SCARRING ALOPECIA IN NEONATES AS A CONSEQUENCE OF HYPOXEMIA-HYPOPERFUSION

Scarring alopecia is relatively uncommon in infants and children and r arely discussed in the paediatric literature. It does not appear to ha ve been previously documented as a consequence of compromised oxygenat ion and blood supply in the neonatal population or as a complication o f extracorporeal membrane oxygenation (ECMO) treatment. During a six m onth period, we observed five patients who presented to our neonatal i ntensive care unit with pressure ulcers that eventuated in scarring al opecia. The patients were all greater-than-or-equal-to 2500 g at birth , had some disruption of the cardiac circulation, were hypoxaemic and acidotic, and required vasopressor treatment. Institution of a positio ning schedule and use of a thermostable Spenco gel pad during the subs equent six month period eliminated the presence of pressure ulceration and scarring alopecia in this at-risk population. Although scarring a lopecia is a permanent condition, skin changes preceding its developme nt in this setting are recognisable and follow a predictable pattern a nd time course, and should therefore allow for intervention at an earl ier stage. Neonatal ECMO patients, as well as those who suffer hypoxae mia-hypoperfusion, but do not require circulatory bypass, appear to be at increased risk for development of the pressure ulcers that precede scarring alopecia. Paediatricians should consider this possibility an d seek the appropriate historical information when confronted with a c ase of scarring alopecia after the neonatal period.