Saturday, July 20, 2013

Answer to Challenge

Harlequin Color Change
The answer to yesterdays Medical Challenge is...drumroll....

#4:  Harlequin color change

Harlequin color change is a dramatic but benign phenomenon in which the color on 1/2  (downward) of an infant turns deep red, while the upper half is pale.  Usually this color change is abrupt and lasts between 30 seconds and 20 minutes, then it resolves.  Up to 19% of infants undergo this color change which occurs between the 2nd and 5th day of life.  It is attributed to a temporary imbalance in autonomic regulation and it is more common among low-birth-weight infants.

The fact that the baby did not have IV lines or oxygen or evidence of being in an ICU pointed to a less serious cause and was the "hint".

The other conditions would indicate a life-threatening condition.
Collodion baby
Collodion baby is a genetic condition that causes the skin surface to crack and completely peel.  It also includes the mucous membranes, eyes and mouth.  It has the same genetic abnormalities as Bullous ichthyosiform erythroderma. Harlequin Ichthyosis is often called collodion baby so there is some confusion but it is quite different from Harlequin color change.

Cutis Marmorata
Cutis marmorata is an extremely rare congenital vascular disorder that affects the blood vessels of the skin and looks like a reticular pattern on the skin.











Wednesday, July 17, 2013

Medical Challenge


 I couldn't resist this challenge from the New England Journal of Medicine.  Make your best guess in the comment section and answer will be posted tomorrow.  One hint:  The newborn baby doesn't have any IV's or tubes inserted. (click on the image for a close up). 

Any neonatal specialists out there?

1. Bullous ichthyosiform erythroderma
2. Collodion baby
3. Cutis Marmorata
4. Harlequin color change
5. Staphylococcal pyoderma

Thursday, July 11, 2013

Delay Cord Cutting in Newborns

A new study has shown that delaying cutting the cord in a newborn baby is associated with better health for the baby because more blood (hemoglobin) passes from the mother to the baby as the cord is still attached.  Prior studies have also shown this advantage but there was a concern of hemorrhage in the mother if the cord cutting was delayed.  Doctors often rush to cut the umbilical cord as soon as the baby is delivered.  This study, published in The Cochrane Database of Systematic Reviews, shows there is no increased danger of hemorrhage  to the mom and the benefit is for the neonate.

The researchers found that babies who had later cord cutting (after one minute) had higher hemoglobin levels 24-48 hours post-partum and they were less likely to have iron deficiency at 6 months, compared to the early cutting babies.

This is especially important in developing countries where anemia is common.  The World Health Organization (WHO) has long recommended waiting 2-3 minutes to cut the umbilical cord to improve the status of the infant.  In the United States, where low iron is not as much of a problem, the American College of Obstetrics and Gynecology (ACOG) has not recommended the early cut practice.  Concerns about jaundice and the longstanding practice of early cutting caused ACOG to say there is insufficient evidence.

Changes in medical practice to not come easily.  It took over 200 years for sailors and seafaring merchants to accept the fact that deadly scurvy could be prevented in sailors by just taking citrus fruit on board long voyages.  Dr. Ignaz Semmelweis proved that hand disinfectant could prevent child bed fever (with a maternal mortality up to 35%) but his ideas were rejected by the medical community and he ended up dying in an insane asylum.  Despite his publishing of a book that showed the death rate falling to under 1% if physicians would just wash, it was decades before his theories were adopted.

We shall see if delayed cord clamping becomes adopted practice in the United States.  In nature, the mother animal (including humans without medical assist) have to severe the cord naturally and that certainly takes a bit of time.  Maybe there is some selection advantage to that delay in the health of the baby.

Probiotics - What and When?

Probiotics contain microorganisms that are similar to the beneficial bacterial that occur naturally in our intestinal tract.  There is so...