PURPOSE: Transient tachypnea of the newborn (TTN) is a respiratory disorder resulting from delayed clearance of fetal lung fluid. Initiation of empiric antibiotic therapy for possible early-onset sepsis is usually recommended until negative blood cultures for 48 hours. The aim of this study was to compare outcomes of infants with TTN managed with a risk-factor-based restrictive antibiotic use policy. METHODS: A single institution retrospective study was conducted on full-term infants admitted with TTN from January, 2008 to December, 2013. Infants were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics depended upon the covering physician at admission. The clinical and laboratory outcomes were evaluated between two groups. RESULTS: A total of 98 full-term infants diagnosed with TTN were admitted to the neonatal intensive care unit; of them 39 (39.8%) received and 59 (60.2%) did not receive antibiotics. Physicians had tendency to start antibiotics in patient with mild-to-moderate chest retraction, need oxygen therapy, high white blood cell count, segmented neutrophil and positive C-reactive protein. All of them had negative blood cultures, no readmission, and no late-onset sepsis. The duration of hospital stay was longer in patients received antibiotics group (10.7+/-3.0 days vs. 9.0+/-4.4 days, P=0.04). CONCLUSION: This study suggests that empiric antibiotic therapy may not be recommended for full-term infants with classic TTN without perinatal risk factors. With the application of strict criteria for classic TTN and the close observation, the empiric use of antibiotics may be avoidable.
Anti-Bacterial Agents ; C-Reactive Protein ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Length of Stay ; Leukocyte Count ; Lung ; Neutrophils ; Oxygen ; Retrospective Studies ; Risk Factors ; Sepsis ; Thorax ; Transient Tachypnea of the Newborn*

PURPOSE: Many studies have reported the merits of breastfeeding, and increasing efforts are made to encourage breastfeeding for preterm babies. Recently, YouTube is being increasingly used as a source of medical information. We evaluated the quality of information provided on YouTube on breastfeeding for preterm babies.METHODS: On June 20, 2018, we performed a YouTube search using four terms related to breastfeeding for preterm babies. Of the 355 videos in the first five pages, 78 were analyzed; videos with irrelevant content (n=200), duplicated material (n=71), and those using another (non-Korean) language (n=6) were excluded. Videos were classified according to upload source and usefulness, and were evaluated based on reliability and quality.RESULTS: Medical websites or TV channels (46.2%) and physicians or hospitals (12.8 %) were the most and least common upload sources, respectively. The usefulness of the information was rated the highest in physician or hospital-uploaded videos (70.0%). The reliability of the physician or hospital-uploaded (2.70±1.42) and medical website or TV channel-uploaded (2.91±1.42) videos were statistically significant. The highest proportion of good quality videos (≥good) (60.0%) comprised physician or hospital-uploaded videos. Of the videos evaluated, 44.9% were useful. The highest proportion of useful videos comprised those uploaded by medical websites or TV channels (68.6%). The highest proportion of non-useful videos comprised civilian videos (80.8%).CONCLUSION: Physician or hospital-uploaded videos were more useful and had excellent reliability and quality; however, these had the least amount of information. Development of educational programs by experts that can be accessed by public through popular platforms like YouTube is necessary.
Breast Feeding ; Health Education ; Humans ; Infant, Newborn ; Infant, Premature ; Internet

Ectopic pancreas is defined as an abnormally located pancreatic tissue not sufficiently connected with the normal pancreas, which rarely occurs in neonates. To our knowledge, only a few cases of ectopic pancreas have been reported in newborns in South Korea. We report a case of ectopic pancreas as the cause of intussusception and jejunal atresia in a newborn. This clinical association is extremely rare, and this is the first report in South Korea.

Ectopic pancreas is defined as an abnormally located pancreatic tissue not sufficiently connected with the normal pancreas, which rarely occurs in neonates. To our knowledge, only a few cases of ectopic pancreas have been reported in newborns in South Korea. We report a case of ectopic pancreas as the cause of intussusception and jejunal atresia in a newborn. This clinical association is extremely rare, and this is the first report in South Korea.

Food allergy is a rare form of feeding intolerance in preterm infants, with symptoms similar to necrotizing enterocolitis. We report a case of clinically diagnosed cow’s milk-induced eosinophilic enterocolitis in an infant with extremely low birth weight. The patient was born at 24 weeks and 1 day gestation, weighing 610 g, had repeated episodes of gastrointestinal symptoms after feeding, and was placed on nil per os. On day 67, the eosinophil count increased suddenly (7,852.8/mL), and the formula was changed to amino acid-based (Neocate). Gradually, the eosinophil count returned to normal. Ileostomy was performed and full enteral feeding was achieved with Neocate. Intraoperatively, the intestine was nonnecrotic and viable; the biopsy report showed massive mucosal eosinophilic infiltration. The patient was diagnosed with cow’s milk-induced eosinophilic enterocolitis.

The Diego blood group is expressed as the Di(a) antigen and Di(b) antigen, and the frequency of the Di(a) antigen among the Korean population is estimated to be 9.4~14.5%. We report here on a case of hemolytic disease caused by anti-Di(a) antibody. A full-term male infant was admitted due to hyperbilirubinemia on the first day of life. The total bilirubin level was decreased after phototherapy, but the hemoglobin level was decreased 6.9 g/dL and an exchange transfusion was then performed. The direct antiglobulin test was strongly positive, but the indirect antiglobulin test using screening blood cells without the Di(a) antigen was negative. After we suspected neonatal hemolytic disease caused by the anti-Di(a) antibody, it was confirmed using selected blood cells containing Di(a) antigen. The newborn and father had DI*A/DI*B and the mother had DI*B. The inclusion of Di(a) antigens in an unexpected antibody screening test should be actively discussed in Korea.

PURPOSE: Meconium aspiration is assumed to be a risk factor for bacterial infection, and patients with meconium aspiration syndrome (MAS) are commonly treated with empiric antibiotics in clinical settings. However, little is known about the effectiveness of the empirical antibiotics treatment. Here, we compared the short-term clinical outcomes associated with empirical antibiotics treatment in non-ventilated cases of MAS. METHODS: A retrospective study was conducted on infants admitted with non-ventilated cases of MAS from March 2008 to September 2016. The infants enrolled in the study were divided into two groups based on the antibiotics treatment, and their clinical outcomes were compared. The incidence of sepsis during the hospitalization period and the incidence of delayed sepsis up to 3 months were evaluated. The effects of empirical antibiotic use on respiratory symptoms were evaluated, and the complications were compared. RESULTS: A total of 109 infants were evaluated, of which 61 (56.0%) received antibiotics and 48 (44.0%) did not receive antibiotics. No differences in clinical characteristics were noted between the two groups. However, the empirical antibiotics group showed a significantly higher mean of respiratory rates, C-reactive protein levels, and positive rates, as well as a significantly longer hospitalization period. In clinical outcomes, there were no differences in sepsis rates or respiratory support duration. Furthermore, there were no differences in complications. CONCLUSION: The empirical use of antibiotics did not affect the clinical outcomes in cases of non-ventilated MAS. The role of empirical antibiotics in these infants may need to be reevaluated.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Meconium Aspiration Syndrome ; Meconium ; Respiratory Rate ; Retrospective Studies ; Risk Factors ; Sepsis

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.
Adult ; Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Histiocytes/pathology ; Histiocytosis, Sinus/*diagnosis/metabolism/pathology ; Humans ; Lymph Nodes/pathology ; Male ; Neck ; Pleural Effusion/*radiography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
Critical Care Nursing/*ethics ; Humans ; *Intensive Care Units ; Nurses ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers