Hemorrhage In Infants Research Articles

Natural history of traumatic meningeal bleeding in infants: semiquantitative analysis of serial CT scans in corroborated cases

The natural history of posttraumatic meningeal bleeding in infants is poorly documented, and the differences between inflicted head injury (IHI) and accidental trauma (AT) are debated. Autopsy findings have suggested that anoxia also plays a role in bleeding; however, these findings may not reflect what occurs in live trauma patients. We studied the natural history of traumatic meningeal bleeding in infants using serial computed tomography (CT) scans in corroborated IHI and AT. From our prospective series, we selected corroborated cases (confessed IHI or AT having occurred in public), who underwent at least three CT scans in the acute phase. We performed a semiquantitative analysis of meningeal bleeding using a four-tier scale (absent, faint, frank, and thick) derived from the Fisher grading for aneurysmal bleeding in four regions of interest (convexity, falx cerebri, sagittal sinus, and tentorium cerebelli). We studied 20 cases: ten IHI and ten AT. Bleeding was maximal at the convexity initially, then increased along the falx and sagittal sinus, and then along the tentorium. Decrease and disappearance of blood was variable according to the site and the initial quantity of blood. We found no difference between IHI and AT. Our findings suggest that the primary site of meningeal bleeding in infantile head trauma is the convexity of the brain; blood cells then migrate toward the midline following the flow of cerebrospinal fluid circulation and inferiorly following gravity. The pattern of bleeding in traumatic cases appears similar in IHI and AT but different from anoxic lesions.

Do retinal haemorrhages occur in infants with convulsions?

Aim: To determine the prevalence of retinal haemorrhages in infants presenting with convulsions and admitted to hospital, and to consider whether this finding indicates shaken baby syndrome. Methods: Prospective study...

Vitamin K deficiency bleeding in cholestatic infants with alpha-1-antitrypsin deficiency

Objective:Exclusively breastfed infants with unrecognised cholestatic jaundice are at high risk of a vitamin K deficiency (VKD) bleeding. It is presently unknown whether (the size of) this risk depends on...

A rare case of hemangioma of infancy presenting as intraspinal hemorrhage

Hemangiomas of infancy (HOIs) are among the most common benign tumors of childhood and classically appear as a vascular stain or small vascular papule at birth. They are unique tumors due to their propensity to proliferate, involute, and finally regress. These lesions can be associated with visceral malformations that have been shown to affect mainly the liver and the gastrointestinal tract, but rarely the spinal cord. The authors report a rare case of a spinal HOI in a 2-month-old infant presenting with quadriplegia due to intratumoral hemorrhage. Following resection of the lesion, the child regained function. This first reported case of spinal HOI suggests another location for hemangiomatosis. Spinal HOI should be included in the differential diagnosis of acute intraspinal hemorrhage in infants.

Familial factor VII deficiency with foetal and neonatal fatal cerebral haemorrhage associated with homozygosis to Gly180Arg mutation

Inherited factor VII (FVII) deficiency is a rare autosomal recessive disorder with a wide heterogeneous clinical pattern. Intracranial haemorrhage in infants has been previously reported in the severe form of the FVII deficiency and it has a high fatality rate. We report a family with high consanguineous relations, who experienced death of two baby girls, the first with prenatal manifestation of foetal hydrocephalus secondary to intracranial bleeding and the second with postnatal intracranial bleeding, both with less than 1% activity of FVII. Genetic analysis revealed that both parents are heterozygous and both daughters homozygous for a point mutation gG9639A in exon 7, predicting Gly180Arg substitution. This mutation was described previously in a compound heterozygous patient with mild bleeding manifestation. It seems that in this family, the mutation in its homozygous state is fatal and the lethal clinical expression can appear in utero at an early stage of gestation.

Rupture of Intracranial Arterial Aneurysms in Neonates: Case Report and Review of the Literature

The rupture of cerebral arterial aneurysm is an extremely rare cause of intracranial hemorrhage in infants. Brain magnetic resonance imaging is an excellent technique commonly used to suggest the diagnosis. In this article, we propose color flow Doppler ultrasound as a useful, simple, inexpensive, noninvasive, and accessible option for confirming the lesion.We report one case of cerebral aneurysm in a neonate admitted to our unit. Furthermore, we performed a thorough review of the literature on cerebral aneurysm that led us to the observation that the vast majority of untreated patients suffered a second bleeding that caused death. Thus, we insist on the benefits of a timely treatment.

Incidence of oronasal haemorrhage in infancy presenting to general practice in the UK

The frequency of oronasal haemorrhage in infancy was estimated from two national GP research databases (6% UK population). When a case was identified, other presentations in the child over the first year were available from one dataset. In the first year haemoptysis is rare. In contrast, epistaxis (7-20 cases of per 10,000 infants) was 10 times more common, and 14.3% of these infants had an injury at some other point in infancy, (four times greater than the general population). In general practice epistaxis may herald other trauma presentations, implying that such infants may be part of a high-risk group for injury.

Dramatic Efficacy of Sequential Bypassing Agent Treatment for a Life-Threatening Bleeding in An Infant with Severe Hemophilia and Inhibitor

In hemophiliacs the treatment of bleeding in infancy is more difficult than in adults and children due to insufficient knowledge in pharmacokinetics. Moreover the clinical response to coagulation concentrates is known to have not only inter-patients but also inter-bleeding episodes variability and only scarce experience is available. We report an experience in a one-month old infant managed with a successful sequential therapy.Severe hemophilia A was diagnosed at day 4 of life because of a cephalhematoma without intra cerebral hemorrhage (ICH) and severe anemia (Hb: 4 g/dl). Packed red blood cells (RBC) were given, FVIII concentrate was infused daily during 12 days and the hematoma resolved. At day 50 recurrent seizures led to the diagnosis of subdural haemorrhage, in the absence of any trauma. Anti FVIII inhibitor was detected (while negative 10 days before). Treatment with recombinant FVIIa (rFVIIa) was started at 1.2 mg (200μg/kg) every 2 hours and then progressively decreased. Outcome was good. To avoid ICH recurrence because FVIII inhibitor titer>30 BU, rFVIIa prophylactic treatment was decided and a central venous access device (CVAD) was inserted into the left internal jugular vein. No abnormal blood loss was observed during this procedure and a compressive bandage on CVAD was immediately performed. Collapse and respiratory distress developed within 24 hours. Chest X-ray showed a complete left hemothorax. Hemoglobin(Hb) level dropped to 5.2 g/dl. RBC infusion was required and rFVIIa dose was increased to 2.4 mg then alternately 1.2 mg and 2.4 mg every 2 hours until hemodynamic stabilization. Pleural aspiration yielded only 25 ml bloody fluid. Twelve hours later the Hb level fell again to 7 g/dl and RBC were again infused. Recombinant FVIIa treatment was stopped and activated prothrombin complex concentrate (aPCC) was started at a dose of 500 units (83u/kg) every 6 hours. After 2 doses of aPCC the Hb level fell again requiring new RBC infusion. A sequential therapy was decided with alternate rFVIIa 1.2 mg and aPCC 500 units every 4 hours. and, the hemodynamic parameters and Hb level stabilized. Pleural aspiration yielded 190 ml. The infant's clinical status improved dramatically with the disappearance of the hemothorax. This alternative treatment was maintained for 20 hours with good tolerance according to frequent monitoring of platelet count, D-dimers and fibrinogen. A more usual treatment (aPCC 500 units tid) was prescribed but after the first 2 infusions fibrinogen level fell to 0.9 g/l, with positive D-dimers and platelet count dropped to 36 109/l. The therapy was decreased to 500 units bid and the biological parameters quickly improved. The baby's clinical status was excellent and one day after, therapy was switched to rFVIIa 1.2 mg every 6 hours. The outcome was excellent.Conclusion: This report evidences differential response to the same treatment according to the type of bleeding in the same patient with inhibitor. After inhibitor development, for ICH, where r FVIIa treatment is well known to be efficient, the patient's response was very good at usual doses for this age. For the second episode (hemothorax) where life was threatened at several instances the escalating and sequential treatment schedule shows that sometimes very aggressive therapy is required despite high risks of thrombosis and disseminated intravascular coagulation.

Eosinophilic Gastrointestinal Diseases (EGIDs)

Eosinophilic Gastrointestinal Diseases (EGIDs)

Gastrointestinal bleeding in infants and children

Gastrointestinal (GI) bleeding in infants and children is an alarming symptom to both the patient and parents. It can present orally and/or rectally. While minor GI bleeding is usually a self-limited condition, requiring only minimal intervention, it can certainly be a life-threatening condition at times. An initial focused review of the history and physical examination, followed by a detailed history, investigations and management, is necessary to identify the etiology of the bleeding and aid in its treatment. This article reviews the different etiologies, investigation and therapeutic options for management of GI bleeding in infants and children.

Inhalation of Stachybotrys chartarum causes pulmonary arterial hypertension in mice

Inhalation of Stachybotrys chartarum, a ubiquitous fungus in our living environment, has been suspected as a cause of acute idiopathic pulmonary haemorrhage in infants, but its relation to human diseases is not yet known. The aim of present study was to investigate the effect of repeated intratracheal injection of the fungus into mice, paying special attention to the pulmonary vascular system. Spores of S. chartarum were injected into the trachea of mice from 6 to 18 times over 4-12 weeks, and the lungs were examined by histopathology, morphometrics and haemodynamics. When 1 x 10(4) spores/mouse were injected, histopathological examination showed the development of pulmonary arterial hypertension (PAH). Symmetrical thickening of the intima and media of the pulmonary arterial walls was seen after six injections over 4 weeks. Right ventricular hypertrophy was also evident after 12 injections. PAH was confirmed by the elevation of right ventricular systolic pressure (20.1 +/- 5.7 mmHg in the injected group vs. 12.0 +/- 2.4 mmHg in the control group, P < 0.01). This study showed that the inhalation of S. chartarum caused PAH in mice, suggesting a potential of S. chartarum as a cause of human health problem such as PAH.

Severe cough and retinal hemorrhage in infants and young children

Severe cough and retinal hemorrhage in infants and young children

Testing antimicrobial cleaner efficacy on gypsum wallboard contaminated with Stachybotrys chartarum

Reducing occupant exposure to indoor mold is the goal of this research, through the efficacy testing of antimicrobial cleaners. Often mold contaminated building materials are not properly removed, but instead surface cleaners are applied in an attempt to alleviate the problem. The efficacy of antimicrobial cleaners to remove, eliminate or control mold growth on surfaces can easily be tested on non-porous surfaces. However, the testing of antimicrobial cleaner efficacy on porous surfaces, such as those found in the indoor environment such as gypsum board can be more complicated and prone to incorrect conclusions regarding residual organisms. The mold Stachybotrys chartarum has been found to be associated with idiopathic pulmonary hemorrhage in infants and has been studied for toxin production and its occurrence in water damaged buildings. Growth of S. chartarum on building materials such as gypsum wallboard has been frequently documented. Research to control S. chartarum growth using 13 separate antimicrobial cleaners on contaminated gypsum wallboard has been performed in laboratory testing. Popular brands of cleaning products were tested by following directions printed on the product packaging. A variety of gypsum wallboard surfaces were used to test these cleaning products at high relative humidity. The results indicate differences in antimicrobial efficacy for the six month period of testing. Results for the six types of GWB surfaces varied extensively. However, three cleaning products exhibited significantly better results than others. Lysol All-Purpose Cleaner-Orange Breeze (full strength) demonstrated results which ranked among the best in five of the six surfaces tested. Both Borax and Orange Glo Multipurpose Degreaser demonstrated results which ranked among the best in four of the six surfaces tested. The best antimicrobial cleaner to choose is often dependent on the type of surface to be cleaned of S. chartarum contamination. For Plain GWB, no paint, the best cleaners were Borax, Lysol All-Purpose Cleaner-Orange Breeze (full strength), Orange Glo Multipurpose Degreaser, and Fantastik Orange Action. These results are not meant to endorse the incomplete removal of mold contaminated building materials. However, it is recognized that complete removal may not always be possible and solutions to control mold regrowth may contribute to reduced occupant exposure. Current recommendations of removal and replacement of porous building materials should be followed. It is not the intension of this discussion to endorse any product. Reporting on the performance of these products under the stated conditions was and remains the only purpose.

Therapeutic Endoscopy for Nonvariceal Gastrointestinal Bleeding

The evaluation and management of acute gastrointestinal bleeding in infants, children, and adolescents is a reason for emergency consultation frequently cited by pediatric gastroenterologists. After stabilization of the patient's condition, endoscopic evaluation remains the most rapid and accurate method to identify the origin of acute bleeding in the majority of lesions in the pediatric age group. Several endoscopic techniques may be applied to bleeding lesions to achieve hemostasis. Familiarity with the various techniques and with the specifics of their use is essential for the pediatric endoscopist. This review focuses on the endoscopic management of acute nonvariceal bleeding in infants and children.

Intracranial hemorrhage in infants after massaged by a traditional birth attendant

Background The overall incidence of birth related injuries declineswith the improvement in obstetrics. However, the incidence ofhead trauma in infants after massaged by a traditional birthattendant (TBA) is still unknown.Objective To study the characteristics of intracranial hemorrhagein infants after massaged by a TBA.Methods A retrospective study was conducted in Sardjito Hospital,Yogyakarta, Indonesia between October 2001 and May 2005.Infants with intracranial hemorrhage after massaged by a TBAwere included. Data on patients’ demography, history of massagingby TBA, clinical presentation, and injury characteristics such asanemia, clotting time (CT), bleeding time (BT), prothrombin time(PT) and activated partial thromboplastin time (APTT) werenoted. Computed cranial tomography (CT) scans were performed.Results A total of seven infants were diagnosed with intracranialhemorrhage after massaged by a TBA. There were four malesand three females (mean age 46 days; range 27-60 days). Allinfants were referred to Sardjito Hospital, Yogyakarta, Indonesiawith bad condition and anemia; mean hemoglobin level was 5.5g/dl (range 3.7-8.3 g/dl). All infants presented with seizures.Coagulation screening showed normal results in five patients. Theremaining patients had a prolonged CT and PT. CT scan showedsubdural hemorrhage in four patients, intracerebral hemorrhagein four, epidural hemorrhage in two, and subarachnoid hemorrhagein one. Two patients had chronic hemorrhage, while the rest hadacute hemorrhage. Four of them underwent craniotomy, twopatients were under an observation only, and one patient was nottreated due to parental refusal. Six patients survived and the onewho refused to be treated died.Conclusions The parents, midwives, and doctors have to be awareof head massaging since it may harm infants.

XIII. Antiseizure Prophylaxis

XIII. Antiseizure Prophylaxis

Intracranial Hemorrhage in Infants Associated With Congenital Biliary Dilatation : A Case Report

Intracranial Hemorrhage in Infants Associated With Congenital Biliary Dilatation : A Case Report

Spectrum of Noninfectious Health Effects From Molds

Molds are multicellular fungi that are ubiquitous in outdoor and indoor environments. For humans, they are both beneficial (for the production of antimicrobial agents, chemotherapeutic agents, and vitamins) and detrimental. Exposure to mold can occur through inhalation, ingestion, and touching moldy surfaces. Adverse health effects may occur through allergic, infectious, irritant, or toxic processes. The cause-and-effect relationship between mold exposure and allergic and infectious illnesses is well known. Exposures to toxins via the gastrointestinal tract also are well described. However, the cause-and-effect relationship between inhalational exposure to mold toxins and other untoward health effects (eg, acute idiopathic pulmonary hemorrhage in infants and other illnesses and health complaints) is controversial and requires additional investigation. In this report we examine evidence of fungal-related illnesses and the unique aspects of mold exposure to children. Mold-remediation procedures are also discussed.

Spectrum of Noninfectious Health Effects From Molds

Molds are eukaryotic (possessing a true nucleus) nonphotosynthetic organisms that flourish both indoors and outdoors. For humans, the link between mold exposure and asthma exacerbations, allergic rhinitis, infections, and toxicities from ingestion of mycotoxin-contaminated foods are well known. However, the cause-and-effect relationship between inhalational exposure to mold and other untoward health effects (eg, acute idiopathic pulmonary hemorrhage in infants and other illnesses and health complaints) requires additional investigation. Pediatricians play an important role in the education of families about mold, its adverse health effects, exposure prevention, and remediation procedures.

Intracranial hemorrhage due to late hemorrhagic disease in two siblings

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.