P302 Prematurity with facial nerve palsy

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This case based presentation focuses on a premature infant born at 30+5 weeks gestation with facial nerve palsy, without any preceeding trauma. His antenatal scans had been normal and he was born in good condition by emergency caesarean section for antepartum haemorrhage, with no history of instrumental delivery or facial trauma.

This infant required some respiratory support with facial oxygen and was transferred to the Neonatal Intensive Care Unit (NICU) after he had been given surfactant directly via endotracheal tube route. In NICU the infant was given continuous positive airway pressure. It was noticed on admission to the neonatal unit that he had mild facial palsy on the left side. In NICU his cranial ultrasounds were normal and he established feeding.

To our knowledge this is a very rare case of lower motor neuron facial palsy reported in a 30 week premature baby in absence of traumatic delivery or dysmorphic features suggestive of any syndrome. It raises a possibility of inutero pressure on the facial nerve.

Neonatal nerve palsies can be either developmental or acquired. The incidence in the literature has been quoted as 2 per 1000 births most commonly caused by birth trauma of which there was no history of in this case. Rarer associations include Möbius’s syndrome, hemifacial microsomia, Goldenhar’s syndrome, DiGeorge syndrome and Poland Syndrome. With this case, we are aiming to discuss possible causes of facial nerve palsy, rarely seen in premature neonates without any associated birth trauma, and the management as well as prognosis of neonatal facial nerve palsy.

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