Anaphylactic shock due to hepatitis B immunoglobulin in a newborn

Hepatitis B immunoglobulin (HBIG) is administered for the passive immunisation of all infants born to HBsAg-positive mothers within 12?h of birth. Adverse effects of HBIG are very rare. In this study, we report a newborn (a female, 33 weeks' gestation and 2030?g birth weight) developing anaphylaxis after HBIG administration. The mother was a Hepatitis B virus (HBV) carrier. Hypotension and erythematous rash developed 7?min after HBIG administration. Reporting the first anaphylaxis case in newborns due to HBIG in literature, we suggest the condition be taken into account, and requisite precautions should be taken against this probable complication in the newborn.     

Prevention of Vitamin K Deficiency Bleeding

The risk that a newborn will develop vitamin K deficiency bleeding is 1700/100,000 (one out of 59) if vitamin K is not administered. When intramuscular vitamin K is administered, the risk of vitamin K deficiency bleeding is reduced to 1/100,000. While women may have misconceptions about vitamin K prophylaxis for their newborns, health care providers should be prepared with factual information. Prophylaxis is needed even for healthy newborns without risk factors for bleeding. Other forms of vitamin K supplementation, including oral administration of Food and Drug Administration‐approved vitamin K preparations and maternal supplements during pregnancy or lactation, do not have the same effectiveness as the parenteral form. The formulations of vitamin K approved for use in the United States have not been associated with childhood leukemia or other childhood health problems. Care providers need to give accurate information to families regarding the risks and benefits of vitamin K prophylaxis. An interprofessional approach to education can be effective in increasing acceptance of vitamin K prophylaxis and decreasing the incidence of vitamin K deficiency bleeding. This article uses a case study approach to highlight common misconceptions about vitamin K prophylaxis and discuss a recent interprofessional collaboration to prevent vitamin K deficiency bleeding.     

A rare entity: idiopathic priapism in a newborn and review of the literature

Priapism is a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is an important medical condition, which requires evaluation and may require emergency management. This condition occurs very infrequently in paediatrics outside of the sickle-cell population and is exceedingly rare in newborns. The evaluation and management of neonatal priapism can be challenging for paediatricians, neonatologists and paediatric urologists alike given the lack of experience with this condition, its poorly understood pathophysiology and the absence of well-established guidelines. We present a case of idiopathic neonatal priapism because of its rarity and review of the literature.     

Persistent intestinal bleeding due to severe CMV-related thrombocytopenia in a preterm newborn

The optimal threshold for neonatal platelet transfusions in sick newborns is still uncertain. We report a congenital cytomegalovirus (CMV) infection in a premature neonate with severe thrombocytopenia who subsequently presented with necrotizing enterocolitis and intestinal bleeding. The baby recovered after platelet transfusions were discontinued and the therapy was switched from intravenous ganciclovir to oral valganciclovir. We discuss both measures, speculating on the key role of platelet transfusions.     

Strategies for managing transient tachypnoea of the newborn - a systematic review

Objective: To conduct a systematic review of strategies for the management of transient tachypnoea of the newborn (TTN).

Methods: The Cochrane Collaboration and PRISMA guidelines were used for conducting and reporting this systematic review, respectively. The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases were searched in February 2016. Only randomised and quasi-randomised controlled trials (RCTs) assessing any intervention for the management of TTN in infants <7 days of age, born at 35 or more weeks with a clinical diagnosis of TTN were eligible for inclusion. Primary outcomes included the duration of respiratory support, oxygen support, tachypnoea and hospitalisation.

Results: Nine RCTs with moderate risk of bias were included. The interventions assessed included furosemide (2 trials, n?=?100), inhaled salbutamol (2 trials, n?=?94), inhaled epinephrine (1 trial, n?=?20), restrictive fluids (2 trials, n?=?146) and non-invasive ventilation (2 trials, n?=?80). Amongst all interventions, inhaled salbutamol significantly reduced the duration of hospitalisation (2 trials, n?=?94) [mean difference (MD) - 1.63 days (95% CI ?2.71 to ?0.55); p?=?0.003] and duration of oxygen requirement (1 trial, n?=?37) [MD - 43.10?h (95% CI ?81.82 to ?4.38; p?=?0.03] without adverse effects.

Conclusion: Limited low-quality evidence exists on the effects of different management strategies for TTN. The safety and efficacy of inhaled salbutamol in the treatment of TTN can be assessed in a large RCT.     

Circumcision bleeding complications: neonatal intensive care infants compared to those in the normal newborn nursery

Purpose: To determine if a significant difference exists in the bleeding complications following circumcision in neonates admitted to neonatal intensive care unit (NICU) versus the normal newborn nursery (NNN).

Materials and methods: Observational cohort study of 260 infants undergoing circumcision with Gomco clamp. Vitamin K was given to neonates at delivery. Demographic data, procedural characteristics, bleeding complications, and interventions were recorded. The bleeding rates of the two groups were compared using chi square.

Results: NICU neonates experienced increased bleeding complications versus NNN neonates (22% vs. 9.6%, p?=?.029). No differences were found regarding gestational age at delivery, age at circumcision, and birth weight. Neonates with circumcision performed at ≥5?days of life experienced increased rates of bleeding complications versus those performed at ≤4?days (28% vs. 10.3%, p?=?.023). All neonates with circumcision performed ≥5?days of life were initially admitted to the NICU.

Conclusion: NICU neonates had increased rate of bleeding complications following circumcision when compared to the NNN neonates. There was an increased rate of bleeding complications in neonates who undergo circumcision at ≥5?days of life. Further research may help to determine if redosing of vitamin K or variations in the circumcision procedure are necessary for circumcision at >4?days of life.     

The routine use of vitamin K in the newborn

The coagulation system of the newborn infant shows some functional impairment during the first few days of life. While these abnormalities are transient and can probably be regarded as ‘physiological’ in some babies, others, especially those who are breast fed, are at risk of suffering life-threatening haemorrhage. There is good evidence that, in at least some newborn babies, the coagulation abnormalities may be corrected by giving vitamin K. Although occasional serious accidents have resulted from the practice of administering intramuscular vitamin K in the delivery room, no fatalities have been reported in the recent literature. The preparation of vitamin K in current use appears to have no side effects when given intraumscularly or orally to newborn infants. Since the majority of newborn babies in most hospitals in this country are breast fed for at least the first few days of life it would seem appropriate for prophylactic vitamin K to be given either to all newborn infants soon after birth or to those at increased risk of developing HDN. Administration by mouth is probably safer than by intramuscular injection but more detailed research is needed to establish the efficacy and optimal dosage for the oral route. The requirement for vitamin K beyond the first few days of life has not been defined and objective recommendations concerning the prevention of late-onset haemorrhagic disease must await the results of further studies.     

Transient ventricular hypocinesia after in utero anthracyclines exposure: a case-report and review of the literature

Due to the low occurrence of cancer during pregnancy, limited data are available about outcome of infants exposed to chemotherapy in utero. We report the case of a newborn who developed transient ventricular hypocinesia and late-onset infection after in utero exposure to four epirubicin cycles for pregnancy-associated breast cancer. Moreover, we provide an overview of literature on neonatal outcome after anthracyclines-based chemotherapy regimen during pregnancy. Existing data support use of anthracyclines, as few cases of fetal cardiac toxicity were reported and most of short-term complications were transient. Need for prospective collection of data and longer follow-up is highly recognized.     

Metabolism of vitamin K dependent factors in mothers and their newborn infants

Little is known about the absorption, excretion and transplacental transport of vitamin K in the perinatal period. From this point of view, the following studies were carried out. 1) Hepaplastin tests were performed on 65 women in the last stage of pregnancy and each coagulation factor was estimated as well. 2) Correlations were made between mothers' and babies' Hepaplastin test values. 3) Transplacental transport of vitamin K2 was studied. The general activity of vitamin K dependent factors in pregnant women was much higher than in non pregnant women. As far as the correlation between mothers' venous blood during delivery and cord venous blood is concerned, in the group of mothers with Hepaplastin test value of less than 120% of the normal adult value, the value of the Hepaplastin test was less than 30% of normal adult value in the cord venous blood. We also established that vitamin K passed through the placenta but only in small qualities.     

Association of vitamin D deficiency with acute lower respiratory tract infections in newborns

Objective: To determine the association between serum 25-hydroxy vitamin D [25(OH)D] levels and acute respiratory tract infections (ALRTI) in newborns.

Study design: The study group consisted of 30 term newborns with ALRTI who were admitted to our neonatal intensive care unit. Controls were 30 healthy newborns with the same age as the study group. Newborns and their mothers were tested for serum 25(OH)D levels, with a low level defined as ≤15?ng/mL.

Results: The groups were similar in gestational week, birthweight, postnatal age and gender. Forty-three of the 60 infants (including study and control) had low 25(OH)D levels. The median 25(OH)D levels were lower [9.5?ng/mL (IQR?=?7.9–12.2)] in the study group than those of the control group [15.5?ng/mL (IQR: 12–18)] (p?=?0.0001). The median serum 25(OH)D levels in the mothers of the study group were also lower than those in the mothers of the control group [11.6?ng/mL (IQR?=?9.4–15.8) and 17.3?ng/mL (IQR?=?13.7–20.6), respectively] (p?=?0.0001).

Conclusion: Lower blood 25(OH)D levels might be associated with increased risk of ALRTI in term newborn babies. Appropriate vitamin D supplementation during pregnancy and early childhood may enhance newborns’ respiratory health.     

Fetal and neonatal abnormalities due to congenital rubella syndrome: a review of literature

Objective: Rubella virus infection during the first trimester of pregnancy can cause congenital rubella syndrome (CRS). We aimed to describe the abnormalities in order to define the ultrasound features to look for when performing prenatal scans. The goal of this review is to focus specifically on the signs of CRS accessible to prenatal diagnosis.

Methods: We analyzed every case of CRS described before and/or after birth that we identified in the Pubmed database and classified them as accessible or not to prenatal diagnosis.

Results: The most frequently reported malformations accessible to prenatal diagnosis were: cardiac septal defects, pulmonary artery stenosis, microcephaly, cataract, microphtalmia, and hepatosplenomegaly.

Conclusion: This extensive literature review shows that the ultrasound features of CRS are not well known, even though rubella was the first teratogenic virus described. This review will help clinicians in the management of rubella during pregnancy by clarifying the findings to be sought.     

从胎儿期延续至新生儿期的心房扑动三例报告(附文献复习)

目的 探讨新生儿心房扑动(简称房扑)的起病、病因、治疗及预后. 方法回顾分析2005年至2007年我院新生儿病房收治的3例房扑患儿的起病、治疗和预后,并对相关文献进行复习和总结. 结果 3例患儿药物治疗有效,随访结果预后较好,分别随访至8个月和2岁,房扑未复发. 结论宫内胎儿房扑应积极给孕母治疗,新生儿房扑可选择药物治疗、食道心房超速起搏及直流电复律等,预后较好.     

Plasma growth arrest-specific 6 levels in term and preterm newborns

Objective: Growth Arrest-Specific 6 (GAS6) is a vitamin K-dependent protein. Despite a similar structure to Protein S, it has no anticoagulant activity. An association between GAS6 and some diseases for adults has been reported. In the absence of prospective clinical studies of GAS6 in neonates, so far, the objective of this study is to obtain, for the first time, plasma GAS6 levels before and after vitamin K1 prophylaxis in full-term and pre-term newborns.

Methods: 80 newborns (40 term and 40 preterm) were recruited for this study. Cord blood samples and peripheral blood samples 48?h after vitamin K1 injection were collected into EDTA-tubes. GAS6 levels were measured in platelet-poor plasma by ELISA.

Results: Cord blood plasma GAS6 levels in preterm and term newborns were 9.07?±?5.30?ng/mL and 9.75?±?4.34?ng/mL, respectively. In response to vitamin K1 injection, GAS6 levels increased in preterm newborns (10.50?±?5.28?ng/mL) (p?p?>?.05).

Conclusion: This pilot study provided, to the best of our knowledge, the first report that GAS6 levels increased significantly after vitamin K1 prophylaxis in preterm newborns but not in term infants. This study may serve as a first step toward more extensive studies in neonates.     

Thoracic cord compression due to gout: a case report and literature review.

An 82-year-old man developed progressive weakness of both legs 1 month prior to admission. He reported no previous history of trauma. Spine radiography revealed marked thoracic and lumbar spondylosis. Magnetic resonance imaging of the spine disclosed segmental stenosis with cord compression at T10-11 due to an extradural soft tissue lesion. Based on a diagnosis of thoracic spondylosis with cord compression, decompression laminectomy was performed. During the operation, fragile chalky-white material was noted over the epidural space, compressing the thoracic cord. The granular lesion was meticulously removed until the dura was identified and the cord was decompressed. Histologic examination of the surgical specimen revealed deposits of needle-like crystals that were consistent with monosodium urate, demonstrating that a gouty lesion of the thoracic spine had caused the cord compression. The patient had previously experienced several attacks of gouty arthritis of his feet. The postoperative serum uric acid concentration was 8.5 mg/dL. After surgery, he was treated with benzbromarone 100 mg per day. He was able to walk 3 months after the operation. A high index of suspicion of gouty involvement of the spine is necessary in patients with gout. Surgical decompression followed by regular administration of antigout drugs can provide satisfactory results.     

Chronic tuboovarian abscess due to Staphylococcus aureus: a case report and literature review

A 40-year-old woman presented with a right adnexal mass. Laparotomy revealed a large tuboovarian abscess due to Staphylococcus aureus. The only significant past medical history was a Cesarean section and bilateral tubal ligation 10 years prior to admission. The tuboovarian abscess, due to this unusual organism, may have developed insidiously over a 10 year period. The patient recovered completely after excision of the abscess and antibiotic treatment.     

Massive haemoperitoneum due to uterine artery erosion by endometriosis and a review of the literature

The aim of the literature review was to compile and compare similar cases of massive haemoperitoneum in an asymptomatic woman where the bleeding was from the right uterine artery, which had been eroded by pelvic endometriosis. To our knowledge this is the second case reported in the literature. Case reports of other sources of bleeding leading to haemoperitoneum were studied, comparisons were made, and the results compiled. Although several cases of massive haemoperitoneum have been reported, spontaneous bleeding from uterine artery erosion is a rare occurrence. The abdominal surgeon should be vigilant and alert to localise rare sites of bleeding. This literature review emphasises that endometriosis can present in many ways and a high level of clinical suspicion is necessary.     

Septicemia due to Aeromonas hydrophila in a pregnant woman: a case report and review of the literature

Background: In the late 1960s, the first isolates of Aeromonas were recovered from human specimens. Presently, there is sufficient evidence to suggest that the different isolates of the genus Aeromonas are human pathogens. The most frequent site of infection is the digestive tract, although extraintestinal infection also occurs. In those cases involving septicemia, most infections occur in individuals with underlying diseases. This report presents the case of a pregnant woman with no underlying disease or signs of immunodeficiency who developed A. hydrophila septicemia at 24 weeks gestation.Case: A 20-year-old pregnant woman was admitted with a history of 10 days of fever, chills, and diaphoresis. Three days before her hospitalization, she noted jaundice and choluria. Her liver was enlarged and her liver function tests were abnormal, with a moderate elevation of serum aminotransferases and direct serum bilirubin and a high serum alkaline phosphatase. Her blood and bone-marrow cultures revealed A. hydropkila. She was treated with parenteral ceftriaxone. She experienced a complete remission of her symptoms and laboratory abnormalities after therapy. The remainder of the pregnancy was normal. At 39.2 weeks gestation, she delivered a healthy male infant.Conclusion: An association was noted between pregnancy and A. hydrophila septicemia in a woman without immunodeficiency or underlying disease, possibly indicating another infectious complication in pregnancy.     

PIVKA-II plasma levels as markers of subclinical vitamin K deficiency in term infants

Background: As the vitamin K content of human milk is low and the newborn infant's stores of vitamin K are small, vitamin K deficiency with hemorrhage in the newborn is a worldwide problem. Proteins Induced by Vitamin K Absence (PIVKA-II) are the inactive under-γ-carboxylated forms of vitamin K-dependent clotting factors and they could be useful in predicting subclinical vitamin K deficiency (VKD). Objectives: To demonstrate that PIVKA-II are earlier markers of subclinical VKD than Prothrombin time (PT) in exclusively breast-fed newborns. Methods: A prospective, controlled, randomized study, including 53 term newborns receiving vitamin K prophylaxis (0.5 mg i.m.) at birth, was performed. At 30 days newborns were divided into three groups (G) receiving respectively: 25 μg/die of vitamin K (G I), 12 μg/die (G II) or placebo (G III). PIVKA-II and PT were measured on 30th and 90th days of life. Results: G III and GII showed a significant increase in PIVKA-II from 30 to 90 days of life respectively from 2.6 to 4.7 (p = 0.001) and from 2.3 to 3.5 (p < 0.001). No significant changes were found in GI. PT showed no significant changes among groups. Conclusions: PT is a less sensitive marker than PIVKA II. Oral supplementation with 25 μg/die avoids an increase of PIVKA-II. Despite increased PIVKA-II do not mean an impending occurrence of bleeding, they highlight a subclinical VKD and its relative risk.