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The article focuses on the rise in reports of parental refusal of prophylactic intramuscular (IM) vitamin K for newborns in the U.S., with limited literature describing clinician practices and perspectives. It mentions study aimed to understand clinician experiences and perspectives surrounding vitamin K refusal to identify successful strategies for addressing this issue.

Context: Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life. Aims: To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute. Settings and Design: It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications. Materials and Methods: All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes. Results: Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases (n = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum (n = 17), followed by gallbladder (n = 6), appendix (n = 3), gastric (n = 1), jejunum (n = 1), esophagus (n = 1), ileocecal junction (n = 1), duodenum (n = 1), sigmoid (n = 1), and anal canal (n = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception (n = 6) was the most common, followed by intestinal atresia (n = 5), anorectal malformation (n = 3), abdominal wall defect (n = 3), hemorrhagic cyst (n = 1), Meckel's diverticulum (n = 1), and sacrococcygeal teratoma (n = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases. Conclusion: GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract. [ABSTRACT FROM AUTHOR]

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]

Introduction: Early, classical and late type hemorrhagic disease may develop as a result of the decrease in the synthesis of Factors II, VII, IX, and X in the newborn due to the low rate of transfer of vitamin K from the placenta in the prenatal period. Neonatal hemorrhagic disease can be significantly prevented with postnatal vitamin K prophylaxis. Although the clinical presentation varies, intracranial hemorrhage and multiple system hemorrhages can be seen. In the study, it was aimed to discuss the sociodemographic, clinical, radiological and laboratory characteristics of the cases that did not receive vitamin K prophylaxis and were reflected in the medicolegal process. Materials and Methods: The study was planned as a descriptive retrospective study. Between January 2017 and June 2021, 7 cases who underwent medicolegal evaluation with the diagnosis of "Neonatal Hemorrhagic Disease" in the 7th Specialization Board of Forensic Medicine were included in the study. Sociodemographic, clinical, radiological and laboratory features of the cases were retrospectively analyzed and recorded. Results: The age range of 5 (71%) male and 2 (28.5%) female cases was 15-49 days (median: 29 days). Allegations of medical malpractice in all cases; It was related to the fact that vitamin K prophylaxis was not applied and the diagnosis was insufficient in the follow-up. It was recorded that all of the cases did not receive vitamin K prophylaxis in the neonatal period. All of our cases presented with intracranial hemorrhage and recovered with neurological sequelae. In the evaluation of the committee, malpractice was detected in two cases, and no medical malpractice was found in 5 cases. Conclusion: Since neonatal hemorrhagic disease is a preventable condition with high morbidity and mortality, the application of vitamin K prophylaxis should be standardized by expanding it. [ABSTRACT FROM AUTHOR]

Background: The American Academy of Pediatrics recommends one intramuscular (IM) vitamin K injection at birth to prevent Vitamin K Deficiency Bleeding of the Newborn (VKDB). Among factors associated with IM vitamin K refusal, investigators have reported an increased frequency of IM vitamin K refusal among parents who select midwife-assisted deliveries. Reasons behind this association are unclear. Methods: To understand the perspectives of midwives on IM vitamin K prophylaxis and approach to counseling parents using qualitative methodology, we conducted in-depth semi-structured interviews of midwives associated with 3 tertiary academic medical centers and surrounding communities in Connecticut, Iowa and Michigan. We used the grounded theory approach and the constant comparative method until saturation was reached. Results: We interviewed 19 white female midwives from different training pathways. Participants who were Certified Nurse Midwives (CNMs) routinely recommended IM vitamin K prophylaxis and Certified Professional Midwives (CPMs) took a more neutral approach. The following 4 themes emerged: (1) Emphasis on an educational approach to counseling that supports parents' decision-making authority; (2) Low-intervention philosophy in the midwifery model of care attracts certain parents; (3) Need for relationship building between midwives and pediatricians and (4) Opportunities for the future. Conclusions: Midwives in our study perceived that the midwifery model of care, the focus on physiologic birth and prioritizing parents' decision-making autonomy appears to attract a sub-set of expectant parents with certain belief systems who question interventions such as IM vitamin K prophylaxis. There are opportunities for better collaboration between midwives and pediatricians. [ABSTRACT FROM AUTHOR]

The article focuses on confronting diagnostic uncertainty in pediatric care, distinguishing between aleatory uncertainty (the knowable unknown) and epistemic uncertainty (the unknowable unknown), emphasizing the need to navigate the unknowable unknown and guide families through difficult experiences. Topics include the authors presenting a case of a newborn with an unknown diagnosis, discussions on the role of physicians in end-of-life care.

L'objectif de cette revue de la littérature est d'émettre des recommandations concernant les premiers gestes et soins apportés au nouveau-né bien portant. Consultation de la base de données Medline, de la Cochrane Library et des recommandations des sociétés savantes françaises et étrangères. L'évaluation initiale du nouveau-né permet de déterminer rapidement si des manœuvres de réanimation sont nécessaires (Avis d'Expert [AE]). Toute anomalie nécessite un recours au pédiatre (AE). Chez un nouveau-né sans difficultés d'adaptation cardiorespiratoire, le clampage retardé du cordon peut être considéré comme une modalité plus physiologique de l'accouchement, pouvant aider à prévenir une carence en fer au cours des premiers mois de vie, sans effet délétère pour l'enfant ou sa mère, en dehors du risque d'ictère néonatal légèrement augmenté (grade C). Afin d'éviter la séparation de la femme et de son enfant, il est recommandé de différer les soins de routine laissant la place au contact peau-à-peau entre la mère, si elle le souhaite, et son nouveau-né selon un protocole de surveillance défini (grade B). L'allaitement maternel doit être encouragé et accompagné surtout lors de la première mise au sein (AE). En l'absence de signes cliniques évocateurs, l'aspiration des voies aériennes supérieures et la vérification systématique de la perméabilité des choanes et de l'œsophage ne sont pas recommandées (AE). La prévention de la maladie hémorragique du nouveau-né par l'administration orale de vitamine K1 à tous les enfants nés à terme débute en salle de naissance, de préférence en présence des parents et après avoir recueilli leur consentement (AE). À la naissance d'un nouveau-né sain, il est fortement conseillé d'éviter les gestes techniques inutiles et de privilégier la relation mère–enfant dans un climat de sécurité. The purpose of this literature review is to make recommendations regarding the first steps and care provided to the healthy newborn. Consultation of the Medline database, and of national and international guidelines. The initial assessment of the newborn should quickly determine whether resuscitation is necessary or not. Any anomaly requires the help of the pediatrician (Consensus agreement). For a newborn with no cardiorespiratory adaptation, delayed cord clamping may be considered more as a physiological modality of delivery, which may help prevent iron deficiency in the first months of life, without deleterious effects for the child or his/her mother, apart from a slightly increased risk of neonatal jaundice (grade C). In order to avoid separating a woman and her child, it is recommended to postpone routine postnatal procedures, to allow for skin-to-skin contact between the mother and the newborn, if she wishes, according to a defined/specified surveillance protocol (grade B). Breastfeeding should be encouraged, and supported, especially the first time (Consensus agreement). In the absence of suggestive clinical signs, aspiration of the upper airways and systematic verification of the permeability of posterior nasal apertures and of the esophagus are not recommended (Consensus agreement). The prevention of hemorrhagic disease of the newborn by the oral administration of vitamin K1 to all healthy term babies begins in the delivery room, preferably in the presence of the parents and after having obtained their consent (Consensus agreement). Regarding the birth of a healthy newborn, it is strongly advised to avoid unnecessary technical actions and to favor the mother–child relationship in a safe environment. [ABSTRACT FROM AUTHOR]

To train, evaluate, and validate the application of a deep learning framework in three-dimensional ultrasound (3D US) for the automatic segmentation of ventricular volume in preterm infants with post haemorrhagic ventricular dilatation (PHVD). We trained a 2D convolutional neural network (CNN) for automatic segmentation ventricular volume from 3D US of preterm infants with PHVD. The method was validated with the Dice similarity coefficient (DSC) and the intra-class coefficient (ICC) compared to manual segmentation. The mean birth weight of the included patients was 1233.1 g (SD 309.4) and mean gestational age was 28.1 weeks (SD 1.6). A total of 152 serial 3D US from 10 preterm infants with PHVD were analysed. 230 ventricles were manually segmented. Of these, 108 were used for training a 2D CNN and 122 for validating the methodology for automatic segmentation. The global agreement for manual versus automated measures in the validation data (n = 122) was excellent with an ICC of 0.944 (0.874–0.971). The Dice similarity coefficient was 0.8 (± 0.01). 3D US based ventricular volume estimation through an automatic segmentation software developed through deep learning improves the accuracy and reduces the processing time needed for manual segmentation using VOCAL. 3D US should be considered a promising tool to help deepen our current understanding of the complex evolution of PHVD. [ABSTRACT FROM AUTHOR]

Vitamin K is a fat-soluble vitamin essential for the formation of factors in the clotting cascade. Newborns are born with insufficient levels of vitamin K, resulting in high risk for vitamin K deficiency bleeding (VKDB). Vitamin K deficiency bleeding can occur in the first week of life ("classic" VKDB) and also between 2 weeks and 3 months of age ("late" VKDB). Vitamin K deficiency bleeding can present as bleeding in the skin or gastrointestinal tract, with as many as half of affected neonates experiencing intracranial bleeding. A single intramuscular injection of vitamin K effectively prevents both classic and late VKDB. Although intramuscular vitamin K is safe and effective, VKDB has reemerged because of decreased utilization. Parents refuse intramuscular vitamin K for a variety of reasons, including a disproven association with childhood cancer, the desire to avoid exposure to additives, and valid concerns about early neonatal pain. Many parents request oral vitamin K, an inferior alternative strategy that requires multiple doses utilizing products not designed for neonatal oral administration. In this setting, health care professionals must understand the epidemiology of VKDB and compassionately counsel parents to assuage concerns. Delivery of intramuscular vitamin K to all newborns remains a public health imperative, benefitting thousands of infants annually. [ABSTRACT FROM AUTHOR]

Objective: To undertake surveillance of vitamin K deficiency bleeding (VKDB) in Australia from 1993 to 2017, during a time of change to national recommendations and available vitamin K formulations.Methods: Paediatricians reported cases of VKDB in infants aged <6 months and provided demographic, clinical and biochemical information via the Australian Paediatric Surveillance Unit.Results: 58 cases were reported, of which 5 (9%) were early, 11 (19%) classic and 42 (72%) late VKDB. 53 (91%) were exclusively breast fed. Seven (12%) received oral prophylaxis, the majority (86%) of whom did not receive all three recommended doses. The overall reported incidence was 0.84 per 100 000 live births (95% CI: 0.64 to 1.08) and the incidence of late VKDB was 0.61 per 100 000 live births (95% CI: 0.44 to 0.82), which are similar to rates reported by other countries where intramuscular vitamin K is recommended. VKDB rates were significantly higher (2.46 per 100 000 live births; 95% CI: 1.06 to 4.85) between 1993 and March 1994 when oral prophylaxis was recommended (p<0.05). Vitamin K was not given to 33 (57%) cases, primarily due to parental refusal, and the number of parental refusals increased significantly after 2006 (p<0.05). There were six deaths, all due to intracranial haemorrhage, and three associated with home delivery and parental refusal of vitamin K.Conclusions: Incidence rates of VKDB in Australia are among the lowest in the world; however, we have identified an increasing trend of parental refusal. Ongoing surveillance and educational campaigns for health professionals and parents are needed to prevent VKDB. [ABSTRACT FROM AUTHOR]

Cephalhematoma is a benign condition which describes a subperiosteal hemorrhagic collection that occurs in newborns. It is caused by a prolonged birth or an instrumented assisted birth and is much more common in newborns delivered with a vacuum extractor. Although considered common, with complete resorption in most cases after 4-6 weeks, its persistence differentiates it from other pathologies. The diagnosis of this pathology is made by imaging to exclude other deeper and more severe pathologies from the cranial level. A multimodal approach to managing cephalhematoma is recommended, initiated from the earliest moments of life in order to ensure a favorable outcome. Simple cephalhematoma generally needs a noninvasive, expectant approach, while for calcified cephalhematoma, surgery is frequently required. The current general recommendations are to have an imaging examination of all newborns with cranial injury caused by birth and also that cephalhematoma cases be referred to the pediatric neurosurgery service for a more precise evaluation. [ABSTRACT FROM AUTHOR]

Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk. Systematic review of evidence to date suggests that a single intramuscular (IM) injection of vitamin K at birth effectively prevents VKDB. Current scientific data suggest that single or repeated doses of oral (PO) vitamin K are less effective than IM vitamin K in preventing VKDB. The Canadian Paediatric Society and the College of Family Physicians of Canada recommend routine IM administration of a single dose vitamin K at 0.5 mg to 1.0 mg to all newborns. Administering PO vitamin K (2.0 mg at birth, repeated at 2 to 4 and 6 to 8 weeks of age), should be confined to newborns whose parents decline IM vitamin K. Health care providers should clarify with parents that newborns are at increased risk of VKDB if such a regimen is chosen. Current evidence is insufficient to recommend routine intravenous vitamin K administration to preterm infants undergoing intensive care. [ABSTRACT FROM AUTHOR]

Background: To evaluate the hazard of prolonged antibiotic therapy and/or persistent diarrhea on vitamin K1 (VK1) level and bleeding profile in infants (2-24 weeks). Methods: A one-year case-control study, conducted at Ain Shams University, Egypt. 338 infants (2-24 weeks) were recruited and divided into 3 groups (1:1:3 ratios); group A (n=67) patients who received antibiotics for ≥10 days, group B (n=67) who had persistent diarrhea ≥ 14 days and group C (n=204) age- and gender-matched infants who had not either received antibiotics nor had diarrhea. All subjected to clinical assessment, bleeding history and had their complete blood count (CBC), PT and PTT, liver transaminases and VK1 level assayed. Results: There was a significant increase in frequency of VKDB (vitamin K deficiency bleeding) and abnormal bleeding profile in cases than control group. There was significant negative correlation between VK1 level and duration of diarrhea, length of antibiotics used and bleeding profile. Antibiotic usage has hazardous effect on VK1 level in those with diarrhea; more patients were receiving antibiotic in those with persistent diarrhea and VKDB (N=55) than those with persistent diarrhea and normal VK1 (N=12). The longer duration of antibiotic therapy the lower level of VK1. Combining cephalosporin/penicillin therapy and/or diarrhea, in particular, had an impact on VK1 level. Conclusion: VKDB, a preventable cause of life-threatening hemorrhage, is still a major health problem in Egyptian infants, where persistent diarrhea and misuse of antibiotics are prevalent, necessitate a booster dose of VK in those high risk infants. [ABSTRACT FROM AUTHOR]

Background. Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk. Methods. We carried out a prospective study during the 2012-2013 dengue epidemic in New Caledonia, its most severe on record. All mothers hospitalized at the Centre Hospitalier Territorial in Nouméa, New Caledonia, with symptoms of dengue infection between 7 days before and 2 days after delivery and/or whose infant was infected during breastfeeding were investigated. DENV was detected and quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in sera and breast milk (mothers), sera and gastric fluid (newborns), cord blood, and placentas. DENV kinetics and sequences in sera and breast milk were studied. Clinical presentation and biological evolution in mother-newborn pairs were analyzed. Results. Ten mother-newborn pairs were investigated over an 11-month period. One premature birth, 3 hemorrhagic complications, and 1 maternal death occurred. Nine newborns were infected and symptomatic. One case of deep thrombocytopenia and 1 case of anoxic encephalopathy occurred. DENV was detected in breast milk samples from 9 (75%) of 12 infected breastfeeding mothers. Original DENV kinetics in sera and breast milk were described. Conclusions. The occurrence of vertical DENV transmission was high (90%) in viremic mothers at delivery, and these mothers and their infants were at major risk for obstetric and neonatal complications. The modes of viral transmission are difficult to clarify. The risk of DENV transmission through breast milk seems plausible. Close follow-up of mothers and prolonged surveillance of their newborns are required for minimizing complications. Complementary studies are needed to elaborate preventive recommendations. [ABSTRACT FROM AUTHOR]

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation. [ABSTRACT FROM AUTHOR]

Vitamin K has been detected more than eighty years ago, considered as a very important agent in hemostasis. There are several natural forms of vitamin K: phylloquinone (vitamin K1) from plants, menaquinones (vitamin K2) are produced by bacterial intestinal flora, while menadione (vitamin K3) is considered as the intestinal catabolic product of oral phylloquinone which is considered as the circulatory precursor of menaquinone-4. Besides in the coagulation, vitamin K has an important role in many other physiological processes by making some important proteins active. Vitamin K does not influence the production of the primary gene product, while its action is very important on posttranslational proteins. Besides that vitamin K increases exchange between sister chromatids, and it has oxidative and antioxidative effects. Hemorrhagic disease of newborn (HDN) or vitamin K deficiency bleeding is acquired disease affecting infants suffering vitamin K deficiency. According to the onset of symptoms, there are three different forms of HDN: early (onset of bleeding within 24 hours after birth), classic (onset of bleeding between the 2nd and the 7th day of life), and late (onset of bleeding from the 8 days through the entire infancy). Intracranial hemorrhage is the most frequent manifestation of the early and the late vitamin K deficiency bleeding. That was the reason why more than fifty years ago, (in 1961) American Academy of Pediatrics issued recommendations on prevention of the HDN. Despite many controversies connected with the prophylactic use of vitamin K, still, intramuscular vitamin K administration is considered the most efficient and safest method for the prevention of late HDN, while vitamin K is used in the treatment of bleeding due to vitamin K deficiency in infancy. The most recent Croatian recommendations for the prevention of HDN are in concordance with many actual international recommendations. [ABSTRACT FROM AUTHOR]

Objective: To explore the influencing factors and reasoning of parents who opt out of intramuscular vitamin K prophylaxis for their newborn.Design: We conducted a qualitative study with 15 families from the Otago/Southland region of New Zealand. Semistructured interviews explored their choice to opt out of intramuscular vitamin K prophylaxis and thematic analysis was used to elucidate themes that captured important aspects of this parental decision-making process.Results: Parents opt out of intramuscular vitamin K for a variety of reasons. These were clustered into three main themes: parents' beliefs and values (philosophy and spirituality), concerns about their child's welfare (pain and potential side effects) and external influencing factors (family, friends, media and health professionals). As part of a wider family hesitancy towards medical intervention, the majority of parents also raised concerns regarding other perinatal or childhood interventions.Conclusion: Many factors influence parental decision making and lead to a decision to opt out of newborn intramuscular vitamin K prophylaxis. Due to strong parallels with other common childhood interventions, these findings have relevance for vitamin K prophylaxis and for other healthcare interventions in childhood. [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]

Hemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but have been considered different diseases depending on their location. Umbilical hemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatin, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal hemorrhagic disease. Kernicterus occurred when high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Acute hemorrhagic edema of infancy is an acute and rare cutaneous disorder that affects children between 4 months to 2 years of age and characterized by cutaneous purpuric lesions with millimeters to centimeters diameter. Systemic involvement is rare. The disease is benign and spontaneously resolved in 1-3 weeks. Case Report: Here we described a 22-months old girl with acute hemorrhagic edema of infancy who hospitalized in department of pediatric with the presence of erythematous-purpuric lesions localized on the face, ears and lower limbs that developed suddenly two days before hospitalization. Laboratory examination revealed including normal cell blood counts, serum complements, serum electrolytes and creatinin. ANA was negative. Coagulation tests were normal. ESR was 45 mm/h. Urine analysis and stool examination revealed no abnormal findings. Disease resolved spontaneously without any problem. Conclusion: According to the contrast between the acuteness of the cutaneous sign, which are typical and unmistakable, and the general condition of the patient, which was good and the laboratory findings, our patient labeled as acute hemprrhagic edema of infancy.

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 and 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: 42 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: Clinical presentation following uncomplicated acute infection with bovine viral diarrhea viruses (BVDV) ranges from clinically unapparent to severe (including hemorrhagic disease and death) depending on the strain virulence. Regardless of clinical presentation, BVDV infection of cattle results in a generalized immunosuppression. BVDV immunosuppression is characterized by a reduction of circulating white blood cells (WBC) that is typically evident by day 3 post infection (PI). In infections with typical BVDV field strains WBC counts decrease until days 6–9 PI and then return to baseline values. In infections with enhanced virulence BVDV, WBC counts may continue to decline through day 14. In this study, the lymph nodes and thymus of non-infected neonatal calves and neonatal calves infected 14 days previously with either a BVDV of typical virulence or one of enhanced virulence were compared. It was found that while calves, infected with the typical virulence BVDV, had cleared BVDV, and WBC counts had returned to near baseline, the number of B-B7+ cells in lymph nodes were reduced whereas numbers of CD4+ cells were increased as compared to control calves. In contrast, calves infected with the high virulence strain, had not cleared the virus by day 14 and WBC counts had not returned to pre-exposure levels. Furthermore, these calves had more substantial deficits of B-B7+ and CD4+ cell subpopulations, compared to calves infected with a typical virulence strain. There were also an increased number of macrophages observed in both lymphoid tissues examined. The thymuses from both groups of BVDV-infected calves were significantly smaller than non-infected age matched calves. The reduction in size was accompanied by a significant depletion of the thymic cortex. These results indicate that regardless of the virulence of the infecting BVDV, infection leaves neonatal calves with deficits in specific lymphocyte subsets and lymphoid tissues that could have long-term immunosuppressive implications. [Copyright &y& Elsevier]

Objetivo. Describir la experiencia con enfermedad hemorrágica del recién nacido en un hospital pediátrico del tercer nivel de atención. Material y métodos. Estudio retrospectivo efectuado en el Hospital del Niño Morelense de la ciudad de Cuernavaca, estado de Morelos, México, durante el periodo 1997-2000, con una muestra de 46 neonatos, afectados de enfermedad hemorrágica del recién nacido (EHRN), referidos de poblaciones de la periferia del estado. Resultados. De los pacientes, 91% presentó la forma tardía grave de EHRN. El 52% de los partos fueron atendidos por médico y 48% por parteras. Se desconoce aplicación de vitamina K en 61%, en 35% no fue aplicada y en 4% sí se aplicó. La mayoría presentó sintomatología severa secundaria a hemorragia intracraneana. Hubo defunción en 11% y secuelas severas en 41%. Conclusiones. La EHRN es un problema frecuente en el estado de Morelos y, por ello, se requiere analizar los programas de salud reproductiva e intensificar la capacitación de médicos y enfermeras sobre la prevención de ésta mediante el uso de vitamina K.Objective. To describe the occurrence of hemorrhagic disease of the newborn (HDN) at a tertiary care pediatric hospital of Morelos state. Material and Methods. A retrospective case series study was conducted between 1997-2000 at Hospital del Niño Morelense (Morelos State Children's Hospital), in 46 newborns aged under 12 weeks. Study subjects were referred from peripheral units with a diagnosis of HDN. Results. The severe late-onset form of HDN was present in 91% of the cases. Fifty-two percent of childbirths were assisted by a physician and 48% by an empiric midwife. Application of vitamin K was unknown in 61% of cases, in 39% it was not applied and in 4% it was applied. The majority of infants presented severe symptoms due to intra-cranial bleeding, 11% died, and 41% had severe disease sequelae. Conclusions. Given the high prevalence of HDN in the State of Morelos, reproductive health programs should be reviewed and training programs intensified to promote the utilization of vitamin K by physicians and nurses for preventing this disease.

Summary: Background: Hemorrhage is a common and serious symptom in the neonatal period. In developing countries, means of exploration are insufficient. Our purpose was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of hemorrhagic syndromes of the newborn in Dakar, Senegal, to identify the risk factors and diseases associated with them in order to propose recommendations for their management. Methods: We conducted a case–control study of 82 newborns with 41 cases of hemorrhagic syndromes and 41 controls. We first described the epidemiological, diagnostic, therapeutic, and evolutionary parameters of the group that submitted a hemorrhagic syndrome and compared their diagnostic data with those of the control group to highlight the risk factors associated with the occurrence of hemorrhagic syndrome. Results: The prevalence of hemorrhagic syndrome among hospitalized newborns was 9.2%, the sex-ratio (M/F) was 1.9. Preterm infants accounted for 26.8%. We often found early onset of bleeding (46.4% before 72h of life). Visceral bleeding was predominant, especially respiratory (34.1%), digestive (31.7%), and cerebral (17%), followed by cutaneous hemorrhages (26.8%). The risk factors identified were respiratory distress, shock, and a stained amniotic fluid. The concomitant diagnoses were dominated by neonatal infection (58.5%), hemorrhagic disease of the newborn (21.9%), and disseminated intravascular coagulation (19.5%). The mortality rate was high (34.1%), most often associated with disseminated intravascular coagulation. Conclusion: This study reveals the high mortality due to hemorrhagic syndromes caused by these three diseases for which prevention must be stressed. [Copyright &y& Elsevier]

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]

Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for infants and children with cardiac and respiratory failure. However, thrombosis and hemorrhage are common complications. To determine clinical and laboratory predictors of thrombosis and hemorrhage resulting from ECMO, records and slides were reviewed from 29 consecutive autopsies from 2004 through 2008 of pediatric patients who received ECMO at our institution. Laboratory results, including prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen level, and activated clotting time, were analyzed, as was heparin dosing. Thrombosis and hemorrhage were very common, with 1 or both seen in 86% of patients. Sixtynine percent had thrombosis, and 52% had hemorrhage after ECMO initiation, including intracranial hemorrhage in 33% of the patients in whom brain examination was permitted. Hemorrhage and thrombosis coexisted in 31% of patients. Thrombosis was significantly more common in patients with congenital cardiac disease. Duration of ECMO therapy, being on ECMO at death, sepsis, and patient age and sex did not predict hemorrhage or thrombosis at autopsy. Laboratory tests were poor predictors of thrombosis and hemorrhage, with no correlation between these complications and prothrombin time, partial thromboplastin time, platelet count, fibrinogen level, activated clotting time, or heparin dose. In conclusion, thrombosis and hemorrhage continue to be frequent complications among patients who die during or after ECMO therapy. Patients with congenital cardiac disease appear especially susceptible to thrombosis on ECMO. Prothrombin time, partial thromboplastin time, platelet count, fibrinogen level, activated clotting time, and heparin dose are poor predictors of thrombosis or hemorrhage for pediatric patients who die after ECMO. [ABSTRACT FROM AUTHOR]

A 12‑month‑old boy presented with swelling all over body, reddish brown lesions over both lower extremities, and mild fever. On examination, pallor was present, vitals were stable, and child appeared well‑except for edema and rashes. Pitting edema was present over all extremities and periorbital region. There was no edema over scrotum and abdominal wall. Skin examination showed erythematous, palpable, purpuric lesions (0.5–3 cm in diameter) over buttocks and lower limbs sparing trunk, face, and upper limbs. All other systems were within normal limits. Skin biopsy showed the features suggestive of leukocytoclastic vasculitis. Diagnosis of acute hemorrhagic edema was made on the basis of clinical examination and skin biopsy. The child responded to steroids. [ABSTRACT FROM AUTHOR]

Introduction: This review summarizes current knowledge on vitamin K for the paediatrician. Vitamin K is a fat-soluble vitamin, present in plants as phylloquinone and produced by bacteria as menaquinone. It is acting as a co-factor for gamma-glutamyl carboxylase. This enzyme is responsible for post-translational modification of some glutamate side chains to gamma-carboxyglutamate. The majority of gamma-carboxylated proteins function in blood coagulation; others play a role in calcium homeostasis.Data: Newborn babies are at particular risk of vitamin K deficiency, as placental transfer is limited and human milk is a poor source. Vitamin K prophylaxis at birth effectively prevents vitamin K deficiency bleeding (VKDB), formerly known as "haemorrhagic disease of the newborn". Recent epidemiological studies provide data on the effectiveness of different administration routes and dosing schemes. Infants of mothers taking drugs that inhibit vitamin K are at risk of early VKDB and should receive 1 mg intramuscular (i.m.) as soon as possible after birth. Classic VKDB is prevented by intramuscular as well as by oral administration of 1 mg vitamin K. In exclusively breast-fed infants, single i.m. administration at birth is also effectively preventing (rare) late VKDB but single oral administration is not. If given orally, prophylaxis should be continued by either weekly administration of 1 mg till 12 weeks or repeating 2 mg at weeks 1 and 4. Daily administration of 25 microg offers insufficient protection. The only infants not fully protected in this way are those with yet unrecognised liver disease.Conclusions: Further work is needed before firm recommendations can be made regarding dose in preterm infants and in patients with fat malabsorption/cholestasis or regarding the role of vitamin K in the prevention of osteoporosis. [ABSTRACT FROM AUTHOR]

Acute liver failure in neonates is rare and is frequently associated with an unfavourable outcome. There is no curative treatment other than liver transplantation. Screening for viral, metabolic, toxic or vascular disease is essential to assess the prognosis and to guide specific treatment. Hepatic haemorrhage in neonates is often associated with bacterial infection, trauma and coagulopathies. We present a unique case of neonatal acute liver failure and multifocal massive haemorrhagic intrahepatic lesions of traumatic origin, documented by US and MRI. The patient made a spontaneous recovery. Clinical, biological and imaging outcome was excellent despite the apparent severity of the initial features. The only possible aetiology was a difficult caesarean delivery for mild fetal macrosomia. [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]

The objectives of our study were to determine the actual frequency of the different disorders causing neonatal hypotonia and to assess the reliability of the first physical examination as well as the contribution of the main standard diagnostic tests. One hundred and forty-four infants diagnosed with neonatal hypotonia between January 1st 1999 and June 30th 2005 in our tertiary care facility were retrospectively included in the study. Perinatal history, clinical type of hypotonia, results of standard diagnostic tests, final diagnosis and outcome were abstracted from the original charts. A final diagnosis was reached in 120 cases. Central (cerebral) causes represented 82% of the elucidated cases, mostly hypoxic and hemorrhagic lesions of the brain (34%), chromosomal aberrations and syndromic disorders (26%) and brain malformations (12%). Peripheral (neuromuscular) causes were mainly represented by spinal muscular atrophy (6%) and myotonic dystrophy (4%). Positive predictive value of the initial clinical examination was higher in central type hypotonia. Neuroimaging, karyotype analysis and DNA-based tests were the most helpful diagnostic tools. These recent clinical data can be used to improve our strategy in investigating neonatal hypotonia and a diagnostic algorithm is proposed based on our findings. [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]

Acute hemorrhagic edema of infancy typically occurs in infants less than 2 years of age and follows a benign clinical course. Gastrointestinal complications are unusual in this entity, in contrast to children with Henoch–Schönlein purpura, who are predominantly older than 2 years and at risk for potential morbidity from gastrointestinal tract and kidney involvement. We describe an infant with acute hemorrhagic edema of infancy who developed intussusception. [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]

Intracranial (ICH) and extracranial (ECH) haemorrhages are potentially life-threatening events that may occur comorbidly in neonates with haemophilia. There is little data on the use of recombinant factor IX (rFIX; BeneFIX®) in the neonate. Children <15 years of age are known to require higher doses of recombinant Factor IX (FIX) than older persons, which raises specific concerns in the neonate due to the increased risk of thrombosis in this age group ( Thromb Haemost 2002; 87: 431). This report describes a case in which a high rate of continuous infusion of recombinant FIX was used to treat a newborn with significant intracranial and subgaleal haemorrhages. A high rate of infusion maintained at 30–35 U kg−1 h−1 was necessary to maintain adequate FIX levels. Despite the high rate of continuous infusion, no adverse events were noted. Our patient had a rare genetic mutation causing severe haemophilia B. A neonate with severe haemophilia B was treated successfully with recombinant FIX through continuous infusion. A high rate of infusion was required and no complications were noted. [ABSTRACT FROM AUTHOR]

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]

Aim: The motor performance of 165 very low birthweight (VLBW) infants was assessed prospectively at 5, 10, 18 mo and 5.5 y. The aim of the study was to evaluate longitudinal stability of motor development and its association with birthweight (BW), gestational age at birth, intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL) and retinopathy of prematurity (ROP). Furthermore, at 5.5 y the motor behaviour of the VLBW population was compared with that of 124 children born at term.Methods: The results of each examination were ranked into four levels and the stability of motor development was evaluated on the basis of this ranking. At 5.5 y, VLBW children and controls were compared according to percentiles in the Movement ABC.Results: Fifty-three percent of the VLBW infants displayed a stable motor development. Only PVL and BW contributed significantly to the variability in their motor performance. Forty-seven percent of the infants exhibited an unstable motor development with no association to risk factors. In the entire group only IVH and severe ROP were related to poor motor performance. The majority of the VLBW children performed within the normal range at 5.5 y but their performances were inferior to those of control children.Conclusion: VLBW infants with poor early motor performance and/or severe IVH/PVL and ROP should be recruited into individualized follow-up programmes, whereas regular ongoing monitoring by follow-up may be sufficient for those with normal early motor performance and normal ultrasound findings. [ABSTRACT FROM AUTHOR]

Reports severe bilateral intraventricular hemorrhage occurring in a 6-day-old term newborn without potentially precipitating events who subsequently was found to have sinus venous thrombosis and a prothrombotic genetic disposition. Description of the male patient; Laboratory findings; Background on the medical condition.

Objective: To investigate the natural history and predictors of outcome of posthaemorrhagic ventriculomegaly in the very Iow birthweight (VLBW) infant. Methods: All VLBW infants admitted between September 1994 and September 1997 to the neonatal intensive care units of Brigham and Women's Hospital (Boston), Children's Hospital (Boston), and Christchurch Women's Hospital (New Zealand) with germinal matrix intraventricular haemorrhage (IVH) were identified. All charts and ultrasound scans were reviewed to define the natural history and perinatal and/or postnatal factors of value in prediction of the course of posthaemorrhagic ventriculomegaly. Progressive ventricular dilatation (PVD) was defined from the results of serial cranial ultrasound scans. Results: A total of 248 VLBW infants had evidence of IVH (22% of all VLBW infants, mean (SD) gestational age 26.8 (2.6) weeks). A quarter of the infants exhibited PVD. Spontaneous arrest of PVD occurred without treatment in 38% of infants with PVD. Of the remaining 62% with persistent PVD, 48% received non-surgical treatment only (pharmacological and/or drainage of cerebrospinal fluid by serial lumbar punctures), 34% received surgical treatment with insertion of a ventriculoperitoneal reservoir and/or shunt, and 18% died. The development of PVD after IVH and adverse short term outcome, such as the requirement for surgery, were predicted most strongly by the severity of IVH. Conclusions: These data reflect the natural history of PVD in the 1990s and show that, despite a slight reduction in its overall incidence, there appears to be a more aggressive course, with appreciable mortality and morbidity in the extremely premature infant. The major predictor of adverse short term outcome, defined as death or need for surgical intervention, was the severity of IVH. These findings may be valuable for the management of very small premature infants. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of this investigation was to verify whether plasma S100B could be a useful tool in identifying which infants subjected to extracorporeal membrane oxygenation (ECMO) might develop intracranial haemorrhage (ICH). A case-control study of eight infants who developed ICH during ECMO was conducted. Plasma samples collected daily after ECMO insertion were assessed for S100B and compared with those obtained from eight infants supported by ECMO who did not develop ICH. Cerebral ultrasound and Doppler velocimetry waveform patterns in the middle cerebral artery (MCA PI) were also recorded at the same time as blood sampling. S100B blood concentrations were significantly higher in the group of infants with ICH 72 h before any signs of haemorrhage could be detected by ultrasound (ICH: 2.91 +/- 0.91 microg/L vs. control: 0.53 +/- 0.15 microg/L), reaching their peak at day 6, when cerebral ultrasound scan patterns were suggestive of intracranial haemorrhage (ICH: 3.50 +/- 1.03 microg/L vs. control: 0.66 +/- 0.27 microg/L) (p < 0.05, for both). The highest S100B levels were observed in the three ICH infants who expired during the ECMO procedure (3.43 microg/L, 4.0 microg/L, 4.12 microg/L, respectively). MCA PI values in the ICH group were also significantly higher, but only 24 h before any ultrasound pattern of bleeding was detected (ICH: 2.31 +/- 0.22 vs control: 1.81 +/- 0.24) (p < 0.05).Conclusion: This study suggests that blood S100B measurement could be a promising tool for the identification of infants at risk of ICH when imaging assessment and clinical symptoms of haemorrhage might still be silent. [ABSTRACT FROM AUTHOR]

Unlabelled: Posthaemorrhagic ventricular dilatation (PHVD) in very preterm infants carries a poor prognosis. As earlier studies have failed to show a benefit of early intervention, it is recommended that PHVD be first treated when head circumference is rapidly increasing and/or when symptoms of raised intracranial pressure develop. Infants with PHVD, admitted to 5 of the 10 Dutch neonatal intensive care units were studied retrospectively, to investigate whether there was a difference in the time of onset of treatment of PHVD and, if so, whether this was associated with a difference in the requirement of a ventriculo-peritoneal (VP) shunt and/or neurodevelopmental outcome. The surviving infants with a gestational age <34 wk, born between 1992 and 1996, diagnosed as having a grade III haemorrhage according to Papile on cranial ultrasound and who developed PHVD were included in the study. PHVD was defined as a ventricular index (VI) exceeding the 97th percentile according to Levene (1981), and severe PHVD as a VI crossing the p 97 + 4 mm line. Ninety-five infants met the entry criteria. Intervention was not deemed necessary in 22 infants, because of lack of progression. In 31 infants lumbar punctures (LP) were done before the p 97 + 4 mm line was crossed (early intervention). In 20/31 infants, stabilization occurred. In 9 a subcutaneous reservoir was placed, with subsequent stabilization in 6. In 5/31 infants a VP shunt was eventually inserted. In 42 infants treatment was started once the p 97 + 4 mm line was crossed (late intervention). In 30 infants LPs were performed and in 17 of these a VP shunt was eventually inserted. In 11 infants a subcutaneous reservoir was immediately inserted and in 8 of these infants a VP shunt was needed. In one infant a VP shunt was immediately inserted, without any other form of treatment. Infants with late intervention crossed the p 97 + 4 mm earlier (p 0.03) and needed a shunt (26/42; 62%) more often than those with early intervention (5/31; 16%). Early LP was associated with a strongly reduced risk of VP-shunting (odds ratio = 0.22, 95% confidence interval: 0.08-0.62). The number of infants who developed a moderate or severe handicap was also higher (11/42; 26%) in the late intervention group, compared with those not requiring any intervention (3/22; 14%) or treated early (5/31; 16%).Conclusion: In this retrospective study, infants receiving late intervention required shunt insertion significantly more often than those treated early. A randomized prospective intervention study, comparing early and late drainage, is required to further assess the role of earlier intervention. [ABSTRACT FROM AUTHOR]

Abstract: Hemorrhages are major complications experienced in 10–35% of neonates treated with extracorporeal life support (ECLS). The increased bleeding tendency is partly due to an ECLS induced thrombocytopenia and impaired platelet function. In the present study, we evaluated the effect of epoprostenol on the ECLS induced platelet consumption and activation. In terms of the methods, identical in vitro ECLS circuits were primed with fresh heparinized human blood and circulated for 24 h. Epoprostenol (2.4 μg/L blood/h) was added to one of the circuits in each pair. In total, 6 paired experiments were performed. The platelet count, neutrophil count, plasma concentration of hemoglobin, and platelet membrane expression of glycoproteins (GP) Ib and IIb/IIIa were assayed before the start and at 0.5, 1, 3, 12 and 24 h of perfusion. Higher platelet counts were observed in the experimental circuits. However, no difference in the platelet membrane expression of GPIb and GPIIb/IIIa could be observed between the circuits. In conclusion, epoprostenol reduces platelet consumption during ECLS without affecting the membrane expression of GPIb and GPIIb/IIIa. [ABSTRACT FROM AUTHOR]

We undertook this survey to determine institutional practices of obstetricians, neonatologists and haematologists regarding care of pregnant haemophilia carriers and newborns with haemophilia and intracranial haemorrhage (ICH). Our purpose was also to determine whether institutions had written guidelines to manage such patients. Questionnaires were sent to 1000 obstetricians and through the Haemophilia Treatment Centres (HTC) to 180 paediatric haematologists and 180 neonatologists, each representing an institution. Twenty-three per cent of obstetricians, 22% of neonatologists and 16% of paediatric haematologists returned completed surveys. Over 94% of the respondents had no written guidelines for management of pregnant haemophilia carriers or their newborns or for neurologic assessment of newborns. For known haemophilia carriers, 57% of the obstetricians routinely preferred vaginal delivery and 11% preferred caesarean section. Availability of perinatal services influenced prenatal management (P < 0.05). In term newborns with documented ICH, only 23% of neonatologists would evaluate for haemophilia, whereas in pre-term newborns with ICH, this number dropped even further to 3%. For all newborns with haemophilia, 40% preferred routine administration of clotting factor concentrates (CFC) immediately following birth to offset the trauma of delivery and 89% of paediatric haematologists favoured early prophylaxis with CFC. Guidelines are needed for management of pregnant haemophilia carriers as well as newborns with haemophilia. Physicians need to be made aware that ICH may be a presenting sign of haemophilia in both term as well as pre-term newborns, so that appropriate therapy can be instituted early in the event of a bleed. [ABSTRACT FROM AUTHOR]

Examines the relationship between hemorrhagic disease of the newborn (HDN) and vitamin K deficiency. Description of vitamin K metabolism; Development of vitamin K deficiency in the early days of life; Discussion on the clinical and hematological manifestations of vitamin K deficiency HDN; Risk, effectiveness and need for vitamin K prophylaxis in newborn infants.