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Elevation of Depressed Skull Fracture in Neonates Using a Breast Pump and a Custom-Molded Flange
Emilie L Martinez1, Ashley Welscher2, Manish N Shah1
1Department of Pediatric Surgery, Division of Pediatric Neurosurgery, UT Health McGovern Medical School, Children's Memorial Hermann Hospital, Houston , Texas , USA.
Insights
A novel bedside technique using a hospital-grade breast pump successfully elevated ping-pong fractures (PPF) in two neonates, avoiding surgery and anesthesia. This method offers a safe and effective alternative for correcting cosmetic deformities in infants.
Area of Science:
- Neonatal care
- Pediatric surgery
- Biomedical engineering
Background:
- Ping-pong fractures (PPF) are common in neonates, causing cosmetic deformities and mass effect.
- Current standard treatment involves surgical elevation, posing risks of surgery and general anesthesia.
Purpose of the Study:
- To demonstrate a novel, non-surgical, bedside technique for correcting neonatal ping-pong fractures.
- To evaluate the efficacy and safety of using a modified breast pump for PPF elevation.
Main Methods:
- A custom device was fabricated using a hospital-grade breast pump flange and moldable seal rings.
- The device was applied to the skull, and brief suction periods were used to elevate the depressed bone.
- Computed tomography scans confirmed successful PPF elevation.
Main Results:
- The non-surgical technique successfully elevated ping-pong fractures in two preterm infants.
- Both infants achieved excellent cosmetic outcomes with no adverse effects.
- Follow-up at 24 and 9 months showed sustained positive results.
Conclusions:
- This breast pump-based technique offers a safe and effective alternative to surgical correction of neonatal ping-pong fractures.
- It eliminates the risks associated with surgery and general anesthesia.
- The method utilizes readily available, inexpensive materials for successful PPF elevation.
Background And Importance:
"Ping-pong fractures" (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed bone when the indentation is considerable or cosmetically apparent. Surgical correction of PPF subjects patients to the risks of surgery and general anesthesia. This article and corresponding video demonstrate a novel means of correcting PPF at bedside without surgery or anesthesia. We used a hospital-grade breast pump connected to a custom-fabricated flange to successfully elevate PPF in two neonates.
Clinical Presentation:
Two moderately preterm infants were noted at birth to have large parietal PPF. To avoid surgical intervention, elevation using a suction device was attempted. A hospital-grade breast pump was used to provide suction. A custom device was fabricated out of a breast pump flange and molded Coloplast Brava® protective seal rings. This device was carefully applied to the skull to exactly match the diameter of the PPF and contour of the bone. Brief (15-30 seconds) periods of suction were applied several times until the PPF was successfully elevated as documented on subsequent computed tomography scans. Both infants achieved excellent cosmetic results with no adverse effects over 24- and 9-month follow-ups, respectively.
Discussion:
This technique eliminates the risks of open surgical correction and corrected the PPF without general anesthesia or adverse effects to the infant. While there may be limitations due to patient age and/or location of the PPF, the use of widely available and inexpensive custom-fitted materials with a hospital grade breast pump achieves maximal efficacy without requiring higher negative pressure suction application.
Conclusion:
Elevation of PPF can be safely achieved in some neonates using readily available equipment: a hospital-grade breast pump, flange, and moldable adherent material. This technique is reasonable to attempt in lieu of surgical elevation.
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