PURPOSE:This study was undertaken to investigate clinical features and outcomes of ventilator- associated pneumonia (VAP) in neonatal intensive care unit (NICU) patients. METHODS:Retrospective analysis of medical records was conducted on 176 patients who were ventilated with endotracheal intubation for 48 hours and over in a NICU over a 3-year period (2005~2007). RESULTS:There were 29 episodes of VAP (16.5%). The main pathogens were Gram-negative bacilli (69%). Patients with VAP had a higher incidence of sepsis (58.6% vs. 34.7%) and bronchopulmonay dysplasia (65.5% vs. 23.1%), and had prolonged duration of hospital stay (median: 86 days vs. 39 days), and also showed higher mortality (41.3% vs. 23.8%). By logistic regression analysis, there were two independent-predicting factors for VAP: reintubation of endotracheal tube (OR: 9.3, 95% CI: 2.2~40.1) and patent ductus arteriosus (OR: 2.7, 95% CI: 1.1~7.2). CONCLUSION:VAP was associated with poor clinical courses and outcomes in NICU patients, and reintubation of endotracheal tube and patent ductus arteriosus may be risk factors of this infection. Additional studies are necessary to make interventions for preventing VAP in mechanically ventilated neonates. KeyWords:
Ductus Arteriosus, Patent ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Length of Stay ; Logistic Models ; Medical Records ; Pneumonia ; Pneumonia, Ventilator-Associated ; Risk Factors ; Sepsis

No abstract available.
Child* ; Edema* ; Humans ; Renal Insufficiency*

PURPOSE: We aimed to compare the clinical findings, including morbidity, duration of parenteral nutrition, and length of hospital stay between very low birth weight infants (VLBWIs) fed bovine milk-based formula (BOV) and VLBWIs fed human breast milk (HBM) in a neonatal intensive care unit (NICU). METHODS: VLBWIs admitted to the NICU of Dongsan Medical Center, Keimyung University, were enrolled. Infants born from March to August 2014 (n=28) were fed BOV (the BOV group), and those born from September to December 2014 (n=18) were fed HBM (the HBM group). Pasteurized (heating at 62.5degrees C for 30 minutes) donor human milk was used if the mother's own milk was not available because of insufficient breast milk production. RESULTS: The gestational age (28.0+/-1.7 weeks vs. 27.8+/-1.4 weeks) and birth weight (1,055+/-265 g vs. 1,175+/-187 g), of the infants in the BOV and HBM, groups were similar. In addition, perinatal characteristics were similar between the groups. The duration of parenteral nutrition (36.4 days vs. 24.1 days, P=0.038), length of hospital stay (74.3 days vs.61.1 days, P=0.037), and incidence of nosocomial sepsis (53.6% vs. 22.2%, P=0.035), significantly differed between the BOV and HBM groups. Furthermore, the frequency of feeding intolerance was higher in the BOV group than in the HBM group, but this difference was not significant. Perinatal cytomegalovirus infection was not detected in any of the infants fed pasteurized donor human milk. CONCLUSION: Human-breast-milk-based diet for VLBWIs significantly reduces the incidence of nosocomial sepsis, duration of parenteral nutrition, and length of hospital stay.
Birth Weight ; Breast* ; Cytomegalovirus Infections ; Diet* ; Gestational Age ; Humans ; Humans* ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Length of Stay ; Milk ; Milk, Human* ; Parenteral Nutrition ; Sepsis ; Tissue Donors

Medical and mortality records of 50 cases of cardiac arrest that occurred during surgery at the operating room in the Seoul National University Hospital were reviewed to identify common factors of unexpected disasters. The cardiac arrest rate was 1:1333 among 66,481 patients from 1985 to 1988. The proportion of cardiae arrests primarily related to anesthetic was thought to be 1.1:10,000. The physical status of 145 patients was in the status I and II under the category of the American Society of Anesthesiologists (ASA). The praposed operation was elective in 38 cases and was an emergency in 12. General anesthesia was used in 48 patients. Cardiac arrests occurred before surgery in 5 patients and during surgery in 45 patients. Primary cardiovascular abnormalities contributed to the cause of cardiac arrest in 29 patients who needed a cardiothoracic operation. One patient had hyperpotassemia. Among these 30 patients, only two recovered. Two patients had vagal reflex followed by cardiac depression. Two patients had severe bronchospasm. One patient had malignant hyperpyrexia. Among 50 patients in this study, 5patients recovered completely, 36 patients died and the remaining 9 patients had major mobidity due to central nervous system damage. Cardiac arrest occurring during operations have tended to be treated as isolated events and go unreported. The outcome in this study was dismal. These results further suggest the need for the establishment of a registry for cardiac arrest case. In addition, the use of the monitors for ventilation and eirculation may decrease the incidence of the unexpected cardiac arrest.
Anesthesia, General ; Bronchial Spasm ; Cardia ; Cardiovascular Abnormalities ; Central Nervous System ; Depression ; Disasters ; Emergencies ; Heart Arrest* ; Humans ; Hyperkalemia ; Incidence ; Malignant Hyperthermia ; Mortality ; Operating Rooms ; Reflex ; Seoul ; Ventilation

Teratoma is one of germ cell tumor, common neoplasm in women of reproductive age, but it can arise at any age. Its malignant transformation is rare, less than 2%, frequently at older age. Nearly all the cases are squamous, sarcomatous and adenomatous transformation. Here we present a case of mixed transformation, adeno-squamous cell carcinoma with brief review of the concerned literature.
Carcinoma, Squamous Cell* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Teratoma*

PURPOSE: This study was conducted to compare the clinical features and outcome of neonatal gastrointestinal perforation due to necrotizing enterocolitis (NEC) and other etiologic diseases (non-NEC). METHODS: The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastrointestinal perforation between January 1999 and December 2009, were reviewed retrospectively. The admission records for clinical findings and mortality were reviewed and statistically analyzed for both groups. RESULTS: Among 28 neonates, NEC group was 35.7% and the other group (intestinal atresia, malrotation, meconium peritonitis, etc) was 64.3%. The mean gestational age was significantly shorter (32.8+/-4.6 weeks vs. 36.8+/-2.7 weeks, P=0.028) and the mean diagnostic day was significantly later (16.3+/-9.7 days vs. 2.2+/-1.8 days, P=0.001) in the NEC group than that of the non-NEC group. The mortality rate was markedly higher in the NEC group (50%) than that of the non-NEC group (5.6%)(P=0.013). By simple logistic regression analysis, gestational age (OR 0.69, 95% CI: 0.51-0.95, P=0.022) and NEC (OR 17.00, 95% CI: 1.60-181.36, P=0.019) were the significant risk factors to increase the mortality rate. Multiple logistic regression analysis showed NEC (OR 7.70, 95% CI: 0.55-108.06, P=0.130) and gestational age (OR 0.79, 95% CI: 0.58-1.09, P=0.151) were not the significant independent risk factors. CONCLUSIONS: This study found that gestational age was shorter and mortality rate was higher in the NEC group than the non-NEC group. However, after multiple logistic regression analysis, NEC or lower gestational age itself did not increase the mortality rate significantly.
Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Meconium ; Medical Records ; Peritonitis ; Retrospective Studies ; Risk Factors

Peripherally inserted central venous catheters (PICC) are commonly used to provide long term intravascular access for parenteral nutrition and medications in preterm infants, but rarely life-threatening complications associated with malposition of catheter tip such as pericardial effusion may be developed. We report a preterm case of early-onset pericardial effusion related to PICC of which the distal part is angulated and located in the right atrium of heart.
Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Heart ; Heart Atria ; Humans ; Infant, Newborn ; Infant, Premature* ; Parenteral Nutrition ; Pericardial Effusion*

PURPOSE: Melatonin is a naturally occurring hormone produced by the pineal gland. Melatonin has many pharmacological effects in different tissues or organs. Melatonin is especially known to have antioxidant and neuroprotective effects. Hypothermia is a therapeutic tool against hypoxia-ischemia (HI) of the brain. This study examines the effect of combined therapy using melatonin and hypothermia in neonatal rats with HI. METHODS: Seven-day old rats were subjected to HI and randomized into four groups : vehicle, melatonin alone, vehicle and hypothermia, and melatonin and hypothermia. Melatonin (30 mg/kg) was intraperitoneally administered in two doses: immediately following HI, and 24 h later. Hypothermia consisted of whole-body cooling (3 hours, 27degrees C). Sham-treated animals not subjected to HI were also studied. P10, P14, and P35 rats were sacrificed for experiments. RESULTS: Vehicle-treated P10 rats increased in brain infarction compared to controls in TTC staining study. And also, P35 rats decreased in brain volume of injured hemisphere in H&E stain. Melatonin or hypothermia alone did not show any protective effect against HI. However, a combination of melatonin and hypothermia effectively reduced the brain injury. In addition, the results of in situ zymography, TUNEL assay and immunofluorescence studies showed that neuroprotective effects were achieved only with combined therapy. CONCLUSION: Melatonin may contribute to synergistic effects to neuroprotection of hypothermia on brain damage after HI.
Animals ; Brain ; Brain Infarction ; Brain Injuries* ; Fluorescent Antibody Technique ; Hypothermia* ; In Situ Nick-End Labeling ; Melatonin* ; Neuroprotective Agents ; Pineal Gland ; Rats*

PURPOSE: To investigate the pulmonary outcomes of early extubation (within the first 24 hours of life) with synchronized nasal intermittent positive pressure ventilation (NIPPV) in extremely premature infants born at 25-26 weeks' gestation. METHODS: Medical records of extremely premature infants (gestational age: 25-26 weeks) born and admitted to the Keimyung University Dongsan Medical Center between January 2015 and December 2015 (n=42) were reviewed retrospectively. The early extubation group included infants who were extubated within the first 24 hours of life and was compared with a control group that included infants who remained ventilated beyond the first 24 hours of life. Extubation failure was defined as the need for reintubation within 72 hours after extubation. RESULTS: Of the 35 enrolled infants, 22 (62.9%) were extubated within the first 24 hours of life. No significant differences in perinatal factors were observed between the early extubation and control groups. Between the two groups, the incidence rates of extubation failure (18.2% [4/22] vs. 7.7% [1/13], P=0.39), reintubation (50.0% [11/ 22] vs. 46.2% [6/13], P=0.84), mortality (18.2% [4/22] vs. 15.4% [2/13], P=0.83), and the combined rates of clinical bronchopulmonary dysplasia (BPD) or death (40.9% [9/22] vs. 38.5% [5/13], P=0.89) did not significantly differ. CONCLUSION: Early extubation (within the first 24 hours of life) with synchronized NIPPV is safe and effective in the extremely premature infants born at 25-26 weeks' gestation, and does not indicate increased risks of extubation failure and other morbidities.
Bronchopulmonary Dysplasia ; Humans ; Incidence ; Infant ; Infant, Extremely Premature* ; Infant, Newborn ; Intermittent Positive-Pressure Ventilation* ; Medical Records ; Mortality ; Noninvasive Ventilation ; Pregnancy ; Retrospective Studies

Diatomology has provided important evidences for diagnosis of drowning in forensic practice. However, conflicting opinions about the reliability of diatom test still exist. As a part of efforts to end this controversy, it is very important to secure the diatom profile in the water sample of drowning site. Our results obtained in this study show the characteristics of temporal and spatial distribution of diatom collected from the main drowning sites of Han river in Korea. During spring, 111 taxa (98 species and 13 varieties) were identified from 31 genera, and 87 taxa (77 species and 10 varieties) were identified from 22 genera during summer. At the level of genus Achnanthes, Cyclotella, Cymbella, Fragilaria, Navicula, Nitzschia, and Stephanodiscus represented the highest numbers, and were the most widely occurred during two seasons. The centric diatoms, Stephanodiscus hantzschii f. tenuis and Cyclotella atomus were typical of spring and summer, respectively, and identified as dominant indicator species. The commonly occurred species, including dominant species in the seasonal cluster analysis influenced the formation of site - specific groups. As a result, our results will be able to be used not only as the comparison data of diatom found in the drowning victim's tissue but also a reference data to rule out the possibility of contamination.
Diatoms ; Drowning ; Korea ; Rivers ; Seasons ; Water