Multidisciplinary management of a neonate with kaposiform hemangioendothelioma with extensive cranial fossa destruction.

Kaposiform hemangioendothelioma is a rare, benign, locally destructive vascular tumor. Kasabach-Merritt phenomenon, a consumptive coagulopathy, is a life-threatening complication associated with kaposiform hemangioendothelioma. We describe a case of kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon in a neonate born with a large facial mass with deep extension toward the cranium and airway. The mass was not identified prenatally. The patient was a 37-week gestation age female neonate born via spontaneous vaginal delivery and noted to have a large left-sided facial mass that was not noted on the most recent prenatal ultrasound at 22 weeks gestation age. At birth, the patient was in respiratory distress and required continuous positive airway pressure support. Imaging revealed a large highly vascularized soft tissue mass adjacent to the airway with intracranial extension and bony destruction. Fine needle aspiration confirmed kaposiform hemangioendothelioma. On day of life 6, the patient was noted to have thrombocytopenia, elevated d-dimer, anemia, and hypofibrinogenemia, consistent with Kasabach-Merritt phenomenon, which resolved at day of life 12. Given the location and extent of the mass, medical therapy with single agent oral sirolimus was chosen over surgery. At 13-month follow-up, the infant is well on sirolimus therapy, and the mass has decreased in size, both clinically and on imaging. This case highlights the importance of prompt diagnosis and management of kaposiform hemangioendothelioma with extensive craniofacial and bony involvement with Kasabach-Merritt phenomenon with single oral therapy of sirolimus. Fibrinogen concentrate may be considered in the Kasabach-Merritt phenomenon refractory to cryoprecipitate.

Fellows as Teachers: Supporting Future Educators.

Teaching is inherent to the practice of medicine, as physicians are relied on to educate those around them, including staff, trainees, colleagues, and the patients and families for whom they provide care. Neonatal-perinatal medicine fellows uniquely serve as both trainee and subspecialty expert and are additionally expected to be strong teachers. In this article, the authors review the benefits of developing fellows as teachers, the challenges and potential mitigating strategies of fulfilling this objective, and the educational foundations and future directions that may inform the development of curricula for training fellows as teachers.

Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions.

Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.

Perspectives: The Flipped Classroom in Graduate Medical Education.

Andragogy, the art and science of helping adults learn, is a learner-centric conceptual framework that considers adult learner characteristics and their motivations for learning. These motivations range from internal will, readiness to learn, and relevance to one's own life. The flipped classroom, an increasingly popular educational method for both learners and educators, aligns with an andragogical approach as it uses classroom time for application of knowledge and critical thinking rather than for a passive didactic lecture. The growing body of educational research demonstrating increased performance and knowledge retention using this method has led to its incorporation into graduate medical education materials, including the National Neonatology Curriculum. In this article, the authors review how the flipped classroom, an active educational method that embraces the tenets of adult learning theory, may be more effective in graduate medical education compared with traditional lecture.