SGH is an uncommon type of birth trauma, and is associated with delivery or attempted delivery by vacuum extraction. The most commonly associated clinical problems were hypovolaemia and coagulopathy. The long-term outcome for neonates with this condition is good.

Coordination of infants' suck-swallow-breathing patterns is integral to safe and efficient feeding. However, assessment of these patterns is difficult and often invasive, particularly in breast-fed infants less than 4 months of age. The aims of this study were to develop an ultrasound approach to visualize swallowing in term breast-feeding infants and to determine the accuracy of ultrasound imaging of swallowing compared to respiratory inductive plethysmography (RIP). On ultrasound, the breast milk bolus was observed as a predominantly echogenic area moving inferiorly. Of the 388 swallows detected with ultrasound, 379 correlated with the swallow apneas detected by RIP (R(2) = 0.98). The mean duration of the swallow was 0.63 +/- 0.06 s. Ultrasound imaging is a noninvasive accurate method for detection of swallowing by visualization of movement of the milk bolus through the pharyngeal area of a breast-feeding infant. These techniques may potentially provide useful information for infants experiencing breast-feeding difficulties.

Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Postfrenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.