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Objective: To identify the clinical presentations and outcomes of infant with Hemorrhagic Disease of Newborn (HDN). Study Design: Descriptive Cross-sectional study. Setting: Department of Neonatology, National Institute of Child Health (NICH), Karachi, Period: July to December 2021. Material & Methods: The babies diagnosed with HDN were included in the study. Age at onset of symptoms, gender, feeding pattern, place of delivery, site of bleeding and outcome were recorded. The outcome was compared with the chi-square test and the p-value <0.05 is considered significant. Results: Ninety five babies were included in the study. Male to female ratio was 1.87:1 and mean age of admission was 6.31 ± 5.98 days. The type of HDN was Early in 21 (22.1%), Classic in 55 (57.9%) and Late in 19 (20%) babies. In this study, 77.9 % babies were on exclusive breast feeding. Fifty four (56.8%) were delivered at homes, 9 (9.5%) at private clinics and 32 (33.7%) at government hospitals. In our country most babies are delivered at home where vitamin K is not given prophylactic to the newborn, leading to HDN. The site of bleeding were gastrointestinal, superficial, umbilicus and intracranial in 36 (37.9%), 24 (25.3 %), 21 (22.1%) and 12 (12.6%) neonates respectively. In this study, majority of babies (88.4 %) discharged. Conclusion: HDN was common in male gender, home deliveries, vaginal deliveries and breast fed. [ABSTRACT FROM AUTHOR]

The important causes of neonatal mortality are congenital malformations, birth trauma, neonatal infections, and respiratory, metabolic and heart diseases. Although many of the neonatal problems are benign, self-limited and treatable, some are life-threatening and a direct cause of disability and death. Professionals who provide care for children must be aware of these problems, their natural history, their impact on children’s heath and their treatment. Birth marks are common and often harmless, but parents need explanation and reassurance. Follow-up appointments are often necessary to ensure the general wellbeing of the affected children. Birth trauma, such as intracranial haemorrhage or arm paralysis, may occur during delivery, and treatment at a specialised unit is usually required. The prognosis of neonatal infections is generally poor, with high mortality unless treatment is started promptly and adequately. Respiratory diseases occur mainly in low birth-weight infants who may require mechanical ventilation. Metabolic and heart diseases are rare, but early detection is essential to ensure a high survival rate. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic disease of the newborn is a coagulation disturbance in newborns due to vitamin K deficiency. In our region most babies are delivered at home or in private clinics where vitamin K is not given in routine, leading to hemorrhagic disease of the newborn. The current study was conducted to determine the clinical presentation of hemorrhagic disease of the newborn and to assess the response to injection vitamin K. Material & Methods: This descriptive study was conducted at Neonatal Unit, Department of Child Health, Hayatabad Medical Complex, Peshawar, from January to December 2011. All neonates who presented with bleeding were admitted in the Neonatal Unit of Hayatabad Medical Complex, Peshawar. After sending blood for investigations, 2mg Vitamin K was injected intravenously. In babies with continuous bleeding, fresh frozen plasma was also given. PT and APTT were repeated after 6 to 12 hours and after one week. Results: Forty two cases were included in the study. 76.2% were born at home and did not receive vitamin K at birth. 57% were low birth weight. 88% were breastfed. Gastrointestinal tract, skin and nasal mucosa were the common sites of bleeding. PT and APTT were prolonged in all the cases. Their values improved after 6 hours and normalized in one week. Conclusion: Vitamin K deficiency causing hemorrhagic disease of the newborn is a common problem in neonates. It shows a dramatic response to vitamin K injection. It is more common in male, preterm and low birth weight babies. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effect of oral versus intramuscular vitamin K on PT (Prothrombin time) and APTT (Activated partial thromboplastin time) in neonates. Ninthy five healthy term live born neonates with birth weight more than 2500 grams who delivered in Mashhad Emmamreza hospital since 6 feb 2006 were elected. They were divided in two groups. The injection group( n=45) that recived 1 mg vitamin K (Phytonadion) intramuscularly and oral group ( n=50 ) 2 mg vitamin K Per oral in first 6 hours of age. PT and APTT was measured 12 hours after vitamin K administration. PT and APTT was measured at 24.78 ± 9.95 hours after vitamin K injection and 22.16 ± 7.4 hours in oral groups (P=0.14 ). Mean PT in injection group was 16.77 ± 4 second and in oral group was 16.39 ± 2.98 second (P=0.38). Mean APTT in injection and oral group were 37.73 ± 22.25 second and 34.95 ± 7.73 second respectivly (P=0.69). As classic form of hemorraghic disease of the newborn is prevented with vitamin K. This study showed that there were not significant differences in PT and APTT between two groups. Therefore both oral and intramuscular vitamin K can prevent classic hemorraghic disease of the newborn , but for showing prevention effect of oral vitamin K in late onset vitamin K further study is needed for targeting of newborns. [ABSTRACT FROM AUTHOR]

Abstract Background  Nonaccidental head trauma in infants is the leading cause of infant death from injury. Results and discussion  Clinical features that suggest inflicted head trauma include the triad of the so-called shaken baby syndrome, consisting of retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma. Studies have shown that, in general, the average short fall in the home is extremely unlikely to produce either subdural or retinal hemorrhage, although focal injuries such as skull fractures and epidural hemorrhage may be seen. Acceleration/deceleration, especially of the rotational type, is believed to be the most probable mechanism of injury in cases of nonaccidental head trauma. Damage to the cervicomedullary junction and the respiratory centers, with subsequent hypoxia and intracerebral edema, has also been implicated. After the initial trauma and hemorrhage, loss of cerebral autoregulation, breakdown of the blood-brain barrier, and disruption of ionic homeostasis occur, leading to brain edema and cytotoxicity. Cellular damage can involve large volumes of tissue, without respecting vascular territories. Conclusion  Overall, a satisfactory biomechanical model is lacking, and the criminal nature of abusive injury makes it difficult to perform systematic, controlled studies. Unfortunately, outcomes are poor, and the rate of repeated abusive episodes is high. Future research should focus on the development of a satisfactory research model and on prevention strategies. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to characterize total homocysteine (tHcy) levels at birth in preterm and term infants and identify associations with intraventricular hemorrhage (IVH) and other neonatal outcomes such as mortality, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and thrombocytopenia. Methods: 123 infants < 32 weeks gestation admitted to our Level III nursery were enrolled. A group of 25 term infants were enrolled for comparison. Two blood spots collected on filter paper with admission blood drawing were analyzed by a high performance liquid chromatography (HPLC) method. Statistical analysis included ANOVA, Spearman's Rank Order Correlation and Mann-Whitney U test. Results: The median tHcy was 2.75 µmol/L with an interquartile range of 1.34 - 4.96 µmol/L. There was no difference between preterm and term tHcy (median 2.76, IQR 1.25 - 4.8 µmol/L vs median 2.54, IQR 1.55 - 7.85 µmol/L, p = 0.07). There was no statistically significant difference in tHcy in 31 preterm infants with IVH compared to infants without IVH (median 1.96, IQR 1.09 - 4.35 µmol/L vs median 2.96, IQR 1.51 - 4.84 µmol/L, p = 0.43). There was also no statistically significant difference in tHcy in 7 infants with periventricular leukomalacia (PVL) compared to infants without PVL (median 1.55, IQR 0.25 - 3.45 µmol/L vs median 2.85, IQR 1.34 - 4.82 µmol/ L, p = 0.07). Male infants had lower tHcy compared to female; prenatal steroids were associated with a higher tHcy. Conclusion: In our population of preterm infants, there is no association between IVH and tHcy. Male gender, prenatal steroids and preeclampsia were associated with differences in tHcy levels. [ABSTRACT FROM AUTHOR]

Abstract: Deficiency of vitamin K predisposes to early, classic or late hemorrhagic disease of the newborn (HDN); late HDN may be associated with serious and life-threatening intracranial hemorrhage. Late HDN is characterized by intracranial bleeding in infants aged 1 week to 6 months due to severe vitamin K deficiency, occurring particularly in exclusively breastfed infants. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. In this study, we report on two siblings with intracranial bleeding who were fully breastfed without a routine supplementation of vitamin K. Vitamin K should be given to all newborns as a single, intramuscular dose of 1 mg. [Copyright &y& Elsevier]

The constitutional deficiency in factor VII is a hereditary disease of recessive autosomic transmission. its incidence is estimated at 1/500 000 to 1/1 000 000 in the general population. We report a case about factor VII deficiency in newborn reveled in j0+2 of life for hemorrhagic syndrome. An assessment of coagulation makes showed a deficiency in factor VII evaluated with 12%. We would like to describe the clinical, biological and therapeutic characteristics of this exceptionally obvious affection in newborn period. [Copyright &y& Elsevier]

Background Subdural haematomas are thought to be uncommon in babies born at term. This view is mainly based on findings in symptomatic neonates and babies in whom subdural haemorrhages are detected fortuitously. We aimed to establish the frequency of subdural haemorrhages in asymptomatic term neonates; to study the natural history of such subdural haematomas; and to ascertain which obstetric factors, if any, are associated with presence of subdural haematoma. Methods We did a prospective study in babies who were born in the Jessop wing of the Central Sheffield University Hospitals between March, 2001, and November, 2002. We scanned neonates with a 0.2 T magnetic resonance machine. Findings 111 babies underwent MRI in this study. 49 were born by normal vertex delivery without instrumentation, 25 by caesarean section, four with forceps, 13 ventouse, 18 failed ventouse leading to forceps, one failed ventouse leading to caesarean section, and one failed forceps leading to caesarean section. Nine babies had subdural haemorrhages: three were normal vaginal deliveries (risk 6.1%), five were delivered by forceps after an attempted ventouse delivery (27.8%), and one had a traumatic ventouse delivery (7.7%). All babies with subdural haemorrhage were assessed clinically but no intervention was needed. All were rescanned at 4 weeks and haematomas had completely resolved. Interpretation Presence of unilateral and bilateral subdural haemorrhage is not necessarily indicative of excessive birth trauma. [ABSTRACT FROM AUTHOR]

Vitamin K prophylaxis prevents hemorrhagic disease of the newborn. The present review estimates the potential magnitude of this problem in less developed countries, assessing the need for prophylaxis, along with its cost-effectiveness and feasibility. Late hemorrhagic disease, occurring between 2 and 12 weeks, often leads to death or permanent disability. Its median incidence in developed countries is 7 per 100 000 births. Incidences in less developed countries may be much higher. Three incidence scenarios are proposed and the corresponding losses of disability-adjusted life-years (DALYs) calculated. Under the intermediate scenario, late hemorrhagic disease accounts for 0.1% to 0.2% of DALYs lost to children less than 5 years of age. Assuming a cost of $1.00 per injection, each DALY saved would cost $133. Decisions on prophylaxis must be made on a national basis, considering mortality levels and causes, health budgets, and feasibility. Comparison with the impact of diseases prevented by breast-feeding shows that concern with hemorrhagic disease should not affect breast-feeding promotion efforts, although strategies for supplementing breast-fed infants must be explored. [ABSTRACT FROM AUTHOR]

Abstract. One hundred neonates determined prospectively to be at risk for neurologic handicap underwent magnetic resonance imaging with a high-field (1.5 T) imager. Thirty-three demonstrated a total of 37 lesions consistent with hypoxic-ischemic encephalopathy, including periventricular leukomalacia (n = 12), basal ganglia hemorrhage (n = 5), multicystic encephalomalacia (n = 5), and focal parenchymal hemorrhage (n = 15). Diagnoses by ultrasonography and computed tomography were compared with those by magnetic resonance imaging in 29 and 17 infants, respectively. Ultrasonography agreed more frequently with magnetic resonance imaging than did computed tomography. Ultrasonography detected 79% of lesions demonstrated by magnetic resonance imaging whereas computed tomography detected only 41%. Periventricular leukomalacia was seen most often in preterm infants, basal ganglia hemorrhage and multicystic encephalomalacia primarily occurred in term infants, and focal parenchymal hemorrhage occurred at all gestational ages. Basal ganglia hemorrhage and multicystic encephalomalacia were strongly associated with histories of perinatal asphyxia, seizures, and early abnormal neurologic status. All infants with basal ganglia hemorrhage (5/5) and multicystic encephalomalacia (5/5) and the majority with periventricular leukomalacia (9/12) and focal parenchymal hemorrhages (9/15) had developmental abnormalities at discharge. Pediatrics 1991;87:431-438; magnetic resonance imaging, hypoxicischemic encephalopathy, periventricular leukomalacia, basal ganglia hemorrhage, multicystic encephalomalacia, parenchymal hemorrhages. INSET: RAISING BABY BY THE BOOK. [ABSTRACT FROM AUTHOR]

Abstract. Intraventricular hemorrhage is an uncommon problem in the full-term newborn. In a review of 19 full-term infants with intraventricular hemorrhage diagnosed on computed tomography prior to I month of age, thalamic hemorrhage associated with the intraventricular hemorrhage was documented in 12 infants. Thus, thalamic hemorrhage appears to he the most common source of intraventricular hemorrhage in this age group, particularly in infants who had uneventful birth histories and in whom clinical abnormalities (signs of increased intracranial pressure, seizures, altered level of consciousness) developed after the first week of life. The majority of these infants had predisposing factors for cerebral venous infarction such as sepsis, cyanotic congenital heart disease, and coagulopathy. The clinical appearance and outcome for infants with thalamic hemorrhage/intraventricular hemorrhage were similar to those in infants with intraventricular hemorrhage originating from other sites, except for an increased incidence of cerebral palsy in infants with thalamic hemorrhage/intraventricular hemorrhage. Definitive diagnosis was made on the basis of characteristic radiologic abnormalities. [ABSTRACT FROM AUTHOR]

Abstract. Ultrasound has been routinely used since late 1979 to diagnose periventricular-intraventricular hemorrhage in infants whose gestational age was 34 weeks or less. During the years 1980 to 1987 the ultrasound scans were interpreted by one person, and a steady decline in incidence of periventricular-intraventricular hemorrhage was observed. Both for infants of 34 weeks or less and for very low birth weight (<1500 g) infants, periventricular-intraventricular hemorrhage incidence decreased, respectively, from 34% and 39% in 1980 to 1981 to 19% and 25% in 1986 to 1987. This decrease was confined to true intraventricular hemorrhages, which decreased from 22% in 1980 to 1981 to 7% in 1986 to 1987 for infants of less than or equal to 34 weeks' gestation. These results were not influenced by a change in the distribution of birth weights or gestational ages of the infants evaluated nor by a change in the inborn to outborn ratio. The incidence of periventricular-intraventricular hemorrhage was lower in infants born by cesarean section than those delivered vaginally, but the decrease could not be attributed to an increased number of deliveries by cesarean section. Although there were undoubtedly changes in neonatal care during this time period, no planned intervention occurred. It was concluded that pharmacologic intervention studies must be interpreted with caution. [ABSTRACT FROM AUTHOR]

Abstract. Fifty-one sequential intubated babies with birth weights of less than 1,751 were evaluated by serial Doppler ultrasound during the first three days of life. These babies were part of a phenobarbital prophylaxis trial cohort study. Subependymal-intraventricular hemorrhage developed in 17 of the babies. Infants with subependymal-intraventricular hemorrhage, whether or not they received pancuronium or phenobarbital, had coefficients of variation comparable to those of babies without hemorrhage. Coefficient of variation values of the right were comparable to values obtained from the left anterior cerebral artery complex and did not appear to be consistently altered by the presence of subependymal-intraventricular hemorrhage. Coefficient of variation values appeared to be consistently greatest on day I and lowest on day 2. In addition, the values overall increased as the number of waves used to determine the coefficient of variation enlarged from five to 20. This phenomena, however, was not seen among pancuronium recipients and suggests that movement artifact may be a determinant of coefficient of variation values. We conclude that, when the best 20 waves are chosen to evaluate the coefficient of variation, no association exists between coefficient of variation values and development of subependymal-intraventricular hemorrhage or administration of phenobarbital. [ABSTRACT FROM AUTHOR]

Abstract. We enrolled 280 intubated babies with birth weights of less than 1,751 g in a double-blind randomized prospective clinical trial to evaluate whether phenobarbital influences the likelihood of developing subependymal-intraventricular-intraparenchymal hemorrhage. Phenobarbital was associated with an increased risk of developing any subependymal-intraventricular-intraparenchymal hemorrhage and was not associated with a diminished risk of either severe hemorrhage or germinal matrix hemorrhage. This increased risk was apparent even after we considered the influence of phenobarbital levels, timing of phenobarbital administrations, institutional differences, quality of ultrasound scans, gestational age- and birth weight-specific effects, ascertainment bias, and other possible confounders of phenobarbital administration. Pediatrics 1986:77:443-450; phenobarbital, hemorrhage, premature infant. [ABSTRACT FROM AUTHOR]

Abstract. A population of healthy, full-term newborn infants was studied in order to obtain documentation of the prevalence of intracranial hemorrhage. Cerebral ultrasonography was performed within 72 hours of birth on 505 healthy newborn infants, 37 weeks of gestation or greater. Sonographic abnormalities were detected in 23 (4.6%) neonates. Bilateral subependymal germinal matrix hemorrhage occurred in 14 and unilateral hemorrhage in five infants. Other abnormalities detected included agenesis of the corpus callosum in two infants, a cyst involving the subependymal germinal matrix in one (presumably the result of a previous subependymal hemorrhage), and mild ventricular dilation of unknown etiology in one. Newborns with subependymal hemorrhage were compared with newborns without hemorrhage in order to determine whether any significant differences existed between the two populations. No significant differences existed between infants with and without subependymal hemorrhage with regard to gender, obstetrical presentation, use of forceps, birth trauma, Apgar scores, need for resuscitation, maternal age and parity, and neonatal clinical problems. Infants with subependymal hemorrhage were of significantly lower gestational age and birth weight; the overall difference in weight was attributable to lower weight in female infants with subependymal hemorrhage. Significantly more infants with subependymal hemorrhage were small for gestational age, vaginally delivered, and black. [ABSTRACT FROM AUTHOR]

Abstract. The entity of normal pressure hydrocephalus (NPH) following intraventricular hemorrhage in the newborn has been characterized. Of 87 infants with intraventricular hemorrhage, 20 had early and rapidly progressive hydrocephalus with intracranial hypertension and/or death. In 47 cases there was no increase in ventricular size and in 20 cases there was progressive increase in ventricular size with normal intracranial pressure, ie, NPH. Of these infants with NPH, nine had spontaneous arrest with or without resolution of ventriculomegaly, beginning within 31 days of onset. In 11 cases, after a stable period of NPH lasting 12 to 84 days, there was progressive increase in ventricular size accompanied ultimately by raised intracranial pressure. A relationship between the degree of ventriculomegaly and severity of intraventricular hemorrhage was demonstrated. The data thus define a state of NPH after intraventricular hereof-rhage and indicate that approximately half of such cases will not develop progressive hydrocephalus with increased intracranial pressure. If arrest or onset of resolution of ventriculomegaly is not apparent within approximately one month, continued progression and necessity for intervention are to be expected. Serial measurements of intracranial pressure and ventricular size in newborns with posthemorrhagic ventricular dilation allow the diagnosis of NPH and permit early recognition of rapidly progressive ventricular dilation with intracranial hypertension which may follow a stable period of NPH. Such early recognition of this potentially harmful state allows prompt ventricular drainage, thereby preventing brain compression. Pediatrics 68:623-629, 1981; normal pressure hydrocephalus, hydrocephalus in newborn, posthemorrhagic hydrocephalus. [ABSTRACT FROM AUTHOR]

Abstract. In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation pressure >25 cm H[sub 2]O, inspiratory to expiratory ratio >1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration >8 mEq/kg/day, acidosis and birth weight is less than or equal to 1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar is less than or equal to 5 at one and five minutes, birth weight, gestational age, male sex, osmolality is greater than or equal to 300, serum sodium is greater than or equal to 150, hypothermia, continuous distending pressure > 6 cm H[sub 2]O, positive end-expiratory pressure > 5 cm H[sub 2]O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant. Pediatrics 66:42-49, 1980; intraventricular hemorrhage, alveolar rupture, hyaline membrane disease, mechanical ventilation, pneumothorax. [ABSTRACT FROM AUTHOR]

Abstract. Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/ or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures. [ABSTRACT FROM AUTHOR]

Focuses on a study conducted to determine the clinical occurrence of vitamin K deficiency bleeding after the newborn period. Clinical characteristics of the patients; Determination of prothrombin activity of infants with diarrhea treated with a skimmed milk diet and a nonabsorbable sulfonamide; Findings.

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The article examines the feasible administration of whole-body cooling in neonatal encephalopathy (NE) through phase changing materials (PCM) in low and middle-income countries (LMIIC). It notes the insufficiency of low technology cooling devices suitable for LMIC. It points out the effectiveness of PCM cooling at greater than 28 degrees Celsius ambient temperature.

Examines the effect of vitamin K prophylaxis in newborn babies in Great Britain. Prevention of severe hypoprothrombinemia; Resurgence of hemorrhagic disease of the newborn; Measurement of vitamin K concentrations.

Presents an unusual case of hemorrhagic disease of the newborn related to maternal ingestion of an anti-epileptic drug. Detailed description of the case hemorrhagic disease of the newborn; Similarity of physical signs and clinical course to those described in previous studies that a diagnosis of primadone-induced hemorrhage seems a reasonable conclusion; Mechanism behind these events.

Presents an abstract of the study 'Clinically Silent Subdural Haemorrhages in the Newborn Neonate,' by E.H. Whitby, S. Rutter, P. Ohadike, M.F. Smith, N.P. Davies, P.D. Griffiths and M.N. Paley, presented at the 7th Spring Meeting of the Royal College of Paediatrics and Child Health.

Discusses how dural and subdural hemorrhaging in infants usually indicates violent abuse. Controversy about the assertions that a baby's injuries could be due only to violent shaking; Reference to research led by Dr. Jennian Geddes, a consultant neuropathologist at the Royal London Hospital; Lack of evidence to indicate that axonal damages are associated with head trauma in adults.