Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.
Amino Acids ; Fetus ; Gestational Age ; Growth and Development ; Humans ; Infant* ; Infant, Very Low Birth Weight* ; Length of Stay ; Malnutrition ; Nitrogen ; Parenteral Nutrition ; Plasma

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among premature infants. Although the pathogenesis of NEC remains unclear, recent researches revealed several associated factors of the immature intestine, with an emphasis of delayed maturation of motor and digestive function, impairment of regulation of vascular flow and intestinal barrier function, and defective immune defense. Many clinical trials have investigated the preventive role of possible disease-modification factors, but only breast feeding and antenatal steroid were proven to decrease the incidence of NEC in meta- analyses. Recent multicenter studies demonstrated a promising outcome of probiotics supplementation in the prevention of NEC, which emphasized the role of abnormal bacterial colonization in the pathogenesis of NEC. Studies on optimal choice for surgically indicated infants with NEC (laparatomy versus primary peritoneal drainage) still remain inconclusive. As NEC is a disease with a multifactorial etiology, combinations of current evidence in practice are required to reduce the incidence of NEC.
Breast Feeding ; Colon ; Enterocolitis, Necrotizing ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intestines ; Probiotics

No abstract available.
Humans ; Infant, Newborn ; Infant, Premature ; Nutrition Assessment

Newborn infants with huge and highly vascular sacrococcygeal teratoma (SCT) are frequently subjected to renal hypoperfusion secondary to high-output cardiac failure. Any underlying renal dysfunction is a significant risk factor for the development of contrast-induced nephropathy (CIN). However, reports on CIN in infants are rare. I report here a case of a premature infant born at 28 weeks and 3 days of gestation with a huge SCT who survived preoperative embolization and surgical resection but presented with persistent non-oliguric renal failure that was suggestive of CIN. During radiological intervention, a contrast medium had been administered at about 10 times the manufacturer-recommended dose for pediatric patients. Despite hemodynamic stabilization and normalization of urine output immediately following surgery, the patient's serum creatinine and cystatin-C levels did not return to baseline until 4 months after birth. No signs of reflux nephropathy were observed in follow-up imaging studies. Dosing guidelines for the use of a contrast medium in radiological interventions should be provided for infants or young patients.
Acute Kidney Injury ; Creatinine ; Embolization, Therapeutic ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Parturition ; Pregnancy ; Renal Insufficiency ; Risk Factors ; Teratoma*

Several well-designed multicenter clinical trials of therapeutic hypothermia, maintaining rectal temperature of 33-34degrees C for 72 hours in neonates suffered from perinatal asphyxia, have demonstrated both safety and efficacy of therapeutic hypothermia in improving survival and neurodevelopmental outcomes. However, issues regarding the optimal cooling method, the target temperature and the duration of the hypothermia remain unsettled. To overcome limited efficacy of therapeutic hypothermia in the subgroup of infants with severe hypoxic ischemic encephalopathy, a few promising hypothermia-combined therapies, targeting the several steps in the pathogenesis of hypoxic ischemic encephalopathy, are now under investigation. Further data on the neurodevelopmental outcome of the study population of the finished or ongoing clinical trials, during the childhood period or thereafter, are required to settle therapeutic hypothermia as "a standard of care" against perinatal asphyxia. Nationwide establishment of efficient patient referral system and intimate communication of cooling protocol between obstetricians and neonatologists will make therapeutic hypothermia in neonates more available in Korea.
Asphyxia ; Humans ; Hypothermia ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Korea ; Referral and Consultation

Persistent pulmonary hypertension of the newborn (PPHN) is a consequence of the failure of a decrease in the elevated pulmonary vascular resistance after birth. Pulmonary vasodilators, including inhaled nitric oxide (iNO), have been the mainstream of targeted therapy for PPHN, but no drugs have been proven to be effective in preterm infants with PPHN. The fetus remains hemodynamically stable despite lower arterial oxygen tension and pulmonary blood flow as compared to full-term newborns. This adaptation is due to the lower oxygen requirement and high oxygencarrying capacity of fetal circulation. The immature lungs of preterm infants are more vulnerable to reactive oxygen species, and the response of pulmonary vascular dilatation to blood oxygen tension is blunted in preterm infants. Recently, iNO has been reported to be effective in a selected group of preterm infants, such as those with prolonged preterm rupture of membrane-oligohydramnios-pulmonary hypoplasia sequence. PPHN in preterm infants, along with maximum supportive treatment based on fetal physiology and meticulous assessment of cardiovascular function, is in dire need of new treatment guidelines, including optimal dosing strategies for pulmonary vasodilators.

Persistent pulmonary hypertension of the newborn (PPHN) is a consequence of the failure of a decrease in the elevated pulmonary vascular resistance after birth. Pulmonary vasodilators, including inhaled nitric oxide (iNO), have been the mainstream of targeted therapy for PPHN, but no drugs have been proven to be effective in preterm infants with PPHN. The fetus remains hemodynamically stable despite lower arterial oxygen tension and pulmonary blood flow as compared to full-term newborns. This adaptation is due to the lower oxygen requirement and high oxygencarrying capacity of fetal circulation. The immature lungs of preterm infants are more vulnerable to reactive oxygen species, and the response of pulmonary vascular dilatation to blood oxygen tension is blunted in preterm infants. Recently, iNO has been reported to be effective in a selected group of preterm infants, such as those with prolonged preterm rupture of membrane-oligohydramnios-pulmonary hypoplasia sequence. PPHN in preterm infants, along with maximum supportive treatment based on fetal physiology and meticulous assessment of cardiovascular function, is in dire need of new treatment guidelines, including optimal dosing strategies for pulmonary vasodilators.

Continuous renal replacement therapy (CRRT) is one of the hemofiltration-based dialysis modalities used in the management of the high risk neonates with acute renal failure, multi-organ dysfunction and inborn errors of metabolism. While there are different types of CRRT (hemodialysis, hemofiltration or both) used in critically ill patients, there is no consensus on the best type or target ultrafiltration dose of CRRT. In the neonates with hyperammonemia secondary to inborn errors of metabolism, CRRT is more efficient in lowering the plasma ammonia concentration than peritoneal dialysis, although no studies have clearly demonstrated the benefits in decreasing the mortality or the long-term neurodevelopmental morbidities. In neonatal care, the role of CRRT as a primary renal replacement therapy is limited by the difficulties in vascular access, bleeding complications and the lack of neonate-specific hemofiltration devices. Currently, neonatal CRRT in Korea is available only in a few large centers, mostly located in Seoul. The nationwide support for the establishment of the patient referral system and the securing of the personnel who are highly experienced in neonatal CRRT may contribute to improving the quality of neonatal care in Korea.
Acute Kidney Injury ; Ammonia ; Consensus ; Critical Illness ; Dialysis ; Hemofiltration ; Hemorrhage ; Humans ; Hyperammonemia ; Infant, Newborn ; Korea ; Metabolism, Inborn Errors ; Peritoneal Dialysis ; Plasma ; Referral and Consultation ; Renal Replacement Therapy ; Ultrafiltration

Real-time data reporting in clinical research networks can provide network members through interim analyses of the registered data, which can facilitate further studies and quality improvement activities. The aim of this report was to describe the building process of the data display system (DDS) of the Korean Neonatal Network (KNN) and its basic structure. After member verification at the KNN member's site, users can choose a variable of interest that is listed in the in-hospital data statistics (for 90 variables) or in the follow-up data statistics (for 54 variables). The statistical results of the outcome variables are displayed on the HyperText Markup Language 5-based chart graphs and tables. Participating hospitals can compare their performance to those of KNN as a whole and identify the trends over time. Ranking of each participating hospital is also displayed in terms of key outcome variables such as mortality and major neonatal morbidities with the names of other centers blinded. The most powerful function of the DDS is the ability to perform 'conditional filtering' which allows users to exclusively review the records of interest. Further collaboration is needed to upgrade the DDS to a more sophisticated analytical system and to provide a more user-friendly interface.
Data Display/*utilization ; Humans ; Internet ; Quality Improvement ; Registries ; Republic of Korea ; Societies, Medical/*organization & administration ; User-Computer Interface

Mimicking fetal nutrition is the goal of early paretneral nutrition (PN) in very low birth weight infants, however the limited metabolic capacity of immature organs raises concern about the toxicity of metabolites to the developing brain. Starting parenteral amino acids from the first day of life, with a rate of 1.0 to 1.5 g/kg/day, is generally recommended to prevent endogenous protein breakdown by maintaining a positive nitrogen balance. A greater of amino acid infusion rate in the range of the fetal transfer rate (3.5-4.0 g/kg/day) is well tolerated during the early days after birth in VLBWI, however the influence on growth and long-term neurodevelopmental outcome remains unknown. Limited data are available from controlled trials regarding the effects of early supplementation with lipid emulsions on neonatal morbidity. Considering the role of long-chain polyunsaturated fatty acids in the neurodevelopment, the choice of an optimal lipid emulsion should be based on the quality as well as the quantity of the lipid contents. Little is known about the clinical benefit of higher rates of glucose infusion by permitting high serum glucose level or co-administration with insulin.
Amino Acids ; Brain ; Emulsions ; Fatty Acids, Unsaturated ; Glucose ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Insulin ; Nitrogen ; Parenteral Nutrition ; Parturition