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Neonate with annular erythema on his face and scalp at birth

Subcutaneous emphysema (SE) occurs when air tracks along the subcutaneous tissues due to a leak from the lung parenchyma. In a neonate, pneumothoraces and pneumomediastinum can occur spontaneously following birth due to trauma from intubation, high peak inspiratory pressures during mechanical ventilation or from meconium aspiration syndrome. It is most commonly found in the soft tissues of the chest wall and neck and can be diagnosed on examination and by radiological imaging. It presents as a swelling and crepitation on palpation, which is often compared to the feeling of ‘bubble wrap under the skin’. It is usually a self-limiting condition but can be severe or even life threatening if extensive due to restriction of thoracic expansion by a large volume of air in the subcutaneous tissue. This infant had no respiratory compromise and was managed conservatively. SE has been reported in the adult population after chest surgery; to the best of our knowledge, this is the first such report following chest surgery in a neonate.