No Abstract available.
Enterocolitis, Necrotizing* ; Heart Defects, Congenital* ; Humans ; Infant, Newborn* ; Nutritional Support*

Neonatal infections are frequent complications of neonates receiving intensive care unit. In particular, large cohort study has suggested that neonatal infections among extremely low birth weight infants are associated with poor neurodevelopmental and growth outcomes in early childhood. This review article will focus on the rational use of empirical antibiotics/antifungal therapy for early and late onset sepsis/fungemia, duration of antibiotic treatment, highlight clinically relevant aspects of the antibiotics commonly used in the treatment of sepsis, antibiotics requiring therapeutic dose monitoring, and management of antibiotic-resistant infection in the neonate.
Anti-Bacterial Agents ; Cohort Studies ; Drug Monitoring ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units ; Sepsis

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.
Berlin ; Catheters ; Child* ; Diagnosis ; Gravitation ; Humans ; Microbubbles ; Radiation, Ionizing ; Sensitivity and Specificity ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux*

PURPOSE: To compare the incidence and clinical characteristics of infants with atypical CLD and those with classic BPD among premature infants less than 32 weeks' gestation. METHODS: Clinical data was collected retrospectively from the 256 premature infants less than 32 weeks' gestation and their mothers during 3-year study period. RESULTS: Among 212 preterm infants less than 32 weeks' gestation who survived to 28 days of life, 19 (9%) had atypical CLD and 38 (17.9%) had classic BPD. Atypical CLD infants were significantly heavier and more mature than classic BPD infants (mean birth weights, 1,100+/-294 g vs 915+/-225 g; and mean gestational age, 26.9+/-1.6 weeks vs 21.1+/-1.3 weeks). Duration of ventilator therapy and oxygen inhalation within 28 days of age were shorter in atypical CLD infants than in classic BPD infants (mean duration of ventilator therapy, 16.3+/-6.9 days vs 27+/-6.8 days; and mean duration of oxygen inhalation, 25.5+/-13.5 days vs 53.8+/-39 days). Oxygen dependency in atypical CLD infants showed bimodal pattern, decreasing gradually to 3-week after birth and upturning to peak at about 5-week after birth. Comparing the respiratory indices between classic BPD and aypical CLD, FiO2 at day 2,7, and 10, and oxygen index at day 2, and 10 were significant in classic BPD, but MAP were not. Considering the birth weight, MAP per birth weight, and modified oxygen index showed more apparent differencies between the two groups. CONCLUSION: 35.5% of total CLD were atypical CLD and showed bimodal pattern in oxygen dependency. Atypical CLD infants were significantly heavier and more mature than classic BPD infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Inhalation ; Lung Diseases* ; Lung* ; Mothers ; Oxygen ; Parturition ; Pregnancy ; Retrospective Studies ; Ventilators, Mechanical

In our previous study, we have demonstrated that peak inspiratory pressure over birth weight (PIP/kg) and mean airway pressure over birth weight (MAP/kg) were more significant risk factors for the development of neonatal chronic lung disease (CLD) than PIP and MAP. We aimed to develop a scoring method using the modified respiratory variables (SMUMRV) to predict CLD at early postnatal period. From 1997 to 1999, a retrospective review was performed for 197 infants <1,500 g for the development of the SMUMRV based on statistical analysis. From 2000 to 2001, calculated scores on day 4, 7 and 10 of life were obtained prospectively for 107 infants <1,500 g. Predictive values and the area under the receiver operator characteristic curve (AUC) were determined and compared with the result of the previous regression model. Gestational age, birth weight, 5 min Apgar score, PIP/kg at 12 hr of age, fractional inspired oxygen (FiO2), MAP/kg, modified oxygenation index and ventilatory mode were selected as parameters of SMUMRV. No significant differences of AUCs were found between the SMUMRV and the Yoder model. It is likely that our scoring method provides reliable values for predicting the development of CLD in very low birth weight infants.
Analysis of Variance ; Birth Weight ; Chronic Disease ; Comparative Study ; Female ; Humans ; Infant, Newborn ; Lung Diseases/*diagnosis ; Male ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Respiratory Function Tests/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Time Factors

We measured selenium, zinc, copper and manganese concentrations in the human milk of Korean mothers who gave birth to preterm infants, and compared these measurements with the recommended daily intakes. The samples of human milk were collected postpartum at week-1, -2, -4, -6, -8, and -12, from 67 mothers who gave birth to preterm infants (< 34 weeks, or birth weight < 1.8 kg). All samples were analyzed using atomic absorption spectrophotometry. The concentrations of selenium were 11.8 +/- 0.5, 11.4 +/- 0.8, 12.7 +/- 0.9, 11.4 +/- 0.8, 10.8 +/- 0.9, and 10.5 +/- 1.3 microg/L, zinc were 7.8 +/- 0.5, 9.1 +/- 0.8, 7.2 +/- 0.9, 8.0 +/- 0.8, 7.4 +/- 0.9, and 6.6 +/- 1.2 mg/L, copper were 506 +/- 23.6, 489 +/- 29.4, 384 +/- 33.6, 356 +/- 32.9, 303 +/- 35.0, and 301 +/- 48.0 microg/L and manganese were 133 +/- 4.0, 127 +/- 6.0, 125 +/- 6.0, 123 +/- 6.0, 127 +/- 6.0, and 108 +/- 9.0 microg/L at week-1, -2, -4, -6, -8, and -12, respectively. The concentrations of selenium and zinc meet the daily requirements but that of copper is low and of manganese exceeds daily requirements recommended by the American Academy of Pediatrics, Committee on Nutrition.
Adult ; Copper/analysis ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Longitudinal Studies ; Manganese/analysis ; Milk, Human/*chemistry ; Postpartum Period ; Republic of Korea ; Selenium/analysis ; *Spectrophotometry, Atomic ; Trace Elements/*analysis ; Zinc/analysis

Background and Objectives: This study aimed to provide morbidity and mortality information on very low birth weight (VLBW) infants with congenital heart disease (CHD-VLBWs). Methods: The study used a 10-year cohort of VLBW infants from a single institution. CHD was classified according to International Classification of Diseases, Version 9, Clinical Modification. Mortality and neonatal outcomes were assessed by comparing the CHD-VLBWs with gestational age- and birth weight-matched controls. Results: The prevalence of CHD-VLBWs was 7.5% (79/1,050), mean gestational age was 31.1±3.2 weeks, and mean birth weight was 1,126.2±268.3 g; 50.6% of the infants were small for the gestational age. The CHD-VLBWs more commonly had bronchopulmonary dysplasia (BPD), and the longer they were exposed to oxygen, the more frequently they developed BPD. Those with cyanotic heart disease developed severe BPD more frequently. Necrotizing enterocolitis (NEC) occurred frequently in the CHD-VLBWs and was not associated with their feeding patterns. CHD-VLBWs had a higher mortality rate; prematurity-related diseases were the leading cause of death before surgery, while heart-related problems were the leading cause of death after surgery. We found no significant difference in mortality from prematurity-related disease between the CHD-VLBWs and controls. In the subgroup analysis of CHD, the cyanotic CHD group had a higher incidence of BPD and higher mortality rate than the acyanotic CHD group. Conclusions CHD-VLBWs showed higher BPD, NEC, and mortality rates than those without CHD. There was also a higher incidence of BPD and mortality in VLBW infants with cyanotic CHD than in those with acyanotic CHD.

PURPOSE: To evaluate the usefulness of sonography-guided Gastrografin enema for the diagnosis and treatment of meconium plug syndrome in premature newborns in a neonatal intensive care unit (NICU). MATERIALS AND METHODS: Fifteen premature newborns underwent 23 sonography-guided Gastrografin enemas on the 8th day of life on average (range: 3 days-21 days). The gestational age and birth weight (mean+/-standard deviation) of the patients were 29+/-2 weeks and 999+/-148 g, respectively. The diagnosis of meconium plug syndrome was based on relevant clinical and radiological findings. Diluted Gastrografin (1:3, 17-45 ml) was administered through a rectal tube under the guidance of sonography until it reached to the cecum. Thereafter, immediate post-procedure and delayed portable abdominal radiographs were taken. All the procedures were done within the NICU. We reviewed the dates of meconium evacuation and the first feeding after the last enema from the clinical data. Radiologically, the timing of the radiographic improvement after the last enema was checked. In cases of distended distal ileum with meconium on pre-enema sonography, follow-up sonography was performed to determine the interval change after gastrografin enema. RESULTS: None of the sonography-guided Gastrografin enemas performed within the NICU caused procedure-related complications. Meconium was evacuated within one day in all patients. In 14 patients, on average, feeding was started on the 7th day and radiographic improvement was observed on the 3rd day. Four of the five patients showing a distended distal ileum with meconium revealed a decrease in ileal distension on follow-up sonography. On the other hand, the other patient, who did not show such a decrease on follow-up sonography, was found to have ileal stenosis during subsequent surgery. CONCLUSION: Sonography-guided Gastrografin enema is a safe and effective bedside procedure, when performed in the NICU for the diagnosis and treatment of meconium plug syndrome.
Birth Weight ; Cecum ; Constriction, Pathologic ; Diagnosis ; Diatrizoate Meglumine* ; Enema* ; Follow-Up Studies ; Gestational Age ; Hand ; Humans ; Ileum ; Infant, Newborn* ; Intensive Care, Neonatal ; Meconium*

PURPOSE: In preterm infants, neonatologists often encounter abnormally high level of 17-alpha-hydroxy progesterone (17-OHP), however as there is no normative reference level for Korean preterm neonates, repeated tests for 17-OHP are conducted until the level reaches the normal value of term infants. The aim for the study is to investigate the longitudinal follow up of 17 OHP levels according to gestational age. METHODS: The samples for 17-OHP were obtained as tandem mass spectrometry (TMS) by heel prick between the 3rd and 7th day of life from 1,040 preterm infants who were born at Asan Medical Center from June 2008 to June 2010. If initial 17-OHP level was abnormal (>12 ng/mL), the serum levels were followed every 2-4 weeks until normalization. RESULTS: The mean levels of 17-OHP obtained from initial TMS according to gestational age were as follows: 24-26 weeks (26.4+/-20.7 ng/mL, n=20); 27-28 weeks (14.8+/-14.6 ng/mL, n=39); 29-30 weeks (7.6+/-7.3 ng/mL, n=54); 31-32 weeks (5.1+/-5.8 ng/mL, n=86); 33-34 weeks (4.6+/-3.9 ng/mL, n=186); 35 weeks (5.0+/-5.5 ng/mL, n=251); and 36 week (3.6+/-2.3 ng/mL, n=403). The mean and 99.5 percentile 17-OHP levels correlated inversely with gestational age. Those 63 infants (mean gestational age 28.6+/-4.1 weeks) whose initial 17-OHP levels were abnormally high, all became normalized at mean of 67.2+/-49.0 days. The mean number of follow-up was 2.9+/-1.9 times (range: 1-7 times) until normalization. CONCLUSION: The 17-OHP levels correlated inversely with gestational age and the number of false-positive results in the absence of congenital adrenal hyperplasia is high among preterm population. The percentile values presented here for 17-OHP in relation to gestational age could serve as a useful guideline for 17-OHP level follow up.
Adrenal Hyperplasia, Congenital ; Follow-Up Studies ; Gestational Age ; Heel ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Neonatal Screening ; Progesterone ; Reference Values ; Tandem Mass Spectrometry

Background: This study aimed to investigate the survival and morbidities of infants in the Korean Neonatal Network (KNN) with birth weight (BW) < 500 g. Methods: The demographic and clinical data of 208 live-born infants with a BW < 500 g at a gestational age of ≥ 22 weeks who were treated in the neonatal intensive care units of the KNN between 2013 and 2017 were reviewed. Results: The survival rate of the infants was 28%, with a median gestational age and BW of 24 3/7 weeks (range, 22 0/7 –33 6/7 ) and 440 g (range, 220–499), respectively. Multivariable Cox proportional hazards analysis demonstrated that survival to discharge was associated with longer gestation, higher BW, female sex, singleton gestation, use of any antenatal corticosteroids, and higher Apgar scores at 5 minutes. The overall survival rates were significantly different between the BW categories of < 400 g and 400–499 g. However, there was no significant difference in the incidence of any morbidity between the BW groups.Half of the deaths of infants with BW < 500 g occurred within a week of life, mainly due to cardiopulmonary and neurologic causes. The major causes of death in infants after 1 week of age were infection and gastrointestinal disease. Among the surviving infants, 79% had moderate to severe bronchopulmonary dysplasia, 21% underwent surgical ligation of patent ductus arteriosus, 12% had severe intraventricular hemorrhage (grade III–IV), 38% had sepsis, 9% had necrotizing enterocolitis (stage ≥ 2), and 47% underwent laser treatment for retinopathy of prematurity. The median length of hospital stay was 132 days (range, 69–291), and 53% required assistive devices at discharge. Conclusion Despite recent advances in neonatal intensive care, the survival and morbidity rates of infants with BW < 500 g need further improvement.