The benefits of having photos of the newborn baby

Paediatric dermatology

Dr. Emmanuelle Bourrat

Saint-Louis Hospital

The clinical case
Now it's your turn!
Co-prescription and advice

Clinical case presentation

A 6-month-old infant was referred for a large “congenital” left frontal subcutaneous depression.

This healthy baby was born at term by vaginal delivery without instrumental obstetric maneuvers, at the end of an unremarkable pregnancy.

The area of subcutaneous tissue atrophy was well limited, surmounted by normal skin. It was not progressive but grew with the child's growth.

A review of the history and the parents' photographs taken at birth revealed that this depression was the result of the rapid regression of a congenital soft swelling that evolved into a dark red, angiomatous macule within a few days, then into the current state over the first few weeks.

De l’intérêt de disposer des photos du nouveau-né

Your turn

What is your diagnosis?

Select 1 answer(s) from the following choices:

Infantile hemangioma

Rapidly involuting congenital hemangioma (RICH)

Kaposiform hemangioendothelioma

Cystic lymphangioma

Wrong answer!

Good answer!

Selected diagnosis

Thanks to the parents’ photograps, it was possible to attribute this subcutaneous atrophy to the regression of a rapidly involuting congenital hemangioma. This child was indeed born with a rapidly involuting congenital hemangioma (RICH).

Congenital hemangiomas are rare benign vascular tumors of the newborn with two constant clinical features: presence at birth (implying intrauterine development) and negative GLUT-1 staining. These two features distinguish them from classic infantile hemangiomas, even if in practice, histology is only rarely useful for diagnosis.

Three subtypes of congenital hemangiomas are distinguished according to their clinical course:

RICH is rapidly and completely regressive within the first weeks or months of life
NICH (non-involuting congenital hemangioma) remains stable over the long term
And PICH (partially involuting congenital hemangioma) partially regresses.

A recent study confirms that these three subtypes belong to the same nosological spectrum and share many clinical and radiological features.
In contrast, the subcutaneous atrophy-like sequelae appear to be quite specific to RICH.

Explanation of wrong answers

Infantile hemangioma: It is usually not present at birth, grows until around 6 months of age, then slowly regresses over several years, leaving no skin depression except in cases of ulceration.
Kaposiform hemangioendothelioma: This is a very rare congenital or non-congenital capillary tumor of non-specific appearance (flat, infiltrated or tumoral lesion of variable size) that does not tend to regress spontaneously and may be complicated by Kasabach-Merritt syndrome. Diagnosis is histological.
Cystic lymphangioma: This lymphatic malformation often affects the cephalic region of newborns and can be so large that it is sometimes diagnosed by antenatal ultrasound. The swelling is covered by normal-colored skin, is transilluminable and does not spontaneously involute. Diagnosis is based on ultrasound.

Treatment

RICH regresses very rapidly after birth and therefore does not require treatment.

Message from the expert

There is a risk of spontaneous profuse bleeding during the regression phase of RICH, and parents should therefore be warned of the need to consult a doctor promptly in the event of bleeding.

References

^{Braun V, Prey S, Gurioli C, et al.}^{Congenital haemangiomas: a single-centre retrospective review.}^{BMJ Paediatrics Open 2020;4:e000816. doi:10.1136/ bmjpo-2020-000816}