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Background
• Baby boy born by SVD at 40+2 weeks
• Spontaneous onset of labour
• No Infection risks• Crash Call at delivery due
to Shoulder Dystocia• Baby born in good
condition• Apgars 9/1 9/5
• Mum’s second baby• Healthy pregnancy• Blood Group 0 Negative• Anti D during pregnancy
Newborn Examination
• Baby now 15 hours of age– Breast feeding well– Passed urine and
meconium
• Mother – no concerns• Midwife – feels baby
intermittently tachypnoeic
• On examination– Pale– No respiratory distress– Normal tone– Normal examination– Note baby becomes
tachypnoeic on handling– Heart rate +/- 150 when
settled
• Do you think anything is wrong with the baby?
• What do you think it could be?
• What do you do next?
What happened next?• Chased Cord bloods
• Repeated FBC and bilirubin
• Informed mum of rationale
• At Birth– Hb 15.5 HCT 0.56, WCC
19.0, Plat 204, Retics 5.5%– Bili 24. – Blood Group O pos– DCT Negative
• At 15 hrs of age– Hb 8.2 HCT 0.23, WCC
20.1, Plat 143, Retics 7.1%.– Bili 28
Treatment threshold graph for babies with neonatal jaundiceBaby's name Date of birth
Hospital number Time of birth Direct Antiglobulin Test
Click below and choose gestation
Shade for phototherapy Baby's blood group Mother's blood group >=38 weeks gestation
Phototherapy
Exchange transfusion
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0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tota
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Days from birth
MultipleSingle
• Admit to NNU
• Repeat FBC, Partial sepsis screen, DCT, Coagulation
• Chest x-ray – normal• Echo – normal
structure
• Baby examines well– Pale– Tachypnoeic– Tachycardia– Mean BP normal
• At 17 hrs of age– Hb 5.1, HCT 0.19, WCC
22, Plat 98. Retics 8.2%– Bili 29– CRP <6– Coag mildly deranged– Blood Group O pos– DCT Neg
Stabalisation
• TUT• Platlet transfusion• FFP• CRUSS• Abdominal X-ray• Abdominal Scan
Progress
• By 21hrs of age baby developed abdominal tenderness and guarding
• Differential diagnosis– Haemorrhage– ? Bowel– ?Liver
• Transferred to Surgical Centre
• MRI Confirmed Diagnosis
Haemangioma of Liver
Can cause• Heart failure• Anaemia• Thrombocytopenia
Treatment• Corticosteroids• Embolization• Hepatic Artery Ligation• Liver Resection
Congenital Hepatic Haemangioma• Hepatic tumours account for 1-5% of all
Paediatric tumours• Hepatic Haemangioma is the third most
commonest tumour of childhood• Occasionally diagnosed on antenatal scan• Often never detected
– Rarely present as large abdominal mass– Cardiac failure due to massive atreriovenous shunting– Jaundice from compression of bile ducts– GI Bleeding– Fever/illness resembling systemic inflammatory
process
What is a haemangioma?
• A vascular birthmark caused by abnormal blood vessels in or under the skin
• Most common benign tumour of the vascular endothelium in infancy
• Can occur anywhere outside and inside of the body
Salmon Patch
• Pink maculae• Dilated superficial
capillaries• Commonly seen at nape
of the neck, mid forehead and upper eyelids
• Most common vascular malformation
• Usually fades within a year
Strawberry Haemangioma• Bright red vascular
tumour• Dilated mass of capillaries• Usually protrudes above
the skin• Can appear anywhere on
the body• Can start as a flat red
superficial lesion• Can increase in size over
next year
Strawberry Haemangioma• Usually, growth is complete
and involution has commenced by twelve months.
• Half of all infantile haemangioma have completed involution by age five.
• 70% by age seven, and most of the remainder by age twelve
• In more severe cases haemangioma may leave residual tissue damage.
Strawberry Haemangioma Complications
• Psychological• Haemangioma near the
eyes, nose, mouth, or on throat may interfere with vital functions and therefore require removal
• Some may – break down and ulcerate– Bleed
• Rarely can cause heart failure if large and blood being diverted into the excess blood vessels
• Lesions next to bone can also cause erosion of the bone
Strawberry Haemangioma Treatment
• Oral corticosteriods– Smaller lesions
sometimes injected• Propranalol• Timolol gel• Interferon• Vincristine• Surgical removal• Pulsed dye laser
– For very early flat lesions
Port Wine Stain
• Nevus Flammeus• Usually present at birth
and on face, but can occur anywhere
• Permanent capillary angioma
• Does not blanch with pressure
Port Wine Stain
• Grows in proportion to general growth
• Early stains are usually flat and pink – as child matures colour can deepen to a dark red or purple colour
• In adulthood can become bumpy and raised
Port Wine StainComplications
• If over forehead and upper lip Sturge Weber Syndrome must be excluded
• Spine abnormalities• Varicose veins
• Psychological• Eye problems is on
eyelid or next to eye
Port Wine StainTreatment
• Some may improve over time
• Laser treatment– variable results
depending on skin colour
– Works best in young children
– Works best on smaller stains
• Skin camouflage still common treatment – Some provided free on
NHS
• Support Groups– Birthmark Support
Group– British Association of
Skin Camouflage– Changing Faces
Mongolian Blue Spot• Congenital Dermal
Melanocytosis• Benign , flat birthmark• Irregular borders and shape• Commonest colour is blue,
but can also be blue-grey, blue-black or deep brown
• Normally disappears by 3 - 5 yrs of age
• Almost certainly by puberty• Important to document on
record
• Prevalent among– Mongolians– Asians– Malay– Polynesians– East African– Latin Americans– Turkish