OBJECTIVE: To study the clinical features and pathogenic bacteria of late-onset sepsis (LOS) in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. METHODS: Among the VLBW/ELBW infants with a gestational age of <32 weeks who were admitted to the hospital between January 2012 and December 2016, those with LOS were enrolled as the LOS group, and those without sepsis were matched for the infant with LOS in gestational age were enrolled as the control group. According to the presence or absence of in-hospital death, the LOS group was further divided into a death subgroup and a survival subgroup. Risk factors for LOS, clinical features, distribution of pathogenic bacteria, drug resistance, and high-risk factors for LOS-related death were analyzed. RESULTS: A total of 513 VLBW/ELBW infants were enrolled, and there were 65 infants in the LOS group and 130 in the control group. The incidence rate of LOS was 12.7%. In the LOS group, 6 infants died and 59 survived. Compared with the control group, the LOS group had a significantly lower birth weight (P<0.05) and significantly longer indwelling time of peripherally inserted central catheter (PICC), duration of mechanical ventilation, and length of hospital stay (P<0.05). Compared with the control group, the LOS group had a significantly higher proportion of small-for-gestational-age infants, infants undergoing mechanical ventilation, infants with neonatal necrotizing enterocolitis, or infants who died (P<0.05). Low birth weight, small-for-gestational-age infant, and long indwelling time of PICC were independent risk factors for LOS in VLBW/ELBW infants (OR=1.396, 2.550, and 1.068 respectively, P<0.05). Purulent meningitis was an independent risk factor for LOS-related death in VLBW/ELBWIs infants (OR=13.443, P<0.05). A total of 65 strains of pathogenic bacteria were cultured in the LOS group, among which there were 39 strains (60%) of Gram-negative bacteria, including 15 strains producing extended spectrum beta-lactamases (ESBLs), and antibiotics were applied for 67% (10/15) of the ESBL strains within 2 weeks before the onset of LOS. The rate of antibiotic use for ESBL strains was significantly higher than that for non-resistant strains [67% (10/15) vs 29% (7/24); P<0.05]. CONCLUSIONS Low birth weight, SGA infant, and long indwelling time of PICC are independent risk factors for LOS in VLBW/ELBW infants, and death tends to occur in LOS infants with purulent meningitis. Most pathogenic bacteria of LOS are Gram-negative bacteria, and use of antibiotics within 2 weeks before disease onset may increase the risk of ESBL strain infection.
Birth Weight ; Gestational Age ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Small for Gestational Age ; Infant, Very Low Birth Weight ; Risk Factors ; Sepsis

To investigate the trends in the survival rate (SR) for very low birth weight infants (VLBW) and extremely low birth weight infants (ELBWI) in Korea, a total of 43 articles pertaining to SR were analyzed, covering the years from 1967 to 2007. The changes in SR were compared using 5 year periods. The SR for VLBWI has increased remarkably, from 31.8% in early 1960 to 65.8% in early 1990 and 78.8% in early 2000. The SR for ELBWI has increased from 8.2% in early 1960 to 37.4% in early 1990 and 62.4% in early 2000. The SR has improved steeply since early 1990. When the SRs for VLBWI in Korea were compared with those in the U.S.A. and Japan, the figures were 40%, 72%, and 79% in 1985; 65.8%, 82%, and 86% in 1990; 71.3%, 86%, and 88% in 1995; 78.8%, 86%, and 89% in 2000, respectively. Although the recent SRs for VLBWI and ELBWI in Korea has improved rapidly, they have not yet reached the levels in these highly developed countries. To obtain accurate statistics that could be represented as an SR for premature infants in Korea, we have to develop a nationwide network database project.
Developed Countries ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Japan ; Korea ; Survival Rate

OBJECTIVE: To examine blood concentrations of free carnitine (FC) in preterm infants with different gestational ages (GA) and birth weights (BW). METHODS: A total of 3 368 preterm infants were enrolled as subjects. According to GA, they were divided into extremely preterm birth (EPTB) group (GA <28 weeks; n=39), very preterm birth (VPTB) group (28 ≤GA <32 weeks; n=405), moderately preterm birth (MPTB) group (32 ≤GA <34 weeks; n=507), and late preterm birth (LPTB) group (34 ≤GA <37 weeks; n=2 417); according to BW, they were divided into extremely low birth weight (ELBW) group (BW <1 000 g; n=36), very low birth weight (VLBW) group (1 000 g ≤BW <1 500 g; n=387), low birth weight (LBW) group (1 500 g ≤BW <2 500 g; n=1 873), and normal birth weight (NBW) group (2 500 g ≤ BW <4 000 g; n=1 072). Blood concentrations of FC were measured between 72 hours and 7 days after birth. RESULTS: The EPTB and VPTB groups had significantly higher FC concentrations than the MPTB and LPTB groups (P<0.05), and the MPTB group had significantly higher FC concentrations than the LPTB group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in GA. The ELBW and VLBW groups had significantly higher FC concentrations than the LBW and NBW groups (P<0.05). The LBW group had significantly higher FC concentrations than the NBW group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in BW. CONCLUSIONS There is a significant increase in blood FC concentrations in very/extremely preterm infants and very/extremely low birth weight infants, and tend to decrease with the increases in GA and BW.
Birth Weight ; Carnitine ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Pregnancy

PURPOSE: One of the major causes of bowel obstruction in extremely premature infants is a meconium obstruction. However, there are many challenges not only in the recognition and diagnosis, but also in the management of meconium obstruction. This study aimed to find perioperative clinical features and determine the postoperative course of meconium-related ileus in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. METHODS: We retrospectively reviewed the clinical data of premature infants (n = 11, VLBW infnats; n = 16, ELBW infants) with a meconium-related ileus who underwent operation for intractable ileus between January 2009 and May 2013. RESULTS: The average duration of conservative management was longer and postnatal age was older in ELBW infants than VLBW infants: 19.9 days vs. 11.5 days and 34.9 days vs. 19.2 days. The immediate postoperative course (day that beginning feeding and full feeding) was not significantly different based on birth weight, but the ELBW infants had slightly higher mortality. At 12 months of corrected age after operation, both average body weight and average height was below 10th percentile for growth in most infants (61.1%). CONCLUSION: There was a slightly high mortality in the ELBW infants, but two groups did not experience significant differences in the immediate postoperative course of meconium-related ileus. Nevertheless, considering their growth patterns, it is necessary to do a close follow-up and more aggressive nutritional management to achieve optimal growth and development in both patient groups.
Birth Weight ; Body Weight ; Diagnosis ; Growth and Development ; Humans ; Ileus* ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Extremely Premature ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Meconium ; Mortality ; Retrospective Studies

OBJECTIVES: To study the changing trend of abdominal regional oxygen saturation (A-rSO METHODS: The VLBW/ELBW infants who were admitted to the neonatal intensive care unit from September 2019 to May 2021 were enrolled as subjects. Near-infrared spectroscopy was used to monitor A-rSO RESULTS: A total of 63 VLBW/ELBW infants were enrolled, with 30 infants in the <29 weeks group and 33 in the ≥29 weeks group. A-rSO CONCLUSIONS In infants with VLBW/ELBW, A-rSO
Birth Weight ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight ; Oxygen ; Prospective Studies ; Spectroscopy, Near-Infrared

In Korea, the first neonatal intensive care unit was established in the early 1980s, and over the past 30 years, the advancements in the field of neonatology in Korea have led to a significant improvement in the survival of low birth weight infants. The survival rates of very low birth weight infants (VLBWIs) more than doubled, from 38.3% in the 1980s to 84.8% in 2014, and the survival rates of extremely low birth weight infants increased more than five-fold, from 12.3% in the 1980s to 69.6% currently. A comparison of VLBWI survival among countries showed improved survival rates in each birth weight group in Canada, Australia-New Zealand, and various European countries, with Japan at the top. For the first time in Korea, a nationwide prospective web-based registration system for VLBWIs, the Korean Neonatal Network (KNN), was established, and KNN operations were initiated officially on April 15, 2013 by the Korean Society of Neonatology with support from the Korea Centers for Disease Control and Prevention. As of April 2016, clinical data for over 6,700 VLBWIs have been collected from 64 participating hospitals across the country. This network has made it possible to investigate overall survival rates as well as short- and long-term outcomes in VLBWIs. The purpose of this review was to evaluate the recent changes in neonatal outcomes in VLBWIs in Korea based on KNN data.
Birth Weight ; Canada ; Centers for Disease Control and Prevention (U.S.) ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Japan ; Korea* ; Mortality ; Neonatology ; Prospective Studies ; Survival Rate

Recently the Korean Neonatal Network (KNN) was established in order to enhance treatment outcomes further through the registration of very-low-birth-weight infants (VLBWI) data. The present study was conducted on 2,606 VLBWI, 2,386 registered and 220 un-registered, in the KNN participating centers, with the objective of reporting on recent survival rates of VLBWI in Korea and verifying the changing trends in survival rates with data from the 1960s and beyond. The study also aimed to compare the premature infants' survival rate in Korea with those reported in neonatal networks of other countries. The recent survival rate of VLBWI increased more than twice from 35.6% in the 1960s to 84.8%, and the survival rate of the extremely low birth weight infants (ELBWI) increased by more than 10 times, indicating improvement of the survival rate in premature infants with lower birth weight and gestational age. Comparison of VLBWI between countries showed improved survival rates according to each birth weight group in Canada, Australia-New Zealand, and European countries with Japan at the head, but in terms of comparison based on gestational age, differences, except for Japan, have been reduced. Efforts to increase the survival rate of premature infants in Korea with low birth rate are inevitable, and they should be the foundation of academic and clinical development based on its network with advanced countries.
Databases, Factual ; Europe ; Gestational Age ; Humans ; Infant ; Infant Mortality/*trends ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; *Infant, Very Low Birth Weight ; Japan ; Republic of Korea

OBJECTIVETo analyze the clinical data of very low birth weight infants (VLBWIs) and extremely low birth weight infants (ELBWIs) (birth weight ≤1 200 g) and to provide prewarning indicators for prognostic evaluation and clinical intervention.

METHODSA retrospective analysis was performed on the clinical data of 108 VLBWIs and ELBWIs to investigate the maternal history of diseases during pregnancy, neonatal birth status, the process of diagnosis and treatment, and prognosis. Unconditional logistic regression analysis was used to determine prognostic factors.

RESULTSOf the 108 preterm infants, 15 had a birth weight of <800 g, 29 had a birth weight of 800-999 g, and 64 had a birth weight of 1000-1200 g. The mortality was 33.3% (36/108). Placenta previa and Apgar score ≤3 at 5 minutes were the main risk factors for death within 24 hours of birth; premature rupture of membrane, Apgar score ≤3 at 5 minutes, and pulmonary hemorrhage were the main risk factors for death between 24 hours and 7 days after birth; late-onset sepsis caused by invasive fungal infection was an independent risk factor for death over 7 days after birth, while pregnancy-induced hypertension syndrome was a protective factor.

CONCLUSIONSThe mortality in VLBWIs and ELBWIs is relatively high, and the prognostic factors vary between preterm infants of different ages. Clinicians should discuss management options for the infants on the basis of these findings to increase the survival of preterm infants.

Humans ; Infant Mortality ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Logistic Models ; Prognosis ; Retrospective Studies

OBJECTIVETo study the outcomes of very or extremely low birth weight (VLBW/ELBW) infants born between 2000 and 2008 in a single NICU and the medical factors associated with the termination of treatment in some infants.

METHODSIn this case control study, the clinical data of 148 VLBW/ELBW infants were retrospectively studied and the surviving infants were followed up. Both univariate analysis and multivariate logistic regression analysis were used to investigate the medical factors associated with terminating treatment in infants.

RESULTSTwenty infants (13.5%) failed to respond to the therapy and died in the hospital. Three infants (2.0%) died after discharge. Nineteen infants (12.8%) did not receive treatment due to decision of the guardian and died. Thirty infants (20.3%) were not followed up after discharge. Seventy-six infants (51.4%) survived, including 47 healthy infants, 2 cases of congenital diseases and 27 cases with poor prognosis. Multivariate logistic regression analysis showed there were 2 significant factors associated with terminating treatment: neonatal respiratory distress syndrome (P=0.030, OR=11.396, 95%CI 1.-102.701) and hospitalization periods (the year 2004-2006) (P=0.039, OR=9.869, 95%CI 1.118-87.140).

CONCLUSIONSThe survival status of VLBW and ELBW infants needs to be improved. It is important to decrease the incidence of neonatal respiratory distress syndrome for decreasing the proportion of terminating treatment in the infants.

Female ; Follow-Up Studies ; Humans ; Infant Mortality ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Logistic Models ; Male

OBJECTIVETo study the effect of extensively hydrolyzed formula on the growth and development in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.

METHODSA total of 375 VLBW or ELBW infants were enrolled and divided into an observation group (187 infants) and a control group (188 infants) using a random number table. The infants in the observation group were given extensively hydrolyzed formula, and when the amount of extensively hydrolyzed formula reached 10 mL/time, it was changed to the standard formula for preterm infants. The infants in the control group were given standard formula for preterm infants. Both groups were fed for 4 consecutive weeks and were compared in terms of incidence rate of feeding intolerance, time to establish full enteral feeding, time to complete meconium excretion, number of spontaneous bowel movements, growth and development, motilin level at 4 and 10 days after feeding, and incidence rate of infection.

RESULTSCompared with the control group, the observation group had a lower rate of feeding intolerance (P<0.05), a shorter duration to full enteral feeding and time to complete meconium excretion (P<0.05), a higher mean number of daily spontaneous bowel movements (P<0.05), higher body weight (1 793±317 g vs 1 621±138 g; P<0.05), head circumference (30.5±1.1 cm vs 30.0±1.6 cm; P<0.05), and body length (43.9±1.2 cm vs 42.1±2.0 cm; P<0.05), a higher motilin level at 4 and 10 days after feeding (P<0.05), and a significantly lower infection rate (P<0.05).

CONCLUSIONSExtensively hydrolyzed formula can increase motilin level, improve gastrointestinal feeding tolerance, promote early growth and development, and reduce the incidence of infection in VLBW and ELBW infants.

Child Development ; Enteral Nutrition ; Female ; Humans ; Infant Formula ; Infant, Extremely Low Birth Weight ; growth & development ; Infant, Newborn ; Infant, Very Low Birth Weight ; growth & development ; Male ; Motilin ; blood