months. No cause could be found despite multiple investigations. There was poor response to medication. The child was referred to dermatology for the evaluation of a rash that had developed over the past 1 month. According to her mother, the rash appeared as erythematous papules in crops and then resolved with scars. Examination revealed multiple painful erythematous papules scattered over the limbs in different stages of evolution (Figure 1). Some were raised whereas others were umblicated in the center with a necrotic base. Healed lesions appeared as whitish, porcelain-like macular scars (Figure 2). Systemic examination was normal. Her complete blood count, renal functions, liver functions, abdominal sonography and barium meal follow-through, and coagulation profile including the international normalized ratio and serum antinuclear antibody revealed no abnormality. Skin biopsy showed a thin epidermis with hyperkeratosis overlying a necrobiotic dermal collagen with sparse inflammatory infiltrate. The blood vessels were dilated with swelling of endothelial cells and luminal thrombosis. Scattered mucin deposits were also seen. Based on historical features, characteristic skin lesions, and a supportive histology, the patient was diagnosed with Degos disease. Aspirin (3 mg/kg) and dipyridamole (5 mg/kg) were prescribed. Within 48 hours, the patient improved. Irritability reduced significantly. Active lesions started healing. Abdominal pain improved but vomiting continued although frequency was reduced significantly. At the time of reporting, the patient is still admitted in our pediatric

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Objective: To determine the clinical profile, selected antepartum and intrapartum risk factor for adverse shortterm outcomes of hypoxic ischemic encephalopathy in babies with birth asphyxia. Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit of Pak Emirates Military Hospital, Rawalpindi, fromJan to Dec 2018. Methodology: This study including all birth asphyxiated babies born who fulfilled the inclusion criteria.Following data was collected prospectively regarding gender, gestational age, birth weight and mode of delivery, maternal age, antenatal follow up, history of premature rupture of membranes and meconium stained liquor. Babies were categorized into different stages of hypoxic ischemic encephalopathy according to Sarnat and Sarnat staging. Selected antepartum and intrapartum risk factors leading to hypoxic insult at birth were studied and short-term outcome was recorded in the form of need of mechanical ventilation, mortality and discharge from the hospital.Results: The frequency of birth asphyxia turned out to be 122/5986 (2.03%) at our center. Thirty four (27.87%)required mechanical ventilation, mortality was recorded at 20/122 (16.39%). While 61 (50%) babies suffered from stage I hypoxic ischemic encephalopathy, 13/20 (65%) of newborn who expired were suffering from grade III hypoxic ischemic encephalopathy. Conclusion: The severity of hypoxic ischemic encephalopathy affects the outcome of newborns having birthasphyxia with hypoxic ischemic encephalopathy grade III associated with maximum mortality. Early identifycation of pregnancies at risk for asphyxia, with appropriate intervention in selected cases is the key to prevent birth asphyxia and its ensuing neonatal complications.

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