Physiological leucocytosis is common in neonates. Leukemoid reaction is defined as a variable degree of leucocytosis with immature precursors, similar to that occurring in leukaemia but because of other causes. Leukemoid reactions are well-recognised in the neonatal intensive care unit population and are associated with antenatal corticosteroids, Down's syndrome, chorioamnionitis, funisitis and perinatal infections. However, extreme hyperleucocytosis, exceeding a white blood cell count of 100×109/l is rare. In the 7-year period from 2005 to 2012 three premature infants in our hospital presented with extreme hyperleucocytosis. Since there were no signs of neonatal leukaemia, transient myeloid disorder or leucocyte adhesion defect, a leukemoid reaction owing to antenatal corticosteroids, chorioamnionitis and funisitis was diagnosed. No obvious complications of hyperleucocytosis were observed. Therapy was not necessary and the leucocytes normalised spontaneously. In other hand, should consider bdp. https://pediatrics.aappublications.org/content/pediatrics/116/1/e43.full.pdf

And Covid IG G NEGATIVE? Any response to immunoglobulin ?

Good morning 99ers, I would be extremely grateful if anyone has experience or a protocol on the use of anakimra in neonates. Thank you Al

IVH? If WBC counts are showing upward trend I would do LDH.. if it high I would suggest to repeat flow cytometery, as there are 2 cell lines involved or consider bone marrow.

@Vijaykumar Do you mean that caffeine can lead to leucocytosis? If yes, I was not aware of it Could this be a neonatal leukemoid reaction? I am aware this is a "ruling out" diagnosis, but if all testing turns out negative, it would be a likely diagnosis.

caffiene ?

thanks so much for this review. Non-invasive HFO is such an exciting area. I'm certainly not well read in this area, and also wonder whether the oscillations just die out in the oropharynx. I haven't looked at any trial publications of its use prophylactically, but i do agree with you that perhaps the increase in MAP is the main benefit proffered to the baby, and that the control limb in trials should not just be CPAP as it was before randomisation, but CPAP at the same MAP as the non invasive oscillation. What have the trials actually carried out? Can you link your previous reviews please? thanks

1. Consider osteomyelitis and septic arthritis. 2. Leucocyte Adhesion Defects (LAD) cause leukocytosis. Delayed cord separation and lack of pus are indicators; haematology/immunology will be able to check for it.

46 days old; former 28 weeker premature baby with persistent leukocytosis for over four weeks now. Uncomplicated NICU course so far. Since about the second week of life, the baby has had persistent leukocytosis with wbc count in the low to high 30k's. Baby has had multiple crp done and all normals. Culture from blood and Urine including fungal normal as well. Had a course of Meropenem for suspected UTI with 10k colonies of enterococcus fecalis in the urine; but despite negative repeat urine culture and after treatment; leukocytosis persisted. About two weeks ago; now baby with mild thrombocytopenia 80-90k. Cardiac echo done, renal and abdominal US all normal. Viral culture, RPR and urine CMV all negative as well. Currently baby is on room air; growing great. Feeding great. Had completed a 7 days with Fluconazole; without any improvement Hem consulted. Requested a flow cytometry; with left sided neutrophilia with 4% blast. Bone marrow not entertained at this point! What do you think? Anything comes to mind? Thanks

I can only speak for Sweden, and to my knowledge, there is no trials ongoing here. In a recent journal club by the Incubator podcast, I heard about this study: https://fn.bmj.com/content/early/2021/06/09/archdischild-2021-321645 Personally, I think the next approach will be admin through an LMA - check out this recent report from ADC/FN: https://fn.bmj.com/content/106/3/336 and listen to this ADC podcast episode: https://podcasts.apple.com/nz/podcast/laryngeal-mask-use-in-neonatal-practice/id333278832?i=1000531465079

Hi. The last post on surfactant nebulization I found on April 30, 2019. I am curious if this method has become more widely used? Thank you in advance for sharing your experiences and observations.

Are you attending the 4th jENS Congress online? Then we hope to see you in Monivent booth for a demo session of Monivent® Neo100. Neo100 is based on clinical needs and developed for healthcare providers working in delivery rooms or neonatal intensive care units. This unique monitoring device is an add-on to existing manual ventilation equipment, wirelessly measuring several critical parameters including tidal volume. The system offers instant feedback and color-coded guidance during manual ventilation of neonates. Welcome to our booth at jENS or visit our website for more information:www.monivent.se

Very much appreciated.

We also used to store onto discs…. For now we try to write a report in the medical chart for every aEEG assessed (sometimes difficult when longtime monitoring is used during nights and weekends, but I think this is important from the medical-legal aspect (and most recently we are also able to add a screenshot of the trace) and then additionaly store the aEEG trace on a secure (only accessable for medical staff and by password) server for longterm storage.

Hi! Thank you all for trying to help. It's the first time I use this forum. It's very good to finelly find a place where we can share experiences and make some questions with neonatologists all over the world. The baby remains well appearing. We perform an echo and an abdominal ultrassound, both normal (none evidence of abnormal IVC anatomy or portal hypertension). He was discharged at 60 hours of life and is scheduled for follow up appointment in 4 weeks. I'll keep in touch!

@Flavio Martins any updates ?

Hi @ali, I must admit I am not sure about how we do this... but I think it goes about like this. Registrations are first stored on the hard drive of our aEEG machine, and the electrophys depart then "tanks" them over somehow to interpret our tracings. I suppose the electrophys dept keep the aEEG tracings with all their other tracings (EEGs, EMGs etc-etc),i.e. so it complies to legal frameworks.

Hi 99ers, Following completion of aEEG tracing how are you storing the information. We used to physically download onto disc, but with onset of flash drives wondered how it was now being stored given it’s potentially Medico legal ramifications. TIA. Please keep safe. Kind regards Alistair

Hello. I'm agree, it's a very interesting case to learn so much. Caput medusae is a rare neonatal finding. • Primary or secondary Budd-Chiari syndrome should be excluded in the neonatal period. • In contrast to adults with caput medusae from portal hypertension, this collateral abdominal circulation can be a benign variant. • If cardiac or venous malformations are ruled out, an expectant approach is indicated because the collateral veins will gradually involute in the first weeks after birth without sequelae. neoreview.soares2020.pdf

Hello. I think it is really interesting. So I decide to look for and I found this article : Essential telangiectasia in an infant: a diagnosis to be considered, in Dermatology Online Journal, 23(8). It is avalable online and besides it is free. https://escholarship.org/uc/item/8m27b1x4

😊

Quick Facts: The sudden and unexpected death of a child younger than a year is called sudden infant death syndrome. Such infants usually die in their sleep. Infants between 2 to 4 months are more prone to SIDS. The doctor will declare the death of the infant as SIDS if no other cause is identified. The risk of SIDS can be reduced by placing an infant to sleep on his or her back. What Is SIDS (Sudden Infant Death Syndrome)? Sudden infant death syndrome, otherwise called SIDS, is the sudden and unexplained death of an otherwise healthy infant, generally during sleep. As most infants die in the crib during their sleep, it is also called crib death or cot death. It can be difficult to find the cause for SIDS. It is thought to be due to defects in the part of the infant’s brain that controls breathing and wakes up the body from sleep. Doctors and researchers have identified some factors that might be increasing the risk of SIDS, and there are various measures that parents can try to protect their children from SIDS. The most important advice from doctors is to put the baby to sleep on his or her back. SIDS is rare, but still the most common cause of death of infants under a year old in the US. Babies between the ages of 2 and 4 months are most commonly affected. Does SIDS Result in Any Symptoms? SIDS does not result in any symptoms. Babies who are sleeping die suddenly. What Causes SIDS? Researchers are yet to conclude the exact cause of SIDS. They believe a combination of the following factors might be responsible: 1) Physical Factors: Brain Development - Most of these babies are born with some defects in the brain, which makes them more prone to die suddenly. The part of the brain that is responsible for breathing and sleep arousal do not mature enough. Premature Birth - In babies born prematurely, the chances of the brain not developing completely increases. Such babies do not have proper control over breathing and heart rate. Respiratory Infection - Breathing problems due to a cold or any other respiratory infection can lead to SIDS. 2) Environmental Factors: Sleeping Position - Babies that are put to sleep on their stomach or side might find it more difficult to breathe. Bed Sharing - Babies sleeping with their parents in their bed, or any other mattress that is not specially made for them increases the chances of injury, asphyxia, and strangulation. Being too Warm - The risk increases if the baby is too warm while sleeping. Blocked Airway - If a baby rolls over while sleeping on a soft surface like a comforter or soft mattress, it can block his or her airway. Other Causes - Using an unsafe or old crib, using a very soft mattress, filling the crib with soft toys while the baby is sleeping, not using a pacifier, and not breastfeeding. What Are the Risk Factors for SIDS? Apart from the physical and environmental factors, the following factors also increase the risk of SIDS: Boy babies. Infants between 2 to 4 months of life. More than 80 % of babies that die of SIDS are under 6 months of age. Having siblings or cousins who died due to SIDS. Babies exposed to secondhand smoke. Babies with low birth weight. Sleep apnea (breathing stops in periods while sleeping). Mothers can also increase the risk of their baby dying of SIDS. Mothers who: Are younger than 20 years. Smoke cigarettes. Use drugs. Drink alcohol. Do not have proper prenatal care. Try to avoid as many of these risks as possible. How Does a Doctor Diagnose SIDS? There is no specific test to determine that the infant died due to SIDS. The doctor rules out all possible causes of death before declaring the cause to be SIDS. The tests and investigations done by the doctor include: Examining the infant’s body after death. Examining the place where death occurred. Evaluating the symptoms that the baby had before death. Is There Any Treatment for SIDS? Sadly, there is no treatment for SIDS. As there are no symptoms or signs that can alert the parents before the sudden death, nothing can be done. But, there are various ways to reduce the risk. What Can Be Done to Reduce the Risk of SIDS? The following tips can possibly help reduce the risk of SIDS: Put Babies to Sleep on Their Back - Until they are 1 year old, babies should be put on their back for sleep. While they are awake, you can put them on their side or tummy, as it will make the baby grow stronger. But always keep a close eye on them. Prenatal Care - Get early and regular prenatal care. Pregnant women should follow a healthy diet and avoid drinking alcohol and smoking. This can help reduce the chances of premature birth and, in turn, reduce SIDS. Use a Firm Mattress - Always make your baby sleep on a firm bed with a tightly fitted sheet. Avoid using fluffy comforters. Never put soft toys or pillows in the crib. Breastfeeding - Breastfeed your baby at least for the first 6 months. Until suggested by your doctor, do not give your baby water, sugar, or formula milk. Pacifier - Give your baby a pacifier while sleeping. Avoid Overheating - The room temperature should not be too warm, and avoid over covering or overdressing your baby. Do Not Share a Bed - Infants should sleep in a separate crib, that is placed close to the parent’s bed. Never share a bed, especially if you take medicines or alcohol. Do Not Smoke Around Your Baby - Do not smoke when you are pregnant and let any person smoke near your baby. Secondhand smoke can be bad for the baby. Vaccination - Regular checkups and vaccinations to prevent infections can reduce the risk of SIDS. Avoid using baby monitors and other devices that claim to reduce the risk of SIDS. Coping With the Loss of Your Baby: It is essential to get emotional support after losing a baby to SIDS. Most mothers feel guilty and grief. Talking to other parents who have lost their children to SIDS also helps. Communicate with your friends, family, or a counselor. Losing a child strains a relationship, so try to be open with your partner. Give yourself time to grieve.

Constipation has become a very common problem in school-going children, owing to the unhealthy diet and lifestyle practices children follow these days. Kids tend to opt for foods like burgers, pizzas, ice-creams and various deep fried foods which are rich in harmful fats. It may not only cause various heart problems in children, but may also lead to various gut problems like constipation, that is, a difficulty in emptying the bowel and passing stools fewer than three times a week. Following are few of the dietary remedies to treat constipation in children. High Fiber Foods Lack of fiber in your child's diet is one of the most common reasons for constipation in kids. Ask your child to consume a lot of fruits and vegetables which are rich in fiber. Fiber is non-digestible, but it helps the stools to pass smoothly. Fruits can be given to children in the whole form rather than as juice. Various fruits like sapodilla (chikoo), grapes, and papaya help eradicate constipation in children. Plenty of Fluids Lack of fluids can lead to issues like constipation in children. Make sure your child consumes at least eight to 10 glasses of water per day which will also protect your child from dehydration and prevent constipation. Fluids can be incorporated in various forms in your child’s routine like water, fruit juice, tender coconut water or vegetable juices. Vegetable juices are a good source of moisture and fiber and would also provide nutrients needed for growth and development. Good Sources of Probiotics Good sources of probiotics like curd and buttermilk help destroy harmful bacteria in your child’s gut and thus enhance the growth of good bacteria. Never miss out on giving your child probiotics. Not only probiotics, try giving your child prebiotics which enhances the activity of probiotics. Cut fruits can actually be dipped in yogurt dip and given to children along with some sprinkled flax seeds or chia seeds which are very good sources of omega three fatty acids (good fats) and anti-inflammatory in nature and thus protects your kid from various infections and diseases. Physical Activity Make sure your child performs some kind of activity every day. Sitting in front of the television will only make your kid lazy. Make sure s/he hits the ground and plays games like relay, potato race, kho-kho and sack race which will boost the metabolism of your child and also make him/her active. These are some of the natural and effective methods to prevent and permanently treat constipation in children.

Interesting case - looks like Caput Medusae in adults - caused by portal hypertension and dilation of the paraumbilical veins. Could be due to portal hypertension, but not fulminant liver failure? I have seen one child with portal hypertension secondary to umbilical vein thrombosis (probably secondary to umbilical vein catheter), but he presented in young school age. Our plan would probably be something like what Stefan describes - maybe ultrasound with contrast. Attached is a case report with neonatal caput medusa - disappeared within the first months of life. molad2018.pdf