Enrico Valerio

Subcutaneous fat necrosis of the newborn.

Subcutaneous fat necrosis (SCFN) is a rare fat tissue inflammation of the newborn. Risk factors include cord prolapse, perinatal asphyxia, therapeutic hypothermia, meconium aspiration, and sepsis. When present, hypercalcemia comes with lethargy, hypotonia, irritability, vomiting, polyuria, polydipsia, constipation, and dehydration. Kidney injury must be avoided. SCFN is often completely autoresolutive.

Ramsay Hunt syndrome.

A 14-year-old boy developed Ramsay Hunt syndrome after varicellazoster virus infection. He experienced right earache and palatal pain. Two days later, a whitish, exuding vesiculobullous rash developed on the right hard palate (Figure) along with swelling and erythema of the right ear canal, similarly exuding and covered with vesicles (Figure). A right peripheral facial palsy (Figure) was also evident. High-dose antiviral (acyclovir) and corticosteroid (prednisone) therapy was started, with remission of fever and slow improvement of vesicobullous lesions. Right facial palsy and slight right hypoacusis persisted at the time of discharge.

Congenital isolated Iso-Kikuchi syndrome in a newborn.

Classic CO (also called Iso–Kikuchi syndrome) represents a benign, isolated condition associated with normal patient outcome. Nevertheless, clinical follow‐up and/or further clinically‐based tests are needed to exclude other nail diseases associated with multisystem pathology; complete family history is also important to determine sporadic or hereditary transmission of such condition.

Harlequin Color Change: Neonatal Case Series and Brief Literature Review.

First clinical report of Harlequin color change (HCC) phenomenon came in 1952 from Neligan and Strang. Since then, HCC has been described in a fairly broad number of clinical reports involving neonates, infants, children, and adult patients. We here present a small case series of HCC occurring in neonates, pointing out three of the different possible presentations (hemifacial, patchy scattered across the whole body, and hemiscrotal) of this phenomenon. A brief discussion and literature review encompassing epidemiology, clinical features, physiopathology, associated conditions, and differential diagnoses of HCC is then presented. In most cases, HCC represents a benign, idiopathic, and rapidly autoresolutive phenomenon, with no need for treatment. Some drugs (especially anesthetics and prostaglandin E) are thought to enhance HCC expression through their influence on the capillary tone in the peripheral vascular bed; this effect is anyway promptly reversible with drug withdrawal. Only in rare circumstances, HCC may act as a clue for serious central nervous system disorders (e.g., meningitis; hypothalamic, brain stem, or sympathetic nervous system lesions); anyway, in these rare occurrences HCC always represents an epiphenomenon of the disease, never acting as the sole sign of the underlying disorder.

Perinatal zinc deficiency

An ex-preterm, exclusively breastfed baby with poor postnatal growth was evaluated at 5 months of age for perianal erosive dermatitis (figure 1) and foul stools. No other cutaneous involvement was present. Investigations showed mild zinc deficiency (65 μg/dL, range 68–107). Unfortunately, no maternal blood or breast milk zinc levels were available. The dermatitis rapidly improved in six days (figure 2) on oral supplementation with zinc sulfate (2 mg/kg/day), and remained stable on zinc-enriched formula milk, without …

Facial lichen striatus

A 9-year-old girl presented with a 15-day history of abrupt onset of a papular, non-itchy frontofacial rash (figure 1). Her recent anamnesis was negative for contact dermatitis. She had no signs of other dermatological disease (eg, eczema or psoriasis). The rest of the physical examination was normal. The classic appearance and distribution of the rash along Blaschkos lines (BL) (figure 2) was consistent with facial lichen striatus …

Severe asymptomatic maternal antepartum hyponatremia leading to neonatal seizures: prevention is better than cure

BackgroundPre-delivery maternal electrolyte derangements may reflect themselves in the newborn, since placental homeostasis determines electrolyte equilibrium between mother and fetus.Case presentationA term newborn, transferred to our Neonatal Intensive Care Unit 1 h after birth for an apnoea episode, presented with initially left-sided, and subsequently generalized tonic-clonic seizures due to severe hyponatremia (119 mmol/L). Seizures rapidly ceased after electrolyte correction plus a phenobarbital bolus. Deep hyponatremia was also detected in the mother (123 mmol/L).ConclusionsAs placental homeostasis determines electrolytes equilibrium between mother and fetus, obstetrics and neonatologists should be aware that any maternal dyselectrolytemia will reflect itself in the newborn; hence, it is fundamental to detect possible maternal electrolyte imbalances before delivery, in order to be prepared to timely correction of electrolyte derangements in the newborn.

Exstrophy-Epispadias Complex in a Newborn: Case Report and Review of the Literature.

Aim The aim of this report is to present a brief review of the current literature on the management of EEC. Case Report A term male neonate presented at birth with classic bladder exstrophy, a variant of the exstrophy-epispadias complex (EEC). The defect was covered with sterile silicon gauzes and waterproof dressing; at 72 hours of life, primary closure without osteotomy of bladder, pelvis, and abdominal wall was successfully performed. Discussion EEC incidence is approximately 2.15 per 1,00,000 live births; several urological, musculocutaneous, spinal, orthopedic, gastrointestinal, and gynecological anomalies may be associated to EEC. Initial medical management includes use of occlusive dressings to prevent air contact and dehydration of the open bladder template. Umbilical catheters should not be positioned. Surgical repair stages include initial closure of the bladder and abdominal wall with or without osteotomy, followed by epispadias repair at 6 to 12 months, and bladder neck repair around 5 years of life. Those who fail to attain continence eventually undergo bladder augmentation and placement of a catheterizable conduit. Conclusion Modern-staged repair of EEC guarantees socially acceptable urinary continence in up to 80% of cases; sexual function can be an issue in the long term, but overall quality of life can be good.

Ankyloblepharon Filiforme Adnatum in a Newborn

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly consisting of a partial or complete fusion of the eyelid margins. It is usually an isolated and benign malformation but its presence should alert the neonatologist because it can be rarely associated to other important multisystemic disorders. We report a case of a newborn presenting with isolated AFA at birth, treated in the first day of life.

Exuberant upper gum lesions in a neonate.

Figure 2. Resolution of nodular-cystic lesions at 6 months of age. I nitial clinical examination of a term infant 3 hours after birth showed multiple white cystic and laminar lesions at the upper gum (Figure 1); lower gum was intact. Bilateral cryptorchidism and single umbilical artery were also detected. Monthly reevaluation of the baby followed; at 6 months of age, cystic lesions on the upper gum had almost completely vanished, leaving the normal gum structure beneath (Figure 2). Oral mucosa cysts are classified according to nature, location, and putative ontogenesis. In our patient, gingival hyperkeratotic findings were compatible with both Bohn nodules (small, round, and clustered papules) and dental lamina cysts (large, smooth, hard plaquish lesions). These are two relatively common findings in neonates: (reported prevalence is 47.4% and 25%-53%, respectively) however prevalence data are to be considered approximate because of confusion regarding nomenclature and difficulty in spotting and documenting these lesions correctly. In our case, themost remarkable findingwas the exceptional number of lesions scattered along the whole superior alveolar ridge. Both Bohn nodules and dental lamina cysts are, in fact, usually isolated or in a limited number. This case describes an abundant presence of these lesions.