/bcr-2022-251116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Omphalitis is a mild medical condition that can turn severe in exceptional situations leading to necrotising fasciitis. The most common cause of omphalitis is umbilical vein catheterisation (UVC) where the cleanliness measures can be compromised. The treatment options for omphalitis include antibiotics, debridement and supportive care. Sadly, the fatality rate in such cases is high. This report is about a premature female baby who was admitted to a neonatal intensive care unit after her birth at 34 weeks of gestation. UVC was performed on her which led to abnormal changes in the skin around her umbilicus. Further tests revealed that she had omphalitis and was treated with antibiotics and supportive care. Unfortunately, her condition quickly worsened and she was diagnosed with necrotising fasciitis which ultimately resulted in her death. This report provides details about the patient's symptoms, course of illness and treatment for necrotising fasciitis.
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Affiliation(s)
- Maira Jamal
- Pediatrics, Hamdard University College of Medicine and Dentistry, Karachi, Sindh, Pakistan
| | - Kanza Ateeque
- Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | | | - Farah Naz Qamar
- Paedriatrics, The Aga Khan University Hospital Main Campus, Karachi, Pakistan
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20
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Suttle TK, Els T. Massive mature cystic teratoma of the head and neck, masquerading as a glial choristoma, causing respiratory compromise of a neonate. BMJ Case Rep 2023; 16:16/4/e252587. [PMID: 37105594 PMCID: PMC10151894 DOI: 10.1136/bcr-2022-252587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Glial choristoma of the head and neck is a rare, benign congenital malformation consisting of a mass of heterotopic glial cells. In cases involving the upper aerodigestive tract, this can present with upper airway obstruction. In the acute setting, this can lead to diagnostic challenges due to the broad differential, as well as the additional difficulties in obtaining appropriate imaging and tissue samples due to the potential risk of airway compromise. We present a case of a neonate born with a large heterogenous mass involving the upper aerodigestive tract and multiple deep neck spaces which resulted in upper airway compromise requiring emergency surgical intervention in the form of a paediatric tracheostomy. We will discuss the histological findings which initially suggested a glial choristoma, work-up and treatment of this patient with the aim of supplementing the limited existing clinical knowledge of this congenital anomaly and understanding the implications of a paediatric tracheostomy in our setting.
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Affiliation(s)
- Tessa Kirsty Suttle
- Otorhinolaryngology, Livingstone Tertiary Hospital Complex, Port Elizabeth, South Africa
| | - Timothy Els
- Head of Clinical Unit, Otorhinolaryngology, Livingstone Tertiary Hospital Complex, Port Elizabeth, South Africa
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21
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Stephenson DT, Thomas N, Korbely R. Early-onset neonatal seizures: lidocaine toxicity as a rare differential diagnosis to hypoxic ischaemic encephalopathy. BMJ Case Rep 2023; 16:16/3/e252758. [PMID: 36958761 PMCID: PMC10040028 DOI: 10.1136/bcr-2022-252758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
A term newborn girl presented with apnoea and seizures at approximately 20 min of life following an uneventful vaginal delivery. She required admission to the Neonatal Intensive Care Unit following intubation and was commenced on conventional ventilation. Her mother had received a local lidocaine injection for an episiotomy prior to delivery. Initial investigations confirmed electrographic seizures for which she received an anticonvulsant with successful termination of seizure activity. Investigations for hypoxic injury, intracranial trauma, structural brain abnormalities, metabolic disorders and infection were unremarkable. Her blood lidocaine level was subsequently found to be elevated, confirming lidocaine toxicity as the cause of presentation. She demonstrated clinical improvement with no evidence of complications at time of discharge or on early follow-up.
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Affiliation(s)
- Dylan T Stephenson
- Department of Newborn Services, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Victoria, Australia
| | - Niranjan Thomas
- Department of Newborn Services, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Reka Korbely
- Department of Newborn Services, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Victoria, Australia
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22
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Chida R, Iio K, Ishida Y, Yamanaka G. Neonatal frequent premature ventricular contraction. BMJ Case Rep 2023; 16:16/2/e254837. [PMID: 36854486 PMCID: PMC9980312 DOI: 10.1136/bcr-2023-254837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Rie Chida
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Kazuki Iio
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan .,Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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23
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Bhatt H, Regan W, Rosenthal E, Bellsham-Revell H. Flecainide toxicity: ECG changes associated with supratherapeutic levels in milk-fed infants. BMJ Case Rep 2023; 16:16/2/e252823. [PMID: 36731946 PMCID: PMC9896187 DOI: 10.1136/bcr-2022-252823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Flecainide is a class 1C antiarrhythmic and is highly effective for treating a wide range of arrhythmias. It is not licensed for children under the age of 12 years, but has been used safely for years in young children, particularly when first-line agents are not effective. Although toxicity does occur in both adult and paediatric populations, there have been very few reported instances of flecainide toxicity in neonates and children. Supratherapeutic levels of flecainide manifests on ECG with prolongation of the PR interval, QRS duration and QT, and can lead to life-threatening arrhythmias. In milk-fed infants receiving flecainide, regular feeding patterns are paramount to achieve a steady therapeutic state, as milk and dairy products are known to reduce the absorption of flecainide. This case series details four milk-fed infants admitted with ECG changes secondary to flecainide toxicity.
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Affiliation(s)
- Hitarth Bhatt
- Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Will Regan
- Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Eric Rosenthal
- Paediatric Cardiology, Evelina London Children's Hospital, London, UK
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24
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Ray S, Nadeem L. Suppurative parotitis in a preterm infant. BMJ Case Rep 2023; 16:16/1/e253713. [PMID: 36720512 PMCID: PMC9890936 DOI: 10.1136/bcr-2022-253713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sagarika Ray
- Department of Neonatal Medicine, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Lubna Nadeem
- Department of Radiology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
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25
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Zhang Y, Wu J, Zhang D, Mao J. Epigastric heteropagus conjoined twins combined with TRAP sequence. BMJ Case Rep 2023; 16:16/1/e253159. [PMID: 36717158 PMCID: PMC9887695 DOI: 10.1136/bcr-2022-253159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Yongke Zhang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, China
| | - Jing Wu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Dirong Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jianxiong Mao
- Department of Pediatric General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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26
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Bajracharya S, Stich D, Berman J, Biank V. Congenital sodium diarrhoea caused by rare de novo activating guanylate cyclase mutation. BMJ Case Rep 2022; 15:15/12/e251632. [PMID: 36581358 PMCID: PMC9806026 DOI: 10.1136/bcr-2022-251632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A male infant with prenatal history significant for polyhydramnios requiring multiple amnioreductions with suspicion of small bowel atresia was born at 31 weeks 5 days' gestation with abdominal distension. He underwent three exploratory laparotomies and ileostomy for small bowel obstruction and was found to have fluid-filled intestinal dilatation. Serum and stool chemistries suggested sodium secretory diarrhoea. A rapid whole-exome sequencing confirmed de novo guanylate cyclase mutation variant as a cause for his congenital sodium secretory diarrhoea. He required large volume of fluid and electrolyte replacement along with total parenteral nutrition. Several medications to restore normal sodium homeostasis by targeting molecular mechanisms and pathogenesis described in previous literature failed to decrease stool output and electrolyte loss. He was discharged home at 11 months of age on total parenteral nutrition and weekly iron therapy.
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Affiliation(s)
| | - Duane Stich
- Neonatology, Advocate Children's Hospital, Park Ridge, Illinois, USA
| | - James Berman
- Pediatric Gastroenterology, Advocate Children's Hospital, Park Ridge, Illinois, USA
| | - Vincent Biank
- Pediatric Gastroenterology, NorthShore University HealthSystem, Evanston, Illinois, USA
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27
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Porwal M, Anderson D, Razzak AN, Fitzgerald G. Prenatal diagnosis and delivery of megalencephaly-capillary malformation syndrome. BMJ Case Rep 2022; 15:15/12/e249587. [PMID: 36572450 PMCID: PMC9806087 DOI: 10.1136/bcr-2022-249587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemimegalencephaly (HME) is a rare neurological diagnosis defined as hamartomatous overgrowth of one cerebral hemisphere. The hypothesised pathogenesis is due to an increased number or size of neural cells; however, the exact mechanism can vary widely, depending on the underlying aetiology. We report a case outlining the prenatal diagnostic process and obstetric considerations for delivering an infant with HME secondary to megalencephaly-capillary malformation syndrome. After diagnosis, our patient was induced and delivered at 37 weeks of gestation via operative vaginal delivery. To our knowledge, this is the first report describing the course from prenatal diagnosis through delivery of a fetus with HME.
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Affiliation(s)
- Mokshal Porwal
- School of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Danyon Anderson
- School of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Garrett Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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28
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Bayoumi MAA, Khider WM, Elmalik EE. Congenital haemophilia A presenting with subgaleal and intracranial haemorrhage following instrumental delivery. BMJ Case Rep 2022; 15:e248030. [PMID: 35487633 PMCID: PMC9058680 DOI: 10.1136/bcr-2021-248030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Wafa Mubarak Khider
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas Elzubier Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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29
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Abstract
Status epilepticus (SE) is a life-threatening medical emergency which is frequently encountered in the critical care setting and can be refractory to treatment. Refractory status epilepticus (RSE) is defined as SE that has failed to respond to adequately used first-line and second-line antiepileptic medications. Super refractory status epilepticus is defined as SE that persists for 24 hours or more after the use of an anaesthetic agent or recurs after its withdrawal.If SE persists beyond a period of 7 days it is referred to as prolonged, refractory status epilepticus (PRSE). There are limited data guiding treatment of RSE in the paediatric population.Lacosamide (LCM) is licensed as an adjunctive treatment for partial-onset seizures. Evidence for the efficacy of LCM in paediatric SE is scarce. This case report may suggest a synergistic effect of LCM on slow-activation sodium channels in conjunction with medications such as phenytoin that causes fast inactivation of sodium channels. The dual fast and slow inactivation of sodium channels may enhance the effectiveness in treatment of RSE. This is the first case report of PRSE in an infant, successfully treated with LCM. A brief review of literature is also a part of this report.
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Affiliation(s)
- Asra Akbar
- Pediatric Neurology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
| | | | - Sean Creeden
- Radiology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
| | - Girish G Deshpande
- Pediatric Critical Care, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
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30
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Affiliation(s)
- Terry Cullen
- Neonatal Intensive Care Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Clare Tower
- Fetal Medicine Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kristin Tanney
- Neonatal Intensive Care Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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31
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Affiliation(s)
- Rita Espírito Santo
- Paediatrics Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rosa Martins
- Paediatrics Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Sandra Valente
- Paediatrics Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Joana Saldanha
- Paediatrics Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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32
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Agarwal A, Nakao M, Rajadurai VS, Chandran S. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth. BMJ Case Rep 2017; 2017:bcr-2016-218818. [PMID: 28408368 DOI: 10.1136/bcr-2016-218818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
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Affiliation(s)
- Arpan Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore .,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
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