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Introduction: Life-threatening haemorrhage in neonates is related to high mortality rates. Use of Prothrombin complex concentrate (PCC) in such cases could be significantly valuable because of the low levels of vitamin K-dependent coagulation proteins in neonates and their consumption in case of DIC status. Administration of PCC results in a faster and more effective discontinuation of bleeding, providing time to stabilize the neonate without the risks of fluid overloading and bloodstream infections. Objective:Proposal of an alternative therapeutic approach to intractable bleeding in neonates resistant to conventional haemostatic therapy and compared the clinical outcome of newborns treated with PCC for intractable bleeding or severe coagulation disturbances according to time administrated. Subjects/methods:Data of 39 neonates treated successfully with PCC were retrospectively analyzed. Each patient received a median of 2.1 doses of 25/U of PCC in slow iv push with 12 hrs time-interval. Blood samples for evaluation of coagulation parameters (PT,aPTT,INR) were obtained 1/hr following infusion of each PCC dose. Results:The population consisted of 39 neonates, 14 of them survived (group/A) and 25 died (group/B). There was no difference in BW, GA and bleeding cause or/and site between the 2 groups. In the neonates who survived PCC had been administered earlier in the disease process (within 24 hours of beginning of bleeding) compared to those who died (p=0.048). We observed a statistically significant decrease in PT (from 39.5±41 to 18.7±4.41 prior and after to PCC respectively, p=0.001) and in INR (from 3.67±4.01 to 1.61±0.52 prior and after to PCC respectively, p=0.002). There were no clinical signs of thrombosis or any other adverse effect due to PCC treatment. Conclusion: PCC was safe and efficacious in neonates with intractable bleeding and/or severe coagulation disturbances and PCC was more effective in early intervention as rescue therapy, without any adverse events in all neonates [ABSTRACT FROM AUTHOR]

Introduction: Drug-induced immune thrombocytopenia is considered extremely rare, as a cause of neonatal thrombocytopenia (PLT 0.000/μL). Diagnosis of drug-induced immune thrombocytopenia is considered as definite when all four George criteria are met: 1. Drug administration preceded thrombocytopenia. Recovery was complete and sustained after drug discontinuation 2. Other drugs administered prior to thrombocytopenia were continued or reintroduced after discontinuation of the suspected drug 3. Other etiologies of thrombocytopenia excluded 4. Re-exposure to the drug resulted in recurrent thrombocytopenia Objectives: We describe an interesting case of early onset, severe ampicilline-induced immune thrombocytopenia, in newborn twins. Material - Method: Monochorionic- diamniotic female twin neonates (A) and (B) (GA: 36 weeks) Results: Twins were born after an uncomplicated pregnancy via cesarean section (due to previous one). Perinatal history was unremarkable. Administration of empirical treatment with ampicillin and amikasin intravenously. On 2nd day of life (DOL), they exhibited severe thrombocytopenia (table 1), without hemorrhagic diathesis. Coagulation tests of (A) twin were prolonged (day 3). Laboratory screening for infection (CRP, blood culture), TORCH, perinatal asphyxia, necrotizing enterocolitis, neonatal alloimmune thrombocytopenia and disseminated intravascular coagulation, was negative. Drug-induced immune thrombocytopenia is an allergic reaction type II and in our case was related to ampicillin. Antibiotics were discontinued at 2nd DOL. Platelet transfusions were administered in both twins and fresh frozen plasma in (A) twin. On 5th DOL, platelet count was normal as well as coagulation tests of (A) twin, and no recurrence of thrombocytopenia was observed. Conclusions: Drug-induced neonatal immune thrombocytopenia is acute and severe. Clinical suspicion is important for diagnosis, which is probable in our case. [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing enterocolitis (NEC) is one of the most common surgical emergencies in very low birth weight infants (VLBWI) [birth weight(BW)<1,500g]. Objective: The aim of this study was to determine the incidence of NEC in VLBWI and compare the risk factors for outcomes in VLBWI with surgical NEC (sNEC). Subjects/methods: We have performed a retrospective review of VLBWI with NEC who underwent a surgical procedure between January 2009 to June 2017. Data collected include: mode of conception, gestational hypertension, placenta abruption, chorioamnionitis, preterm/premature/rupture/of/membranes (PPROM), uterus contractions (UC), tocolysis, mode of delivery, gestational age(GA), BW, perinatal asphyxia, gender, intrauterine growth retardation, respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, enteral feeding, age at perforation, interval time between the offspring of NEC and the operation and laboratory findings (PLT, PT, INR, aPTT). Data above were analyzed regarding their possible relationship with mortality. Results: During study period 4,618 neonates were admitted to our hospital and 639 (13.8%) of them were VLBWI. Among these 639, twenty-eight(4.4%) have NEC. Of the 28 infants with NEC, 21 (75%) were operated on. Following treatment, 14 patients (groupA) recovered and were discharged, while 7 patients (groupB) died (mortality 33.3%). All deceased neonates were male. The median age of NEC onset (p=0.167), the GA [groupA:29.12.6w vs groupB:27.21.8w, (p=0.108)] and the BW [groupA:1037313g vs groupB:835250g, (p=0.086)] were not different between the two groups. From the above factors only male gender(p=0.018) and PROM(p=0.025) were associated with mortality as well as the presence of UC was associated with a lower incidence of mortality(p=0.024). No difference was noticed between the rest of the factors. Conclusions: In our NICU the incidence of sNEC in VLBWI was low and the survival rate was high and similar to that of other multicenter studies. However, sNEC remains a major cause of morbidity and mortality. [ABSTRACT FROM AUTHOR]