Abstract

percentile). The 1- and 5-minute Apgar scores were both 4. He was immediately intubated and transferred to the neonatal intensive care unit.On day 2 he underwent surgical repair of the congenital left diaphragmatic hernia with positioning of a Vicryl mesh. Severe lung hypoplasia and pulmonary hypertension required 15 days of conventional mechanical ventilation, 8 days of high frequency oscillatory ventilation requiring forced supine decubitus, 5 days of nasal continuous positive airways pressure (CPAP), 23 days of oxygen therapy and 15 days of inhaled nitric oxide; also several vasoactive drugs (dopamine, dobutamine, adrenaline, milrinone) were used.On day 25, three occipital decubitus ulcers developed; two were clean and relatively small (diameter <1 cm). The third, central lesion was 3x3 cm covered by an eschar, and rapidly evolved to stage IV of the US National Pressure Ulcer Advisory Panel classifi cation (Figure 1A)

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