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Intrakranielle Blutungen sind im Säuglingsalter seltene, aber lebensbedrohende Ereignisse. Neben Gefäßmissbildungen, Stoffwechseldefekten sowie Störungen der Blutgerinnung kommen v. a. nichtakzidentielle Traumata, Schütteltrauma in Betracht. Die klinische Diagnostik umfasst hinsichtlich der Blutungsgenese neben Sonographie und MRT als apparatives Verfahren auch eine Fundoskopie sowie laborchemische Analysen, insbesondere der Gerinnungsparameter. Für die Blutgerinnung ist das fettlösliche Vitamin K essenziell: Frühe, klassische und späte Vitamin-K-Mangel-Blutungen werden dabei unterschieden. Um ein gehäuftes Wiederauftreten von Vitamin-K-Mangel-Blutungen bei Neugeborenen und jungen Säuglingen zu verhindern, bedarf es einer hinreichenden Aufklärung der Eltern. Eine Verweigerung der Prophylaxe scheint Folge einer weltanschaulich begründeten Ablehnung der Schulmedizin und ein zunehmendes Phänomen in wohlhabenden Industrieländern zu sein., Intracranial hemorrhages in infants are rare but life-threatening events. Apart from vascular malformations, metabolic disorders and coagulopathies, nonaccidental trauma, in particular shaken baby syndrome must be taken into consideration. Clinical diagnostic tests and procedures to further evaluate the etiology of the hemorrhage include sonography and magnetic resonance imaging (MRI) as imaging procedures as well as fundoscopy and laboratory tests, especially with respect to coagulation parameters. Fat-soluble vitamin K is essential for blood coagulation. A differentiation is made between classical and delayed hemorrhages due to vitamin K deficiency. In order to avoid an increased recurrence of bleeding due to vitamin K deficiency in neonates and young infants, an adequate clarification for the parents is necessary. A refusal of prophylaxis seems to be the result of an ideologically founded rejection of classical medicine and an increasing phenomenon in affluent industrial countries.

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.

Synkopen haben im Jugendalter eine hohe Inzidenz. Berichtet wird von einem bislang gesunden knapp 13-Jahrigen, der im Sportunterricht uber Schwindel, Ubelkeit und einen Bewusstseinsverlust klagte. Eine Salve von polymorphen, deformierten und verbreiterten QRS-Komplexen wahrend der Belastungsuntersuchung fuhrte zur Diagnose einer seltenen, vererbbaren arrhythmogenen Erkrankung, der katecholaminabhangigen polymorphen ventrikularen Tachykardie (CPVT). Berichtet wird der naturliche Verlauf, spezifische Schwierigkeiten der Therapie und die Moglichkeit zur genetischen Sicherung der Diagnose.

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.

Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets.