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Das mannliche Neugeborene fiel am ersten Lebenstag mit einer irregularen Schmalkomplextachykardie auf. Nach sowohl frustraner medikamentoser, als auch elektrischer Kardioversion konnte unter einer intravenosen β-Blockertherapie die zugrunde liegende multifokal-ektopen Vorhoftachykardie diagnostiziert werden. Der weitere klinische Verlauf war trotz wechselnder und kontinuierlich eskalierter antiarrhythmischer Medikation (Esmolol, Propranolol, Propafenon und Amiodaron) von teils paroxysmal rezidivierenden und teils auch langer andauernden Tachykardieereignissen gepragt. Wiederholt wurden diese durch Vorhofflattern mit einer maximalen Vorhoffrequenz bis zu 460/min und 2:1 Uberleitung ausgelost. Erst eine hochdosierte Therapie mit Amiodaron (10 mg/kgKG/d) konnte letztlich eine stetige Frequenzkontrolle ohne Tachykardieereignisse bei weiterhin instabilem Sinusrhythmus etablieren. Aktuell ist der Patient 7 Monate alt und weiterhin in einem uberwiegendem Sinusrhythmus.

Extremely immature preterm infants rarely present with a leukocytosis exceeding 30,000/microL. The pathogenetic sequence leading to leukemoid reactions in non-malignant diseases remains to be elucidated. Potential triggers for leukemoid reactions in premature infants include prenatal corticosteroids, chorioamnionitis and funisitis or systemic infection. In the two-year period from 2006 to 2007 all infants with a gestational age of less than 26 weeks were screened for leukocytosis. Among our cases, one preterm infant presented with a leukocyte count of 229,300/microL at the age of 48 hours, lasting throughout the first three weeks of life. Impairment of microcirculation and resulting organ dysfunction were not observed. Thus, invasive therapeutic procedures, which are routinely initiated in hyperleukocytosis in accompanying malignant diseases, may not have the same significance in extremely immature preterm infants and should be executed in these patients on an individual basis and with extreme caution.

Introduction: Late vitamin K deficiency bleeding in young infants is a rare disorder which occurs almost exclusively in breast-fed infants who did not receive proper vitamin K prophylaxis at birth and who might additionally suffer from cholestasis. Its impact on morbidity is high since in 50% of the cases it presents with intracranial hemorrhage with a mortality rate of 20% and life-long neurologic sequelae in 30% of the affected infants. Case reports: 2 male infants were both admitted to our unit at the age of 5 weeks with subdural hematoma with midline shift due to late vitamin K deficiency bleeding. Both infants did not receive the recommended Vitamin K prophylaxis in Germany. One patient presented with cholestatic jaundice on admission as an additional risk factor. Discussion: Parents who in the apparent best interest for their children refuse the recommended and well established vitamin K prophylaxis at birth leading to the reappearance of late vitamin K deficiency bleeding. These parents also tend to refuse routine immunizations of childhood in later life, which not only have an impact on their own child but might bear a risk for the whole community. Conclusion: It is the responsibility of health-care takers to show increased awareness to the growing number of parents refusing vitamin K prophylaxis at birth and educate them properly about the devastating consequences of late vitamin K deficiency bleeding.