Acute scrotum in a neonate caused by renal vein thrombosis.

The authors report on a rare case of neonatal scrotal oedema occurring concurrently with pain upon palpation of the spermatic cord on the first day of life. An ultrasound examination showed poor perfusion of the left testicle and a thrombosis of the left renal vein; intraoperative exploration indicated necrosis of the left testicle without signs of torsion. Gorged vessels with paravasal bleeding were found in the spermatic cord. The authors hypothesise that necrosis of the testicle may result from haemorrhagic infarction caused by renal venous thrombosis. Acute scrotal discolouration with pain upon palpation in neonates is usually attributed to testicular torsion. The authors report a case where these symptoms had a different cause.

Prenatal ultrasound diagnosis, follow-up, and outcome of congenital varicella syndrome.

OBJECTIVES: To report on a case of fetal varicella infection following the diagnosis of maternal infection at 16 weeks of gestation. METHODS: Diagnosis was based on serology testing and prenatal ultrasound, confirmed by DNA detection in amniotic fluid (Lightcycler-PCR). Serial ultrasound examinations were performed. RESULTS: Sonographic anomalies included borderline ventriculomegaly, intracerebral, intrahepatic and myocardial calcifications, limb deformities, articular effusions, and intrauterine growth retardation (confirmed postpartally). The newborn showed a severe encephalopathy and could not be stabilized sufficiently. The child died 23 days after birth. CONCLUSION: The outcome of an affected fetus may be very serious and prenatal ultrasound is a helpful tool to recognize the severity of the infection.

Isolated internal cerebral venous thrombosis in a neonate with increased lipoprotein (a) level: diagnostic and therapeutic considerations.

Background. Internal cerebral venous thrombosis is a life-threatening condition, which requires immediate therapy. Being infrequent in childhood, internal venous thrombosis is very rare in the neonate and has never been observed without concomitant occlusion of further dural sinuses. Case Description. We report a neonate born at term, who developed seizures on the third day of life after normal pregnancy and uneventful delivery. Ultrasound and CT disclosed bilateral intraventricular and intracerebral hemorrhage with an unusual distribution for germinal matrix hemorrhage. MRI disclosed thrombotic occlusion of the straight sinus and the internal cerebral veins with concomitant bleeding into the ventricles, the basal ganglia, thalamus and the periventricular hemispheres. The other sinuses were not affected. The clinical condition of the child improved after initiation of a low-dose heparin treatment with subsequent partial recanalization of the occluded vessels. The screening for risk factors disclosed an elevated lipoprotein (a) level, also present in both parents. Conclusion. Internal cerebral venous thrombosis may be encountered in neonates and must be included in the list of differential diagnosis of perinatal intraventricular and intracerebral bleeding. MRI allows the diagnosis even in the absence of widespread dural sinus occlusion. Low dose heparin may be a therapeutic option in these cases. This is the first report of neonatal internal venous thrombosis due to hereditary lipoprotein (a) level elevation, which must be included in the list of possible predisposing conditions.

[Pre- and postnatal diagnosis and treatment of hydrops fetalis--an interdisciplinary problem]. / Prä- und postnatale Diagnostik und Behandlung des Hydrops fetalis--ein interdisziplinäres Problem.

Hydrops fetalis (HF) is diagnosed prenatally in one out of 600 pregnancies, thirty percent of these fetuses will die in utero. Post partum, one out of approximately 25,000 newborn infants is affected. With the introduction of Rhesus immunoprophylaxis only fifty percent of the cases with HF are caused by Rhesus hemolytic disease. There is a large variety of non-immunological reasons such as cardiac defects (hypoplastic left healt syndrome, atrio-ventricular canal), arrhythmias, cytomegalovirus- or parvovirus infection (9% HF), twin-to-twin transfusion syndrome (15-30% HF) or chromosomal abnormalities (28-45% HF). However, in one third of the non immunological cases of HF the etiology remains unclear. Early diagnosis by ultrasound scan faces both the obstetrician and the neonatologist with the problem of differential diagnosis as well as therapeutic options, respectively. Various diagnostic procedures such as fetal echocardiography, karyotyping, molecular genetic techniques and sophisticated serological testings will help to classify the etiology and to determine the pre- and postnatal management. Nevertheless, neonatal mortality still varies between 50 and 95%.