Background: Pneumothorax is a common complication in the premature newborn with respiratory distress syndrome. Its incidence may have declined following the widespread use of antenatal steroids and surfactant. However clinicians are concerned that use of CPAP may be associated with increases risk of Pneumothorax. Aim: To describe the demographic profile of a cohort of premature infants with pneumothorax. Method: Regional tertiary neonatal centre in the north east of England. All newborns with pneumothorax or other air leak syndromes over 10 year period were included. Variables recorded; gestation, antenatal steroids, surfactant use and non-invasive respiratory support (CPAP). Results: 3804 admissions, 107 infants were diagnosed with pneumothorax or other air leak syndrome (overall incidence of 2.8%). This included 72 premature infants of whom 37 were under 28 weeks gestation. The incidence of pneumothorax and pulmonary interstitial emphysema (PIE) was 2.3% and 0.47% respectively. There was statistically significant association between the severity of pneumothorax and degree of prematurity, use of surfactant and CPAP. Severe pneumothorax requiring drainage was more in extremely premature infants who didn't received optimal dose of surfactant. No statistically significant effect was noted with variables such as lack of antenatal steroids, gender, mode of delivery, use of muscle relaxants and squad retrievals. Conclusion: Incidence of pneumothorax and other air leak syndromes was lower compared with other cohort studies. Risk of pneumothorax was increased with use of CPAP and suboptimal surfactant dose. Effect of CPAP in extreme premature newborns without antenatal steroids and postnatal surfactant exposure require further evaluation.
BackgroundAn unexplained scalp swelling in under 1 year children are rare and particularly in nonmobile infants raises suspicion of non-accidental injury. We describe a case which presented with an unexplained scalp swelling in an 18 weeks baby.Case reportA 4 month old boy presented to ED with a swelling on the back of head. An 8 × 11 cm swelling on the vertex crossing the suture lines was noted. A CT scan of head showed a subaponeurotic fluid collection(SAFC). As no possible explanation of mechanism of injury was given in a non-mobile infant, it was felt that a non-accidental cause needed to be investigated, so Children social services were involved and the child was removed from the family and kept in a place of safety. On further enquiry from the neighbouring hospital, it was found that fetal scalp electrodes and kielland’s forceps were used before progressing to caesarian section. After reviewing literature it was felt, sub-aponeurotic fluid collection can have a delayed presentation following a birth trauma and the child protection order was retrieved.DiscussionSubgaleal or sub-aponeurotic haemorrhage can occur in immediate post-delivery period due to instrumental delivery or difficult delivery. SAFC is a very rare cause of scalp swelling which can have delayed presentation. Aisling1 have reported 11 cases (7–11 weeks) and Wang2 reported 9 cases of spontaneous SAFC (5 weeks to 9 months) who all had either successful vacuum assisted delivery or attempted vacuum deliver. In a series of 4 cases reported by schoberer3 the aspirated fluid from 3 cases was serosanguinous and interestingly re-accumulated in all 3 cases. SAFC resolves spontaneously without any treatment1,2.Learning pointsSub-aponeurotic fluid collection is a rare cause of scalp swelling in infants which is fluctuant, ill-defined and not limited by sutures. It can have delayed presentation and resolves spontaneously.SAFC usually associated with vacuum or instrumental delivery or use of electrodesSAFC should be considered as differential diagnosis in safeguarding and information should be added to COREINFO
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