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  • Because of persistent respiratory distress, the Ruxolitinib purchase neonate was intubated 20?min after delivery. Owing to a subgaleal bleeding accompanied by hypotension and tachycardia, she received saline, fresh frozen plasma and two blood transfusions in the first few hours after delivery. At birth, extensive swelling in areas of desquamated and necrotic skin of the right lower limb was noted (figure 1). Figure?1 Extensive swelling with areas of desquamated and necrotic skin of the right lower limb immediately after

    birth. Investigations Full blood count was within the normal range. A blood culture demonstrated an infection with Streptococcus anginosus for which she was treated with penicillin during 10?days. C reactive protein levels increased to a maximum of 7?mg/L. X-rays of both lower limbs did not demonstrate fractures or bone deformities. Although flow in the femoral and tibial arteries was detectable, capillary refill in the right toes was diminished. Doppler

    ultrasound suggested raised pressure in the arterial lower limb trajectory without signs of thrombosis. Treatment Because of extensive subcutaneous oedema at the dorsal side of the right foot, decompressing subcutaneous incisions were performed. The perfusion of the toes improved. Emergency fasciotomy was not necessary. Outcome and follow-up In the following days, the extensive swelling decreased and the skin lesions recovered (figure 2). The right lower limb lacked spontaneous movement and the neonate developed an equinus position of the foot with plantar flexion of the toes, for which a paediatric orthopaedist was consulted at day 7. Physical therapy was started in order to maintain maximal range of motion. She was transferred to a high care centre after 12?days, where she was discharged home after 5?weeks. Physical therapy was continued at home. The neonate was seen at the outpatient orthopaedic clinic at a corrected 40?weeks of gestation. The aspect and functionality

    of the right limb was completely normal and there were no signs of muscular atrophy. Figure?2 Extensive swelling decreased after decompressing subcutaneous incisions, and the skin lesions recovered after a couple of days. Note the equinus position of the right foot with plantar flexion of the toes. Discussion We present a neonate born after PPROM and transverse lie at 29?weeks of gestation with signs of neonatal compartment syndrome (NCS). The neonate was born after an emergency caesarean section because of the suspicion of fetal distress. To our knowledge, this is the first presentation of a prematurely born neonate with signs of NCS of the right lower limb after PPROM and transverse lie. An important complication of PPROM is fetal malpresentation at delivery since spontaneous version with PPROM is unlikely.

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