Neonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma.

Hemangioma is the most common vascular tumor of infancy; presentation is often as cutaneous infantile hemangioma (IH). Cutaneous hemangioma is a clinical diagnosis. Most IHs follow a benign course, with complete involution without treatment in the majority of cases. Visceral hemangioma often involves the liver and manifests as a life-threatening disorder. Hepatic hemangiomas may be associated with high output cardiac failure, coagulopathy, and hepatomegaly which generally develop between 1 and 16 weeks of age. Mortality has been reportedly high without treatment. We report a rare case of a male infant with neonatal hemangiomatosis with diffuse peritoneal involvement, which mimicked a malignant-looking tumor on imaging, and discuss therapeutic options and efficacy. Propranolol is efficacious for IH but generally not useful for other forms of vascular hemangiomas, tumors, and malformations. In our case of neonatal peritoneal hemangiomatosis, propranolol appears to have halted the growth and possibly expedite the involution of the hemangiomatosis without other treatments.

Severe childhood injuries and poisoning in a densely populated city: where do they occur and what type?

AIM: The aim of this study was to review the patterns of severe childhood injuries and poisoning necessitating pediatric intensive care in a regional trauma center. METHODS: We reviewed discharge data of all children who were hospitalized for severe injuries and poisoning at the pediatric intensive care unit of a teaching hospital between October 2002 and December 2008. RESULTS: There were 86 patients (males/females, 2:1). Road traffic injuries (n = 19), falls (n = 17), and scalds (n = 13) were the 3 leading categories and accounted for 57% of these pediatric intensive care unit admissions. Injuries more commonly occurred indoor (63%), and victims of indoor accidents were younger (median age, 2.6 vs 8.4 years; P < .0001), with scalds, poisoning, and foreign body aspiration being predominant, whereas road traffic accidents predominated in outdoor accidents. As a risk factor, premorbid neurodevelopmental conditions such as mental retardation, convulsion disorder, or cerebral palsy were only present in indoor accidents. Children in outdoor injuries were generally healthy. Both groups were associated with significant morbidity (mechanical ventilation in 60%, inotrope use in 20%, anticonvulsants in 24%, and neurological/neurosurgical supports in 49%). Comparing the 3 most common categories of patients, there were significant differences in the median age, requirement of neurological/neurosurgical supports, and median hospital stay. Although not requiring neurological/neurosurgical supports, scalds injuries involved the youngest age group and required the longest hospital stay. CONCLUSIONS: The causes of severe childhood injuries are heterogeneous. Cardiopulmonary or neurological/neurosurgical supports are often required. These injuries more commonly occur indoor and involve toddlers with underlying neurodevelopmental conditions. These findings have important implications and serve to heighten public awareness especially on home safety measures in the prevention of childhood accidents.