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Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Scalp-IHs are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. We describe a case of a 30-months old female who presented a large scalp-IH at birth that rapidly grew in the first year of life. Topical and systemic treatments (with timolol ointment and oral propranolol, respectively) were not effective in reducing dimensions of the hemangioma. After vascular imaging study, the patient underwent surgical resection of the IH and primary closure with excellent cosmetic outcome. When medical therapy is ineffective or cosmetic and functional integrity is threatened, early surgery allows to completely removing large scalp-IHs, with good cosmetic results.

We recently came across a male newborn with diffuse pustular eruption of the trunk and the face appeared at 25th day of life. The baby was born from asymptomatic COVID-19-positive mother and was otherwise healthy. Patient's throat swab PCR diagnostic test for SARS-CoV-2 was negative. A detailed clinical examination revealed monomorphic small pustules predominantly affecting the upper part of the chest and to a minor extent the face.

Background Among infants needing urgent transfer after birth, very preterm infants are a high-risk sub-group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer. Methods Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs). Results Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC -3.82%). Use of nasal-continuous-positive-airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self-inflating bag (at call: APC -12.09%), oxygen therapy (at call: APC -13.00%; during transfer: APC -23.77%) and mechanical ventilation (at call: APC -2.71%; during transfer: APC -2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC -5.73%; at transfer APC -8.89%). Surfactant administration at call increased (APC 3%-10%), while surfactant administration when arriving at referring hospital remained around 7-11% (APC 2.55%). Conclusion Relevant trends toward "gentle" approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs.

Increasing recent evidence favors paracetamol use for patent ductus arteriosus (PDA) closure in preterms. Our study aims were (1) to assess efficacy and safety of intravenous (i.v.) paracetamol for PDA closure in a 23-32-week preterm population, as "first-line" (when traditional ibuprofen treatment was contraindicated) or "rescue" treatment (after ibuprofen failed), and (2) to identify predictors of PDA closure. The cumulative efficacy of consecutive cycles of i.v. paracetamol on PDA closure was confirmed after both "first-line" and "rescue" treatment, the overall PDA closure rates being, respectively, 56.7 and 61.1 % (p = 0.7624) after two cycles and 63.3 and 77.8 % (p = 0.2959) after three cycles. No toxicity was apparent after either "first-line" or "rescue" i.v. paracetamol treatment. On multivariate analysis, gestational age (GA) emerged as an independent predictor of PDA closure in the "first-line" i.v. paracetamol treatment group, while clinical risk index for babies (CRIB) score (a patient risk index based on birth weight, GA at birth, sex, patient's temperature on admission, and maximum base excess in first 12 h of life) was an independent predictor of PDA closure failure in the "rescue" group.I.V. paracetamol proved effective in our study population. Randomized control trials (RCTs) are warranted to further investigate the efficacy and safety of i.v. paracetamol for PDA closure in preterms.• Oral paracetamol has been judged as effective as oral ibuprofen for PDA closure in the preterm. • To date, only a handful of non-randomized studies exist to support the effectiveness of i.v. paracetamol in PDA closure. What is New: • Our observations confirm the clinical efficacy of i.v. paracetamol for PDA closure in a very low birth weight (VLBW)/extremely low birth weight (ELBW) preterm population. • Gestational age and CRIB score emerge as independent predictors of PDA closure.

We evaluated an otherwise healthy, full-term female newborn for a soft, non-tender swelling of the left labium majus (figure 1). Ultrasound scan at birth confirmed the absence of indwelling intraperitoneal structures, ruling out the hypothesis of inguinal hernia. A 2-week follow-up ultrasound revealed a hypoechoic/isoechoic tissue with hyperechoic striae in its context. Doppler ultrasound imaging at 6 and 12 months excluded vascular malformations. The baby …

Dermatological hand signs are common and can be benign (with or without treatment implications), linked to a change in patient's behaviour or herald more severe systemic conditions (dermatomyositis). Despite the peculiarity of underlying diseases, their visual appearances may overlap and sometimes be deceptive. It is therefore important for clinicians to be aware of the possible similarities in such diverse conditions, in order to make a correct diagnosis and target treatment. ### Which would be the most likely diagnosis for each image based on the cases below: 1. Gottron's papules 2. Psoriasis 3. Cutaneous T-cell lymphoma 4. Chewing pads 5. Knuckle calluses 6. Herpetic lesions 7. Idiopathic/familial knuckle pads 8. Cold burns (frost bites) 9. Common warts 10. Occupational lesions We evaluated a 17-year-old girl with dark phototype with an upper respiratory tract infection. Physical examination incidentally revealed plaque lesions located only at the extensor surface of her right hand, at the proximal interphalangeal joints (IJ) (figure 1A). Left hand was unharmed. The rest of the examination, apart from the concomitant respiratory infection, was negative. The girl also reported a recent school change as a current stressor. Figure 1 (A) Self-induced ‘chewing pads’, (B) Gottron’s papules, …

Which would be the most likely diagnosis for each image based on the cases below: 1. Physiological breast enlargement 2. Subcutaneous fat necrosis 3. Neonatal mastitis 4. Breast abscess 5. Nipple capillary haemangioma 6. Naevus flammeus of the nipple 7. Port wine stain of the nipple 8. Nipple eczema 9. Pityriasis versicolor A 13-day-old term infant was evaluated for bilateral breast enlargement; no tenderness or discharge was evident (figure 1A). Figure 1 The rest of the physical examination and laboratory were unremarkable. The patient remained well and thriving at regular follow-up; the appearances had completely regressed by 6 weeks. A term female infant was admitted to hospital at 7 days of life for fever (body temperature 38.2°C) and a swollen right breast with erythematous periareolar skin (figure 1B). The patient was slightly miserable on evaluation; the rest of the physical examination was normal. A 1-month-old girl was evaluated for a left nipple lesion which had evolved over the previous 2 weeks: the mother described gradual development of sparse similar smaller lesions over the areolar region, which had coalesced (figure 1C). The remaining physical examination was normal and she had a normal newborn examination. A normal male term newborn was evaluated at 1 month of age for a right nipple lesion with reddish, desquamated areolar and …

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 …

A newborn girl of 36 weeks gestation was noted to have several anomalies, including bilateral low ear attachment with ear pinnae hypertrichosis, left preauricular pit, micrognathia, short lingual frenulum, and short neck. Pregnancy history revealed poorly controlled maternal gestational diabetes (GD). Localized hypertrichosis of the ear pinnae may represent a potential marker of GD and thereby alert physicians to suspect other potentially GD-associated conditions such as macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, hypertrophic cardiomyopathy, and congenital anomalies, particularly those involving the central nervous system.

A previously healthy, immunocompetent 6-month-old girl presented with a 4-day history of fever and a deep, blackish eschar surrounded by extended ulceration and erythema on her right cheek (figure 1), rapidly evolved despite initial treatment with a Calendula and Gentamicin homeopathic ointment. Figure 1 Exudating deep, blackish eschar surrounded by extended ulceration and erythema, as seen at admission. She had not received antibiotics previously. Blood tests at admission showed leukocytosis (white blood cells 10 640/mm3, reference range 6000–17 500/mm3) with normal neutrophil count (N …

A 4-year-old girl with clinical and laboratory signs of Kawasaki disease (KD) was hospitalized and given intravenous immunoglobulin plus aspirin therapy, with rapid defervescence and clinical improvement, and was discharged 48 hours after admission. At the time of her follow-up echocardiography on day 14, orange-brown pigmentation of the nail beds was noticed and confirmed with dermoscopy. No clear association between KD and orange-brown chromonychia has been demonstrated, although reports and case series suggest a possible link between these two entities. We suggest that this particular finding might be encompassed in late (subacute) changes of extremities as part of KD diagnostic criteria.

Despite the fact that sheep are a widely used animal model in cardiovascular research, reference values for transthoracic echocardiography in normal growing animals are not available. Eight healthy female lambs underwent two-dimensional, M-mode and pulsed wave Doppler echocardiographic examination at 100 days of age and every three months thereafter over a 12-month period. The study was conducted under sedation with midazolam, butorphanol and constant rate infusion of intravenous propofol. Their growth phase was completed at about one year of age. All the echocardiographic parameters considered were significantly correlated with body weight and age class except for the left ventricular systolic and diastolic diameters. Functional indices were not correlated to body weight or age except for the E-point to septal separation distance (EPSS). Doppler-derived parameters were not influenced by independent variables. Transthoracic echocardiography can be considered an applicable method for cardiovascular research using a growing lamb animal model after appropriate adjustments for age and body size.

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 Blaschko's lines (BL) (figure 2) was consistent with facial lichen striatus …

A term, small for gestational age girl was diagnosed with congenital isolated left unilateral lacrimal fistula at a 1-month follow-up visit (figure 1). The baby showed regular thriving (weight, length and head circumference between the 3rd centile and the 15th centile of WHO curves) and normal neurodevelopment at 1-month and 4-month controls. Lacrimal fistula remained asymptomatic through time. Figure 1 (A) Lacrimal fistula located at the medial canthus …