Fetomaternal hemorrhage (FMH) is due to the entry of fetal blood into the maternal circulation. Although very rare, FMH complicates pregnancies, presents with severe symptoms, and leads to fetal death. Majority of FMH cases are idiopathic and difficult to diagnose. The known used diagnostic tests are Kleihauer-Betke Test (KBT) and flow cytometry, which can detect fetal hemoglobin in the maternal blood. However, such methods have limited use because of low sensitivity, labor-intensive and error-susceptible procedures, poor reproducibility, and tendency to overestimate the FMH volume. Other tests include high performance liquid chromatography (HPLC) and alpha-fetoprotein (AFP) tests, which can be as favorable to confirm FMH as KBT. However, in case of acute FMH, the diagnostic results of KBT, flow cytometry, and HPLC may be false negative. AFP test is a noninvasive, fast, easily assessable, adjuvant, and confirmatory diagnostic test. Published Korean articles show confirmed FMH by KBT or HPLC in singleton late-preterm and term neonates. Herein, we report a case of monochorionic diamniotic twin neonates (birth weight <1,500 g) who presented borderline fetal hemoglobin level because of acute FMH and were diagnosed with FMH by maternal AFP. Our experience of diagnosing FMH rapidly by AFP test will be very helpful to clinicians for the prevention and treatment of FMH during pregnancy.

Purpose: We aimed to analyze the correlations between the Bayley Scales of Infant Development (BSID)-III and Korean Developmental Screening Test (K-DST) in very-low-birth-weight (VLBW; birth weight <1,500 g) preterm infants. Methods: We enrolled 53 VLBW infants (mean gestational age, 28.9±2.11 weeks; mean birth weight, 1,158.5±241.1 g) and assessed them using the BSID-III and K-DST at a corrected age of 18 to 24 months. We analyzed the correlations between the BSID-III and K-DST subdomains and evaluated whether the estimated developmental levels were consistent with the corrected ages. Results: In the BSID-III, the composite scores for cognition, motor, and language were 105.9±13.1 (median, 105; 66th percentile; 95% confidence interval [CI], 98 to 113), 100.9±12.4 (100; 50th percentile; 95% CI, 92 to 108), and 94.9±16.8 (97.5; 34th percentile; 95% CI, 87 to 102), respectively. The scaled scores for receptive/expressive language and gross/fine motor were 9.9±2.9 (10.5)/8.2±2.7 (8) and 9.6±2.4 (9)/10.6 ±2.3 (10), respectively. In the K-DST, the mean scores of cognition (17.8±4.7 [18.5]), language (16.6±7.2 [20]), fine motor (19.4±3.4 [20]), gross motor (19.9±3.8 [21]), sociality (18.6±4.7 [20]), and self-control (17.3±5.1 [18]) were within the range of normal developmental status. Among the overlapping subdomains, cognition (r=0.58, P= 0.003) and language (r=0.86, P<0.001), but not fine and gross motor status (r=0.05, P= 0.79; r=0.16, P=0.44, respectively), showed significant correlation between the BSID-III and K-DST. Conclusion The language and cognition domains of the K-DST were significantly correlated with the BSID-III in preterm VLBW infants. Clinicians should consider these discrepancies and correlations when evaluating the developmental status of preterm VLBW infants.

Fetomaternal hemorrhage (FMH) is due to the entry of fetal blood into the maternal circulation. Although very rare, FMH complicates pregnancies, presents with severe symptoms, and leads to fetal death. Majority of FMH cases are idiopathic and difficult to diagnose. The known used diagnostic tests are Kleihauer-Betke Test (KBT) and flow cytometry, which can detect fetal hemoglobin in the maternal blood. However, such methods have limited use because of low sensitivity, labor-intensive and error-susceptible procedures, poor reproducibility, and tendency to overestimate the FMH volume. Other tests include high performance liquid chromatography (HPLC) and alpha-fetoprotein (AFP) tests, which can be as favorable to confirm FMH as KBT. However, in case of acute FMH, the diagnostic results of KBT, flow cytometry, and HPLC may be false negative. AFP test is a noninvasive, fast, easily assessable, adjuvant, and confirmatory diagnostic test. Published Korean articles show confirmed FMH by KBT or HPLC in singleton late-preterm and term neonates. Herein, we report a case of monochorionic diamniotic twin neonates (birth weight <1,500 g) who presented borderline fetal hemoglobin level because of acute FMH and were diagnosed with FMH by maternal AFP. Our experience of diagnosing FMH rapidly by AFP test will be very helpful to clinicians for the prevention and treatment of FMH during pregnancy.

Purpose: We aimed to analyze the correlations between the Bayley Scales of Infant Development (BSID)-III and Korean Developmental Screening Test (K-DST) in very-low-birth-weight (VLBW; birth weight <1,500 g) preterm infants. Methods: We enrolled 53 VLBW infants (mean gestational age, 28.9±2.11 weeks; mean birth weight, 1,158.5±241.1 g) and assessed them using the BSID-III and K-DST at a corrected age of 18 to 24 months. We analyzed the correlations between the BSID-III and K-DST subdomains and evaluated whether the estimated developmental levels were consistent with the corrected ages. Results: In the BSID-III, the composite scores for cognition, motor, and language were 105.9±13.1 (median, 105; 66th percentile; 95% confidence interval [CI], 98 to 113), 100.9±12.4 (100; 50th percentile; 95% CI, 92 to 108), and 94.9±16.8 (97.5; 34th percentile; 95% CI, 87 to 102), respectively. The scaled scores for receptive/expressive language and gross/fine motor were 9.9±2.9 (10.5)/8.2±2.7 (8) and 9.6±2.4 (9)/10.6 ±2.3 (10), respectively. In the K-DST, the mean scores of cognition (17.8±4.7 [18.5]), language (16.6±7.2 [20]), fine motor (19.4±3.4 [20]), gross motor (19.9±3.8 [21]), sociality (18.6±4.7 [20]), and self-control (17.3±5.1 [18]) were within the range of normal developmental status. Among the overlapping subdomains, cognition (r=0.58, P= 0.003) and language (r=0.86, P<0.001), but not fine and gross motor status (r=0.05, P= 0.79; r=0.16, P=0.44, respectively), showed significant correlation between the BSID-III and K-DST. Conclusion The language and cognition domains of the K-DST were significantly correlated with the BSID-III in preterm VLBW infants. Clinicians should consider these discrepancies and correlations when evaluating the developmental status of preterm VLBW infants.