Vacuum extraction as a treatment modality of neonatal skull depression in a twin infant.

The management of depressed skull fractures in the newborn infant can be controversial. In this article, we report a case of twin pregnancy wherein one of the fetuses had depressed skull fractures that was not associated with any known trauma during the pregnancy or at delivery. This ping-pong skull depression was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible etiologies and treatment modalities for neonatal depressed fractures, being conservative or operative, are discussed.

Efficacy of erythropoietin in premature infants.

OBJECTIVE: To identify the effect of early parental recombinant human erythropoietin and iron administration on the blood transfusion requirement of premature infants. METHODS: In a controlled clinical trial conducted at the neonatal intensive care unit of Al-Hada Military Hospital, Taif, Kingdom of Saudi Arabia over a 16 months period, we assigned 20 very low birth weight infants with gestational age of (mean +/- standard error of mean) 28.4 +/- 0.5 weeks and birth weight of (mean +/- standard error of mean) 1031 +/- 42 gm, to receive either intravenous recombinant human erythropoietin 200 U/kg/day and iron 1mg/kg/day or conventional therapy over a 21 day study period. Blood transfusion administration undergoes a strict protocol in our nursery. RESULTS: During the 3 week study period, the hemoglobin and hematocrit remained similar in the 2 groups while the reticulocyte counts were greater in the recombinant human erythropoietin recipients on day 14. The number and volume of blood transfusions were similar in both groups. CONCLUSION: Very low birth weight infants receive fewer blood transfusions than the number previously reported. Strict phlebotomy and transfusion criteria could minimize the need for human recombinant erythropoietin.