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Signa Vitae

Journal of Intensive Care and Emergency Medicine

“Spontaneous” ping-pong fracture in newborns: case report and review of the literature

Abstract

“Ping-pong” fractures (PPF) are depressed skull fractures typical of newborns. PPF usually result from head injury and, rarely, may cause severe long-term neurological sequelae. The management of PPF is still controversial. The goal of this paper is to present a case of “spontaneous” ping-pong fracture and to review the pertinent literature of the last 20 years. We report on a newborn who presented with a “spontaneous” parietal depressed skull fracture at birth. Preoperative computed tomography (CT) scan confirmed the PPF and excluded brain injuries. Neurosurgical intervention was performed on day 3 with immediate lifting of the fracture; the postoperative course was uneventful.

During the last 20 years, 22 cases of “spontaneous ping-pong” fractures in newborn have been reported, with different clinical pictures and management but, generally, with a good outcome.

“Ping-pong” fractures can occur in uneventful pregnancies and after uncomplicated vaginal or cesarean deliveries. CT scan, with low-dose protocol for infants, is the gold standard examination to evaluate the fracture and any associated brain lesions. Treatment is selected according to fracture characteristics.

Key words: ping-pong fracture, newborns, CT scan, delivery, neurosurgery

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Risk factors for developing epilepsy after neonatal seizures

Abstract

Neonatal seizures are the most frequent neurological disorder in the neonatal period. The incidence is reported to be higher than at any other period in life. Because of the unique nature of neonatal brain anatomy, connections and the paradoxical nature of neurotransmitters, seizures in this age group vary in semiology from those in older children. They may cause irreversible changes to the synapses in the immature brain and progress to epilepsy.

The aim of the study was to analyse laboratory, clinical, neurophysiological and neuroimaging risk factors for epilepsy in a group of children who experienced seizures in the neonatal period.

A retrospective study of 176 newborns admitted to the Department of Neonatology, University Children’s Hospital Ljubljana, due to seizures, was performed. Metabolic disorders and hypoxic-ischaemic encephalopathy were the most frequent aetiological factors associated with seizures. Epilepsy rate in the group was 18%. Pathological cardiotocography, reanimation after delivery, myoclonic type of seizures, more than one type of seizures, severely abnormal electroencephalography, abnormal neurological examination and neuroimaging, treatment with more than one antiepileptic drug and duration of treatment more than one month constituted statistically significant independent predictive factors for epilepsy (p< 0.05).

The results of our study further elucidate risk factors for epilepsy after neonatal seizures.

Key words: newborns, seizures, epilepsy, risk factors

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