To determine the validity of a repeat thyroid function test for preterm infants, and to investigate factors that influence thyroid function of preterm infants, thyroid functions of 105 infants born at <32 weeks' gestational age were evaluated. Initial serum free thyroxine (fT4) and thyrotropin (TSH) levels were measured during the first 10 days of life, and repeated tests were performed more than 2 weeks apart. We analyzed the effects of gestational age, systemic diseases, and nutrition on the development of thyroid dysfunction. Thirty-one infants (30%) had low fT4 levels (<0.7 ng/dL) in the absence of elevated TSH levels (<7 microU/mL). Thirteen infants (12%) had hypothyroidism (fT4 <0.7 ng/dL, TSH > or =10 microU/mL) and mean age at diagnosis was 28+/-17 days. Twelve infants had moderately elevated TSH (TSH 10-30 microU/mL) with normal fT4 levels after 1 week of postnatal life. The history of undergone surgical procedure which needed iodine containing disinfectants was significantly frequent in the infant with hypothyroidism and transient TSH elevation. Repeated thyroid function tests are necessary for preterm infants, even though they initially show normal thyroid function, and are especially important for infants who have been exposed to excessive or insufficient levels of iodine.
Female ; Gestational Age ; Humans ; Hypothyroidism/*diagnosis/epidemiology/metabolism ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*diagnosis/epidemiology/metabolism ; Pregnancy ; Thyroid Function Tests ; Thyrotropin/*blood ; Thyroxine/*blood

OBJECTIVEHypoxic-ischemic brain damage (HIBD) occurs frequently in premature infants, resulting death or neurological sequela in some survivors. Up to now, however, there are no diagnostic criteria for this disease. The aim of this study was to explore the diagnostic criteria and the grading principle for HIBD of premature infants.

METHODSThe clinical data of 453 premature infants who were diagnosed with HIBD based on the diagnostic criteria for HIBD of term infants, including medical history, clinical manifestations, laboratory results and imaging findings, were studied retrospectively.

RESULTSA preliminary diagnostic criteria for HIBD of premature infants was propounded based on clinical and pathologic features of brain damage of premature infants. Of the 453 premature infants, 346 (76%) matched the diagnostic criteria. Of the 346 cases, PaO2 (42.21 +/- 8.33 mmHg) and /or SaO2 (68.49 +/- 5.19%) decreased in 208 patients and the BE value (-10.86 +/-3.41 mmol/L) decreased in 138 patients. The sensitivity and specificity of cranial computer tomography for the diagnosis of HIBD in premature infants was 100% and 17.8%, respectively. Cranial ultrasound displayed a sensitivity of 87.9% and specificity of 100% for the diagnosis of HIBD in premature infants.

CONCLUSIONSThe diagnostic criteria used for HIBD for term infants is not suitable for premature infants. This study puts forward the reference diagnostic criteria of premature HIBD as following: 1) evidence of hypoxia; 2) neurological symptoms and signs; 3) imaging findings: severe brain edema, germinal matrix intraventricular hemorrhage (GMH-IVH), periventricular leukomalacia (PVL), or brain infarction, and/or the resistance index (RI) > 0.75 or < 0.55 showed by cranial ultrasound; 4) Brain damage caused by infection, electrolyte disturbance and congenital metabolic disease was excluded. The grading principle of premature HIBD is proposed as follows: MILD HIBD when cranial ultrasound shows grade I-II of GMH-IVH or PVL, and SEVERE HIBD when cranial ultrasound shows grade III-IV of GMH-IVH or PVL.

Brain ; diagnostic imaging ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; Male ; Oxygen ; blood ; Prognosis ; Tomography, X-Ray Computed

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.
Adult ; Age of Onset ; Area Under Curve ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Chorioamnionitis/blood/*diagnosis ; Cohort Studies ; Female ; Fetal Membranes, Premature Rupture/blood ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/blood/*diagnosis ; *Predictive Value of Tests ; Pregnancy ; Premature Birth/blood ; ROC Curve ; Retrospective Studies ; Sepsis/blood/*diagnosis

PURPOSE: We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants. MATERIALS AND METHODS: Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin > or =2 mg/dL for > or =14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared. RESULTS: Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25+/-7 days vs. 35+/-14 days, p=0.002) and persisted longer (62+/-36 days vs. 46+/-27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin > or =4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase. CONCLUSION: The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.
Bilirubin/blood ; Case-Control Studies ; Cholestasis/diagnosis/epidemiology/*etiology ; Comorbidity ; Female ; Humans ; Infant, Newborn ; Infant, Premature, Diseases/epidemiology/etiology ; *Infant, Small for Gestational Age ; Infant, Very Low Birth Weight ; Liver/metabolism/physiopathology ; Male ; Parenteral Nutrition/*adverse effects

We report a case of neonatal thyrotoxicosis with concurrent respiratory failure in an infant born to a mother with Graves' disease and review the published literature describing neonatal hyperthyroidism. The male infant who was born by spontaneous delivery at 35 weeks of gestational age presented with fever, tachycardia and tachypnea at rest on day 11 after birth, and developed severe apnea on day 14. Thyroid function studies revealed hyperthyroidism in the infant, and his mother was confirmed to have Grave's disease during pregnancy. Literature review showed that among the 33 infants with similar conditions, tachycardia, tachypnea and poor weight gain were the most distinct clinical features of congenital hyperthyroidism. Accurate diagnosis of Graves' disease in the mother during pregnancy and awareness of the clinical presentations of neonatal hyperthyroidism are key to reducing missed diagnosis or misdiagnosis of neonatal hyperthyroidism.
Antithyroid Agents ; therapeutic use ; Apnea ; etiology ; Female ; Graves Disease ; blood ; Humans ; Hyperthyroidism ; blood ; complications ; diagnosis ; drug therapy ; Infant, Newborn ; Infant, Newborn, Diseases ; blood ; diagnosis ; drug therapy ; Infant, Premature ; Male ; Maternal-Fetal Exchange ; Pregnancy ; Pregnancy Complications ; blood ; Propylthiouracil ; therapeutic use ; Thyrotropin ; blood ; Thyroxine ; blood ; Triiodothyronine ; blood

Fungal endocarditis is a rare disease in infants, but it has been reported with increasing frequency among premature infants requiring neonatal intensive care. Congenital heart disease, pro- longed intravenous catheterization, the use of intravenous alimentation, broad-spectrum antibiotics administration and narcotic addiction are risk factors. Candida endocarditis is an unusual but severe complication of systemic candidiasis. Its occurrence has been related to the placement of a central venous catheter with its tip close to or within the right atrium and persistent candidemia. Embolization to major blood vessels is a common complication of Candida endocarditis and repeated pulmonary emboli are suspected to be cause of the repeated episodes of circulatory shock which finally leads to death. Thus, early diagnosis of Candida invasion and prevention of Candida endocarditis are essential for survival. We report a case of Candida endocarditis which was successfully managed with surgical removal and antifungal therapy. (J Korean Pediatr Soc 2000;43:832 836)
Anti-Bacterial Agents ; Blood Vessels ; Candida* ; Candidemia ; Candidiasis ; Catheterization ; Catheters ; Central Venous Catheters ; Early Diagnosis ; Endocarditis* ; Heart Atria ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Opioid-Related Disorders ; Rare Diseases ; Risk Factors ; Shock ; Tricuspid Valve*