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A Piece of My Mind
April 22 2009

Collateral Damage

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

JAMA. 2009;301(16):1637-1638. doi:10.1001/jama.2009.543

I was in the final week of my fellowship when I began caring for Baby Clark (not his real name), a 34-week premature infant delivered by urgent cesarean birth. Baby Clark had the same tangle of intravenous lines, cardiac monitors, and cannulas as the other babies in the special care nursery, but his examination was notable for deep purple bruising covering much of his head and small body. It was this bruising that had prompted his parents to wait on disseminating “new baby” pictures to friends, family, and coworkers. Over his first 72 hours of life, the bruises began to dissipate, his neonatal jaundice was resolving under “bili lights,” and his labored breathing was giving way to calmer, more measured breaths on room air. All seemed to be falling into place, and then his nurse noticed it: the tell-tale depression along the left side of his head.