High humidity high flow nasal cannula has become a widely used alternative for nasal continuous positive airway pressure for the treatment of apnea of prematurity. We describe our experience of one incident of subcutaneous scalp emphysema, pneumo-orbitis and pneumocephalus with concomitant use of the high-flow nasal cannula. Journal of Perinatology (2008) 28, 779-781; doi:10.1038/jp.2008 Case Baby W was a 26 weeks gestation male with a birth weight of 901 g. He was born to a 20-year-old gravida 1 para 1 mother through a spontaneous vaginal delivery. Pregnancy was complicated by premature labor. His mother received steroids and was treated with magnesium sulfate prior to delivery. Her Group b-streptococcus status was unknown, serology non-reactive, hepatitis B surface antigen negative and Rubella immune. Baby W received continuous positive airway pressure (CPAP) at delivery and was intubated at 15 min of life. One dose of surfactant was given at the time of initial intubation. Baby W remained ventilated until 20 days of life. At that time he was extubated to 4 l min À1 high humidity high flow nasal cannula. Baby W had a large patent ductus arteriosis (PDA) that was treated medically with two courses of Neoprofen. The PDA decreased in size to small-moderate with no clinically significant shunting and did not require surgical ligation. Baby W was weaned to 2 l min À1 high humidity high flow nasal cannula by 36 days of life. At that time, Baby W was noted to have scalp crepitis.Scalp crepitis was noted in the frontal, parietal and occipital regions of the scalp, extending to the temporal regions with swelling noted on the right greater than left. Baby W's right eye was swollen, no proptosis was noted and there was no discharge from either eye. Skull X-rays showed subcutaneous edema and swelling, with no fracture of the skull. A chest X-ray showed no pneumothorax or pneumomediastinum. Baby W's high flow nasal cannula was discontinued and he was placed under an oxygen hood. A computerized tomography scan of the head revealed free air in the orbits bilaterally, and under the scalp. An ophthalmologist evaluated Baby W and his exam revealed no compromise of the blood supply or the optic nerves. The ophthalmologist recommended continued treatment with the oxygen hood as needed for oxygenation and discontinuation of the nasal cannula. Baby W continued under the oxyhood for 22 days and was then weaned to room air.Baby W was clinically evaluated frequently over the next 48 h. The scalp crepitis resolved over that time, as did the scalp swelling and eye swelling. Because the clinical symptoms resolved with use of the oxyhood there were no further studies performed. Baby W was discharged at a weight of 2266 g and at 75 days of life. He was not on oxygen at the time of discharge and had no further recurrence of scalp crepitis or orbital swelling.
Abb. 1 Knorpelnahte mit 4/0 Vicryl bei der Anthelixplastik; zusätzlich Ritzen der ventralen Fläche der Anthelixrolle. Zu den Standard-Operationen der Ohrmuschelkorrekturen gehoren die Techniken nach Pitanguy, Convers, Stenström, Mustarde u. a. (1, 2, 9). Bei uns hat sich in den letzten Jahren eine Modifikation bewährt (Kombination aus den Operationsverfahren von Convers und Stenström). Nach Anästhesje und Anzeichnen wird mit der retroaurikularen Hautexcision begonnen. Anschlielend wird die neue Anthelix durch Kanülen und spiegeIbildliche lnzisionen auf der retroaurikulären Knorpelseite mobilisiert. Nach ausreichender Knorpelinzision erfolgt die komplette Mobilisierung der Anthelix und das Ritzen des Perichondriums an der ventralen Knorpelseite. Nach Mobilisierung des Konchabezirkes auf der prä-und retroaurikularen Seite wird je nach AusmaI der Konchahyperplasie der Knorpel reseziert. Die neue Anthelixrolle wird 10 20-30 30-40 40-50 > 50 Jahre scher Erwachsenentyp, gotischerTyp. Was gibt es Neues in der plastischen Chirurgie?
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