Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rhesus (Rh) antibodies is a significant cause of hemolytic disease of the newborn (HDN). Here, we report a rare case of severe HDN associated with maternal antibody to Rh e. In addition to severe anemia, the infant developed thrombocytopenia, conjugated hyperbilirubinemia and cholelithiasis. Resolution of the infant's cholelithiasis occurred following treatment with ursodeoxycholic acid.

Objective: Long-distance air transport (LDAT) of infants with pneumoperitoneum for pediatric surgical evaluation has not been previously reported. We examined whether extremely low birth weight (ELBW) infants with and without pneumoperitoneum would tolerate transport differently.Study Design: A retrospective cohort study was conducted comparing ELBW infants diagnosed with pneumoperitoneum to other ELBW infants transported >2000 miles by a trained team from a US Department of Defense tertiary care neonatal intensive care unit in Okinawa, Japan.Result: Between 2000 and 2006, 49 air transports met study criteria. Seven of the 49 (14%) infants had pneumoperitoneum at time of transport. The average distance flown was 5346 miles per transport. The 49 infants had a median gestational age of 25 weeks and birth weight of 761 ± 127 g. ELBW infants without pneumoperitoneum were transported at a median 58 days of life (DOL; range 30 to 91 days) compared to infants with pneumoperitoneum, who were transported at a median 8 DOL (range 6 to 14 days). At the time of LDAT, infants with pneumoperitoneum were significantly smaller, receiving more arterial and central venous access, more pressors for hypotension, and more mechanical ventilation compared to ELBW infants transported without pneumoperitoneum. In-flight patient-related medical issues were similar regardless of underlying diagnosis or age at the time of transport.Conclusion: Successful LDAT of ELBW infants, including critically ill infants with intestinal perforation, is possible. Use of personnel, experienced and trained in aviation transport physiology, overcomes the extreme physiologic operating environment associated with LDATs.

This study is a valuable report about pediatric patients with ARDS and allows for an important extension of the application of the modified Berlin Definition in all age groups.

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