PURPOSE: The aim of the study was to examine whether the degree of fetal smallness in small for gestational age (SGA) infants would increase the risk of catch-up-growth failure at 12 and 24 months corrected age (CA), and whether the high-calorie nutritional support would improve catch-up growth between 12 and 24 months CA. METHODS: We conducted a retrospective cohort study on 103 preterm infants born between January 2010 and December 2011. Logistic regression analysis was performed to investigate whether the birth weight z-score would be an independent risk factor for catch-up growth failure at 12 or 24 months CA. Among the 46 infants with failed catch-up growth at 12 months CA, 16 infants were provided high-calorie nutritional support, including nutritional supplements and medium chain triglyceride (MCT) oil at the pediatric gastroenterology clinic. RESULTS: Of 103 preterm infants, 34 infants (33%) were SGA and 69 infants (67%) were appropriate for gestational age (AGA). One birth weight z-score decrement increased the odds for catch-up growth failure 2.9 times at 12 months CA and 3.0 times at 24 months CA after adjustment for major neonatal morbidities. The increase in z-score between 12 and 24 months CA was significantly greater in the infants provided nutritional support than in the infants who were not provided nutritional support. CONCLUSION: The birth weight z-score can be used as a predictor of catch-up growth failure. High-calorie nutritional support may improve weight gain during the second year in preterm infants with failed catch-up growth at 12 months CA.
Birth Weight* ; Cohort Studies ; Gastroenterology ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Logistic Models ; Nutritional Support ; Parturition* ; Retrospective Studies ; Risk Factors ; Triglycerides ; Weight Gain

PURPOSE: Massive pulmonary hemorrhage(MPH) within the first five days after birth is a major cause of early death in extremely low birth weight(ELBW) infants. The objective of this study was to determine risk factors for MPH in ELBW infants. METHODS: Data were retrospectively collected from 115 ELBW infants admitted to Seoul National University Bundang Hospital between January 2007 and September 2012. MPH was defined as the presence of hemorrhagic fluid in the trachea accompanied by acute respiratory failure within the first five days after birth. Initial echocardiography and cranial ultrasonography were performed in all subjects before MPH. Clinical characteristics of ELBW infants with and without MPH were compared and the risk factors for MPH were investigated. RESULTS: MPH occurred at 54+/-30 h after birth and was more frequent in ELBW infants with lower gestational age and lesser birth weight. Older maternal age was also associated with MPH. The presence of patent ductus arteriosus diagnosed using initial echocardiography was not significantly associated with MPH. The presence of intraventricular hemorrhage diagnosed using serial cranial ultrasonography was significantly associated with MPH. Logistic regression analysis indicated that among the variables that preceded MPH, only lower gestational age was independently associated with MPH. CONCLUSION: Lower gestational age was found to be a risk factor for MPH within the first five days after birth in ELBW infants.
Birth Weight ; Ductus Arteriosus, Patent ; Echocardiography ; Gestational Age ; Hemorrhage* ; Humans ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight* ; Infant, Newborn ; Logistic Models ; Maternal Age ; Parturition* ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors* ; Seoul ; Trachea ; Ultrasonography

Maternal chorioamnionitis has been associated with abnormal lung development. We examined the effect of maternal chorioamnionitis on the expression of transforming growth factor-beta1 (TGF-beta1) in the lungs of preterm infants. A total of 63 preterm (< or =34 weeks) infants who were intubated in the delivery room were prospectively enrolled. Their placentas were examined for the presence of chorioamnionitis. Bronchoalveolar lavage (BAL) fluid and cells were obtained shortly after birth. TGF-beta1 was measured in BAL fluid and TGF-beta1 mRNA expression was determined by reverse transcription polymerase chain reaction (RT-PCR) in BAL cells. TGF-beta1 mRNA expression in BAL cells showed a positive correlation with gestational age (r=0.414, p=0.002). TGF-beta1 mRNA expression was significantly decreased in the presence of maternal chorioamnionitis (0.70+/-0.12 vs. 0.81+/-0.15, p=0.007). Adjustment for gestational age, birth weight, and delivery mode did not nullify the significance. TGF-beta1 mRNA expression was marginally significantly decreased in preterm infants who developed bronchopulmonary dysplasia (BPD) later (0.75+/-0.11 vs. 0.82+/-0.15, p=0.055). However, adjustment for gestational age, patent ductus arteriosus (PDA), and maternal chorioamnionitis nullified the significance. These results might be an indirect evidence that maternal chorioamnionitis may inhibit normal lung development of fetus.
Birth Weight ; Bronchoalveolar Lavage Fluid/*chemistry/cytology ; Bronchopulmonary Dysplasia/*etiology ; Chorioamnionitis/*metabolism ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Pregnancy ; RNA, Messenger/analysis ; Transforming Growth Factor beta1/*analysis/genetics

We sought to know whether hypertonic (7%) saline (HTS) attenuates brain injury by improving cerebral perfusion pressure (CPP) and down-modulating acute inflammatory responses in experimental bacterial meningitis in the newborn piglet. Twenty-five newborn piglets were assorted into three groups: 6 in the control group (C), 10 in the meningitis group (M), and 9 in the meningitis with HTS infusion group (H). Meningitis was induced by intracisternal injection of 10(8) colony forming units of Escherichia coli in 100 microliter of saline. 10 mL/kg of HTS was given intravenously as a bolus 6 hr after induction of meningitis, thereafter the infusion rate was adjusted to maintain the serum sodium level between 150 and 160 mEq/L. HTS significantly attenuated meningitis-induced brain cell membrane disintegration and dysfunction, as indicated by increased lipid peroxidation products and decreased Na+, K+-ATPase activity in the cerebral cortex in M. HTS significantly attenuated acute inflammatory markers such as increased intracranial pressure, elevated lactate level and pleocytosis in the cerebrospinal fluid observed in M. Reduced CPP observed in M was also significantly improved with HTS infusion. These findings implicate some attenuation of the meningitis-induced alterations in cerebral cortical cell membrane structure and function with HTS, possibly by improving CPP and attenuating acute inflammatory responses.
Animals ; Animals, Newborn ; Anti-Inflammatory Agents/administration and dosage ; Brain Diseases/*drug therapy/*pathology ; Cerebral Cortex/*drug effects/*pathology ; Disease Models, Animal ; Intracranial Pressure/drug effects ; Meningitis, Escherichia coli/complications/*drug therapy/*pathology ; Research Support, Non-U.S. Gov't ; Saline Solution, Hypertonic/*administration and dosage ; Swine ; Treatment Outcome

PURPOSE: Nephrocalcinosis in very low birth weight(VLBW) infants were known to be caused by a longer duration of furosemide use. However, etiologies, pathogenesis and risk factors remain unclear. Therefore, we examined the incidence and risk factors of nephrocalcinosis in VLBW infants retrospectively. METHODS: Inborn babies of birth weights less than 1,500 gm were examined retrospectively. Data were reviewed on gestational age, birth weight, sex, 5-min Apgar score, oliguria on the first day, respiratory support, surfactant use, duration of nephrotoxic drug use(furosemide, gentamicin, amikin, vancomycin and amphotericin-B) and duration of total parenteral nutrition(TPN) use. Presence of bronchopulmonary dysplasia(BPD), bacterial sepsis, fungal sepsis, osteopenia and necrotizing enterocolitis(NEC) were also reviewed. Serum calcium, phosphorus, total protein, albumin, blood urea nitrogen (BUN) and creatinine at three to five weeks of age and at discharge were reviewed. RESULTS: A t-otal 141 infants were reviewed. 9.2%(13/141) of VLBW infants developed nephrocalcinosis. By univariate analysis, gestational age, birth weight, 5-min Apgar scores, duration of ventilation, duration of oxygen use, postnatal dexamethasone, phototherapy, nephrotoxic drugs(furosemide, amikin, vancomycin, and amphotericin) and TPN were significantly associated with nephrocalcinosis. Low phosphorus level at three to five weeks of age and high BUN levels at discharge were significantly associated with nephrocalcinosis. Presence of RDS, BPD, bacterial sepsis, fungal sepsis and NEC were also significantly associated with nephrocalcinosis. Multivariate analysis showed that the strongest predictors of nephrocalcinosis were duration of furosemide use and birth weight. CONCLUSION: Longer duration of furosemide use and lower birth weight are considered to be independent risk factors. Further more prospective and longterm follow up studies are needed.
Amikacin ; Apgar Score ; Birth Weight ; Blood Urea Nitrogen ; Bone Diseases, Metabolic ; Calcium ; Creatinine ; Dexamethasone ; Follow-Up Studies ; Furosemide ; Gentamicins ; Gestational Age ; Humans ; Incidence ; Infant* ; Logistic Models ; Multivariate Analysis ; Nephrocalcinosis* ; Oliguria ; Oxygen ; Parturition* ; Phosphorus ; Phototherapy ; Retrospective Studies ; Risk Factors* ; Sepsis ; Vancomycin ; Ventilation

PURPOSE: Patent ductus arteriosus (PDA) is a common problem in infants with respiratory distress syndrome (RDS). The reported effects of closure of ductus on pulmonary function are variable. The purpose of this study was to compare the respiratory indices between infants with RDS with and without PDA and in infants with PDA, between before and after closure of PDA. METHODS: The respiratory indices, settings of mechanical ventilation and arterial blood gas analysis were investigated in 31 infants who were admitted to Seoul National University Hospital NICU from June 1998 to May 1999 with a diagnosis of RDS. The respiratory parameters were compared between infants with and without PDA. In the infants with PDA, the parameters were compared before and after closure of PDA with administration of indomethacin. The diagnosis of a significant PDA was made by cardiovascular distress scoring of greater than 3 and echocardiographic confirmation of ductal shunt. RESULTS: Nineteen infants (61.3%) were diagnosed with PDA and 4 infants were excluded due to failure of closure. Infants with PDA showed lesser pre-surfactant PaCO2 (32.5+/-10.5 vs 43.5+/-8.5, P<0.05) and lesser total pulmonary compliance (0.65+/-0.20 vs 1.05+/-0.17, P<0.01), tidal volume (4.78+/-1.53 vs 7.19+/-2.02, P<0.05) and higher airway resistance (435+/-44 vs 301+/-49, P<0.01) at 12 hours after surfactant treatment than infants without PDA. In infants with PDA, oxygenation index (7.27+/-9.84 vs 3.29+/-6.21, P<0.05) and airway resistance(439+/-45 vs 291+/-93, P<0.05) were decreased and total pulmonary compliance (0.55+/-0.21 vs 1.35+/-0.48, P<0.05) were increased after closure of PDA. CONCLUSIONS: The pulmonary functions were poor in infants with PDA and closure of the ductus with indomethacin lead into a significant improvement in pulmonary function.
Airway Resistance ; Blood Gas Analysis ; Compliance ; Diagnosis ; Ductus Arteriosus, Patent* ; Echocardiography ; Humans ; Indomethacin ; Infant* ; Oxygen ; Respiration, Artificial ; Seoul ; Tidal Volume

Congenital methemoglobinemia is caused by NADH-methemoglobin reductase deficiency in more than half of the total reported cases. NADH-methemoglobin reductase deficiency is an uncommon hereditary disorder producing methemoglobinemia and cyanosis in the homozygous subject. A majority of the patients born with these abnormalities have only a cosmetic defect-asymptomatic cyanosis. Congenital methemoglobinemia due to NADH-methemoglobin reductase deficiency is an autosomal recessive disorder and classified into 4 types according to the pathophysiology of the disorder. In type I, the deficiency of NADH-methemoglobin reductase is restricted to erythrocytes of patients with mild cyanosis, and 7 missence mutations have been reported in the case of type I. We report the first Korean pediatric case of type I congenital methemoglobinemia due to NADH- methemoglobin reductase deficiency with a review of the literature.
Cyanosis ; Cytochrome-B(5) Reductase ; Erythrocytes ; Humans ; Methemoglobinemia* ; Oxidoreductases*

No abstract available.
Nose* ; Osteotomy*

No abstract available.

PURPOSE: The purposes of this study were to analyze the association of peripheral and tracheal aspirate neutrophil counts and tracheal aspirate cytokines [interleukin (IL)-8, IL-6, IL-10] concentrations with the development of bronchopulmonary dysplasia (BPD) in preterm infants intubated due to acute respiratory failure, and to speculate the causal relationship between the prenatal or early postnatal inflammation of the lung and the development of BPD. METHODS: A prospective study was conducted from April 1997 to March 1998 in 27 preterm infants, who were admitted to the neonatal intensive care unit of Seoul National University Children's Hospital and intubated due to acute respiratory failure. Tracheal aspirates were collected via endotracheal tube immediately after intubation. Tracheal aspirate neutrophil counts were measured by cytospin method and, cytokine concentrations were measured by ELISA method in the supernatant after centrifugation. RESULTS: BPD was diagnosed in 59.3% (16/27) of preterm infants. Compare to the non-BPD group, the BPD group had lower gestational age (27.6+/-1.3 weeks versus 32.0+/- 1.2 weeks), lower birth weight (1,112+/-228 g versus 1,666+/-334 g), higher incidence of patent ductus arteriosus (27.3% versus 81.3%), increased number of neutrophils (80,337+/-133,993/mL versus 2,672+/-6,600/mL), and increased IL-8 concentration (1,045.4+/-1,346.5 pg/mL vs 106.9+/-151.0 pg/mL) of tracheal aspirate. After control of compounding variables, increased IL-8 concentration of tracheal aspirate was found to be an independent risk factor for BPD (odds ratio; 27.7, 95% confidence interval; 1.8-436.2). CONCLUSION: Prenatal or immediate postnatal lung inflammation is an important risk factor for the development of the BPD, and the lung injuries responsible for the development of BPD might begin at the prenatal or immediate postnatal period.
Birth Weight ; Bronchopulmonary Dysplasia* ; Centrifugation ; Cytokines ; Ductus Arteriosus, Patent ; Enzyme-Linked Immunosorbent Assay ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Intensive Care, Neonatal ; Interleukin-6 ; Interleukin-8 ; Intubation ; Lung ; Lung Injury ; Neutrophils* ; Pneumonia ; Prospective Studies ; Respiratory Insufficiency* ; Risk Factors ; Seoul