No abstract

This case based presentation focuses on a premature infant born at 30+5 weeks gestation with facial nerve palsy, without any preceeding trauma. His antenatal scans had been normal and he was born in good condition by emergency caesarean section for antepartum haemorrhage, with no history of instrumental delivery or facial trauma.This infant required some respiratory support with facial oxygen and was transferred to the Neonatal Intensive Care Unit (NICU) after he had been given surfactant directly via endotracheal tube route. In NICU the infant was given continuous positive airway pressure. It was noticed on admission to the neonatal unit that he had mild facial palsy on the left side. In NICU his cranial ultrasounds were normal and he established feeding.To our knowledge this is a very rare case of lower motor neuron facial palsy reported in a 30 week premature baby in absence of traumatic delivery or dysmorphic features suggestive of any syndrome. It raises a possibility of inutero pressure on the facial nerve.Neonatal nerve palsies can be either developmental or acquired. The incidence in the literature has been quoted as 2 per 1000 births most commonly caused by birth trauma of which there was no history of in this case. Rarer associations include Möbius’s syndrome, hemifacial microsomia, Goldenhar’s syndrome, DiGeorge syndrome and Poland Syndrome. With this case, we are aiming to discuss possible causes of facial nerve palsy, rarely seen in premature neonates without any associated birth trauma, and the management as well as prognosis of neonatal facial nerve palsy.ReferencesOzmen O, Ozgen B, Ozmen S, L Sennaroglu. Congenital Facial Paralysis: Facial Nerve Hypoplasia. Int. Adv. Otol. 2010; 6 (2): 282-284Harrison D. Treatments of Infants with Facial Palsy. Arch Dis Child. 1994; 71: 277-280.

This case report focuses on a premature infant, who showed symptoms of bowel obstruction within the first hours of life, and was subsequently diagnosed with multiple small bowel atresia’s.This infant was born to consanguineous parents by spontaneous preterm vaginal delivery at 33+3 weeks’ gestation, through a yellow-stained liquor thought to be meconium at the time of delivery, but later recognised as bile. The antenatal scans had been normal until one on the day prior to delivery, which showed polyhydramnios and a slightly distended bowel; further imaging and Obstetric review had been arranged for a diagnosis.The infant was born in good condition and required no resuscitation. She was transferred to NICU for further management due to prematurity; there was no difficulty when inserting a nasogastric tube, but unusually 25 ml of bile stained fluid was aspirated immediately. Abdominal palpation was normal, but no bowel sounds were present. An abdominal x-ray showed huge proximal bowel obstruction with a classic ‘double-bubble’ appearance, with no bowel gas visible distal to this lesion. She was urgently transferred to a surgical centre, where she underwent diagnostic surgery and emergency repair of a type 1 and type 3b small bowel atresia, with an associated duodenal perforation.With this case review we will discuss the different types, presentations and prognosis of bowel atresia’s within preterm infants, as well as looking at antenatal diagnosis and the difficulties faced with accurate diagnoses and subsequent management.

This case based presentation focuses on a term infant with multiple traumatic birth injuries, including intra-abdominal injury, following a vaginal delivery with shoulder dystocia.Due to a four-minute delay in which anterior shoulder was stuck, and following less traumatic methods of delivery, the right clavicle was broken to deliver the shoulder; after delivery he was noted to also have a deformed right upper arm and was suspected to have a humeral fracture. He was admitted to the NICU for pain relief and orthopaedic input following x-ray confirmation of the injuries.During examination the following day the baby was noted to have a large mass in the left hypochondria. He was also noted to be significantly jaundiced, but otherwise the rest of the examination was normal and his vital signs were within normal limits. An abdominal ultrasound was performed which revealed a large left adrenal haematoma, which was compressing the kidney inferiorly. His blood tests revealed an unconjugated hyperbilirubinaemia and mild anaemia that support the diagnosis of haemorrhage; endocrine function remained normal. He was placed on continuous monitoring, but despite the adrenal haemorrhage he remained haemodynamically stable throughout admission with a normal urine output; he was discharged following treatment for his multiple fractures.This case highlights rare, but important, intra-abdominal injuries following traumatic births that can cause serious morbidity and even death in newborns. We discuss such birth injuries in this presentation, with a focus on this case and problems arising from adrenal haemorrhage.We suggest that ultrasound abdomen should be considered in situations where significant force has been used to extract the foetus so that appropriate precautions are taken in intra-abdominal haemorrhage and laceration of internal organs.