Congenital heart defects

Congenital heart defects

Critical congenital heart defects (CCHD) present during the neonatal period with cyanosis and/or cardiac failure depending on the particular defect and its severity. The incidence of the CCHD is approximately 1-3 : 1000. These defects can be diagnosed antenatally, however, anomaly scan detection rates vary significantly among different countries and also within the same country (e.g. 33-70% prenatal CCHD diagnosis in…

Polycythemia

Polycythemia

Polycythemia is defined by venous hemoglobin concentration > 220 g/l or by hematocrit value > 0.65 during the first week of life. It correlates clinically with hyperviscosity syndrome. The common causes: chronic intrauterine hypoxia twin-twin transfusion syndrome in monochorionic-diamniotic twins (recipient twin) excessive placental transfusion Diagnosis Clinical signs dictated by the severity of hyperviscosity syndrome (infant…

Leukocyte abnormalities

Leukocyte abnormalities

There are significant differences (leukocyte abnormalities) in white blood cell (WBC) total and differential counts between newborns and older children. Alterations in WBC total and differential count can be an early sign of infection (leukopenia, leukocytosis, shift to the left). Total WBC counts should be always adjusted for given postnatal age – see Table. I/T index…

Bleeding disorders

Bleeding disorders

Newborns (preterm in particular) have relatively low levels of pro-coagulation factors (vitamin K dependent factors), diminished platelet functions (their levels are similar to adults), as well as low anti-coagulation factors (antithrombin III, protein C). Nevertheless, both pro- and anti-coagulation systems are in balance and hemorrhagic or thrombotic events are not usually observed. The levels of fibrinogen, factor V,…

Thrombophilia

Thrombophilia

Neonatal thrombophilia can cause both arterial and venous thromboembolic events. Thrombophilia results from the disrupted hemostatic system that normally consists of 4 integrated components: the coagulation system, endothelium and regulatory proteins, platelets, and fibrinolysis. The peak incidence of pediatric thromboembolic events occurs in neonates and infants < 1 year of age….

Congenital anomalies of gastrointestinal tract

Congenital anomalies of gastrointestinal tract

Congenital anomalies of gastrointestinal tract (GIT) can be sometimes detected by the prenatal screening (ultrasound – polyhydramnios, direct visualisation of affected GIT; biochemistry – elevated alpha-fetoprotein in gastroschisis and omphalocele). Postnatal investigations include proper clinical examination (distended abdomen, vomiting with/without bilious aspirates) and imaging techniques (ultrasound, native or contrast radiography). The lower (distal) the obstruction in the…

Necrotizing enterocolitis

Necrotizing enterocolitis

Necrotizing enterocolitis (NEC) belongs to acute abdomen events (inflammatory subgroup). It is typical disease of extreme prematurity – incidence is inversely proportional to advancing gestational age (1-5% of newborns admitted to the neonatal intensive care unit). Mortality associated with NEC varies between 20-50%. Multifactorial basis of NEC makes it difficult to pinpoint single…

Acute abdomen

Acute abdomen

Acute abdomen events arise from a number of diseases based on the predominant pathophysiology. They require urgent revision. Basic division of acute abdomen in newborns: congenital gastrointestinal malformations non-inflammatory→ ileus of prematurity (IOP)→ spontaneous intestinal perforation (SIP)→ incarceration of inguinal hernia→ testicular torsion (unilateral orchidectomy) inflammatory→ necrotizing enterocolitis (NEC)→ peritonitis (usually…

Early onset sepsis

Early onset sepsis

Early onset sepsis (EOS) is an infectious complication in newborns that have clinical presentation within the first 72 hours of life. Sometimes also called perinatal due to pathogenesis – vertical transmission shortly before the birth (transplacental), ascendent infection from the cervicovaginal space (chorioamnionitis, funisitis, fetal infection) or during the vaginal delivery. The pathogen can be also the cause…

Late onset sepsis

Late onset sepsis

Late onset sepsis (LOS) is an infectious complication in newborns that have clinical presentation after the first 72 hours of life. Sometimes also called nosocomial due to pathogenesis – contact with mother, breastmilk, invasive procedures, hands of healthcare personnel. LOS episodes significantly contribute to neonatal mortality and morbidity rates and can have lifelong…