Objective: Preterm neonates represent a category of neonates at high risk for anemia. Due to particular pathologic processes and clinical presentation in preterm neonates, this type of anemia is described as a separate entity named anemia of prematurity (AOP). The population represented by very low birthweight (VLBW) neonates is at the highest risk of developing anemia of prematurity. Reduced tissue oxygenation due to anemia can have short-term consequences (growth restriction, apnea episodes) or long-term consequences such as delayed neurological development, rapid detection, and management of AOP is needed to avoid its complications. Material and methods: We describe the particularities of this condition and the interventions for its prevention or correction in a group of premature infants born at less than 32 weeks of gestation discharged home during 2021. Results: We assessed the presence of anemia and the need for erythrocyte transfusion in 32 VLBW neonates, separated into two groups based on the gestational age: 24-29 gestational weeks (GW) and 30-31 GW. The number of neonates receiving a transfusion and the number of transfusion events was higher in the former, more immature group. We also identified more significant phlebotomy losses in the first group, contributing to a higher proportion of AOP cases needing erythrocyte transfusion. Conclusions: Although our protocols for transfusion at this moment recommend lower hemoglobin thresholds, we tend to transfuse above those levels based mainly on clinical signs and symptoms. We need better prevention strategies for AOP, both by using cord blood and more strict monitoring of phlebotomy losses.

Objectives. Percutaneously central catheters are typically used in neonatal intensive care units (NICU) to provide parenteral nutrition and drug therapy administration. Their use is associated with specific complications: occlusions, infections, thrombosis, rupture, and migration, including rare life-threatening conditions such as pericardial effusion and cardiac tamponade. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “Sf. Andrei” County Clinical Emergency Hospital of Constanta, diagnosed with cardiac tamponade at 18 days of life. Outcomes. Premature male newborn, gestational age (GA) of 33 weeks, birth weight (BW) 2380 g, Apgar score 5/7, issuing from pregnancy without prenatal care, admitted in NICU with Continuous Positive Airway Pressure (CPAP) respiratory support. He required intensive care during the neonatal period and presented with sudden cardiac instability 18 days after the insertion of a peripherally inserted central catheter (PIC-Line). The echocardiography demonstrated severe pericardial effusion with evidence of cardiac tamponade. Successful urgent subxiphoid pericardiocentesis was performed. Totally 20 ml of fluid was collected, consistent with the composition of the hyperosmolar solution infused. Conclusions. Despite the fact that it is a rare complication, cardiac tamponade should be considered in any newborn with a PIC-Line who presents with sudden suggestive deterioration (cardiorespiratory instability, bradycardia, cyanosis and metabolic acidosis), which does not respond to resuscitation maneuvers, when lines are considered to be placed correctly. Implementing a modern algorithm, who is easy to learn and quick to perform, with the help of ultrasonography, represents the key of success for detecting urgent neonatal complications leading to sudden deterioration.

Objectives. Congenital diaphragmatic hernia (CDH) represents a developmental defect of the diaphragm, which allows the protrusion of the abdominal viscera into the thoracic cavity. In view of the fact that herniation occurs during a critical period of lung development, the pathological effect is pulmonary hypoplasia in different degrees, usually more severe on the ipsilateral side of the hernia, and also may be present contralateral if the mediastinum is bulged, compressing the lung. Material and Methods. We present the case of a patient hospitalized in the Neonatology Department of “St. Andrew” County Emergency Clinical Hospital of Constanta, diagnosed with left CDH at birth. Outcomes. Full-term male newborn, gestational age (GA) 39 weeks, birth weight (BW) 3300g, Apgar Score 6. The 35-year-old mother, Gravida-VI, Para-III, has a pregnancy with inadequate prenatal care, with no structural abnormalities of the fetus detected by the 3rd-semester ultrasound. At birth, the newborn needed neonatal resuscitation, initially with positive pressure ventilation (on mask and bag) and after that, intubated and mechanical ventilated. Chest X-Ray showed a left diaphragmatic hernia, and the pediatric surgery team was called for further therapeutic management. Approximately 48 hours postoperatively, the chest X-Ray identified right upper lobe pneumothorax, with complete remission in 24 hours, under mechanical ventilation. Conclusions. CDH represents a condition with a challenging diagnosis and management. In the best cases, newborns have a very good clinical outcome with neonatal care and surgical treatment after birth. The management of infants with congenital diaphragmatic hernia requires the services of an interprofessional team. After the diagnosis in the antenatal period, parents should be allowed to discuss with a team, including maternal-fetal medicine, pediatric surgery, neonatology, and social work as appropriate. Genetic evaluation and counseling are recommended to identify risks in future pregnancies. Following the repair in the postnatal period, a standardized and interdisciplinary follow-up to provide surveillance, screening, and clinical care is recommended to improve outcomes.