Neonatal anemia due to fetal hemorrhage into the maternal circulation.
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The role of Vit. K prophylaxis in preventing haemorrhagic disease of newborn has been well established for many years. Although the opinions differ on a general prophylaxis and selective prophylaxis i.e. prophylaxis only for newborn at risk. In our hospital only the selective Vit. K prophylaxis was administered to newborns during the last 20 years. We observed a marked reduction in the incidence of haemorrhagic disease of newborn, particularly after the availability of neonatal intensive care unit. This could be attributed to the effectiveness of Vit. K prophylaxis and better neonatal care and observation. Hence, the present study, reinforced by the experience of the past emphasise the efficacy and safety of Vit. K prophylaxis in the prevention of haemorrhagic disease of newborn.
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Neonatal adrenal hemorrhage was diagnosed by ultrasound as an echo-free mass superior to downward displaced normal kidneys in three newborns. In one, the adrenal hemorrhage was bilateral. Fine needle aspiration was performed to confirm the diagnosis in one case. The babies were followed-up until adrenal calcifications were seen on ultrasound as linear echoes with posterior acoustic shadowing. These calcifications were confirmed by plain films. It is suggested that the diagnosis of neonatal adrenal hemorrhage should be based on ultrasound and on one initial intravenous urogram. Follow-up examinations should be restricted to ultrasound and plain films. In doubtful cases fine needle aspiration can be added for confirmation.
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BACKGROUND: Affected patients with neonatal alloimmune thrombocytopenia (AIT) are often severely thrombocytopenic and, if so, may suffer an intracranial hemorrhage (ICH). This study was undertaken to compare the outcome of cases of AIT to cases of neonatal thrombocytopenia shown not to be AIT and to identify clinical features that would facilitate the diagnosis. PROCEDURE: Two hundred twenty two cases of neonatal thrombocytopenia for which serologic testing was obtained by the referring physician were accrued for this study from 11 testing laboratories. The relevant clinical information was pursued. RESULTS: The mean birth platelet count in 110 neonates with AIT was 26,000/mm(3) x 10(9)/L and the rate of ICH was 11% (not all neonates had head sonos). Three criteria distinguished cases of AIT from other causes of neonatal thrombocytopenia (n = 56): (1) severe thrombocytopenia <50,000/mm(3) x 10(9)/L; (2) ICH associated with 1 or more of: a 1-min Apgar score >5, birthweight >2,200 g, grade >1, antenatal occurrence, or signs of bleeding, that is, petechiae, ecchymoses; and (3) no additional, non-hemorrhagic neonatal medical problems. CONCLUSIONS: AIT is a unique type of neonatal thrombocytopenia with significant hemorrhagic consequences. Identification of AIT at the bedside should guide institution of appropriate treatment and lead to serologic testing for confirmation.
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An outbreak of necrotizing enterocolitis and hemorrhagic gastroenteritis occurred in two nurseries during 25 days in August 1982. Eleven of the 40 patients in these nurseries during that time developed disease (attack rate 27.5%). In seven of the 10 patients with gastrointestinal disease, stool samples tested for human rotavirus were positive by ELISA, whereas in 20 unaffected infants, no stools tested demonstrated HRV (P = 0.0001). Eleven staff members had serologic evidence of recent HRV infection. Comparison of risk factors traditionally associated with the development of NEC between the affected and unaffected infants revealed no significant differences. Rotavirus infection was the only finding that was highly correlated with this epidemic.
Real time echoencephalography (RTE) was used to diagnose and serially follow intracranial pathological conditions in the posterior fossa of infants with a gestational age of less than 34 weeks. The posterior fossa was studied in four planes (coronal, modified coronal, sagittal, and parasagittal) with a sector scanner equipped with a high frequency transducer that was placed on the fontanelles and the sutures. Hemorrhagic complications were easily differentiated from normal anatomy. RTE diagnosis was confirmed with computed tomographic scans (5 patients) and postmortem examination of the brain (18 infants). RTE is a precise and noninvasive technique to visualize hemorrhagic and other forms of abnormalities in the infratentorial compartment.
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A case is reported of massive adrenal hemorrhage in a newborn with evidence of bleeding in utero. A large cystic mass noted on prenatal ultrasonography at 20 weeks of gestation was followed by serial examinations until birth at 38 weeks of gestation. Postnatal evaluation included abdominal sonography, diethylenetriaminepentaacetic acid renal scan, voiding cystourethrography and abdominal plain film. Surgical exploration confirmed massive adrenal hemorrhage.
Adrenal hemorrhage and renal vein thrombosis are two distinct vascular entities encountered in the newborn period. Occasionally, both entities may co-exist in the same patient. A premature infant of a diabetic mother presented with intestinal obstruction secondary to extrinsic compression by the mass effect of the enlarged hemorrhagic adrenal and thrombosed kidney on the left hemicolon, a phenomenon which to our knowledge has not previously been described.