In the United States, The concept of designation for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in 1976. The extent of perinatal health care regionalization varies widely from one area to the other. facilities that provide hospital care for newborn are classified into three categories on the basis of functional capabilities; level I-primary or basic care, level II-secondary or specialty care, level III-tertially or subspecialty care. These facilities should be organized within a regionalized system of perinatal care. The transport system of newborn infants should be organized for referral of high risk newborn to centers with the personnel and resources needed for their degree of risk and severity of illness. In Korea, The korean society of neonatology was established and articulated in the 1994. During the past decade, the number of neonatologist has increased and neonatal intensive care units have proliferated in Korea. However, no standard definitions exist for the graded levels of complexity of care that neonatal intensive care units provide and no uniform guideline or recommendation for regionalization and referral system of high risk neonate have been established. With the rapid changing neonatal care system in Korea, the optimal neonatal care demands regionalization of care in utilization of manpower resources and in efficient use of advanced technology and facility.
Delivery of Health Care ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Korea ; Neonatology ; Perinatal Care ; Referral and Consultation ; United States

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Milk ; Milk, Human ; Mothers ; Parenteral Nutrition, Total

No abstract available.

Beals-Hecht syndrome, also known as congenital contractural arachnodactyly, is a rare autosomal dominant, connective tissue disorder characterized by congenital joint contractures, arachnodactyly, dolichostenomelia, crumpled ear, and kyphoscoliosis. We report a case of Beals-Hecht syndrome in a 4 days old female newborn baby, associated with congenital knee and elbow joint contractures, arachnodactyly, dolichostenomelia, crumpled ear, and 4 umbilical arteries, with brief review of the related literatures.
Arachnodactyly ; Connective Tissue ; Contracture ; Ear ; Elbow Joint ; Female ; Humans ; Infant, Newborn ; Joints ; Knee ; Umbilical Arteries

PURPOSE: Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions. MATERIALS AND METHODS: Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed. RESULTS: Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group. CONCLUSION: Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity.
Anemia, Neonatal/complications/*therapy ; Birth Weight ; Erythrocyte Transfusion/*adverse effects ; Gestational Age ; Hemoglobins/metabolism ; Humans ; Infant, Newborn ; *Infant, Premature ; *Infant, Very Low Birth Weight ; Retrospective Studies ; Risk Factors

Purpose: The aims of this study were to test the efficacy of vapocoolant spray to decrease the symptoms associated with pain in newborns undergoing heel stick and intramuscular injection and compare the pain relief effect of oral glucose. Methods: Randomized, controlled study including sixty newborns undergoing heel stick and intramuscular injection. Group 1 was heelsticked, Group 2 was intramuscular injected, Group A did not recieve any treatment, Group B recieved 30% glucose solution orally, Group C was applied vapocoolant spray symptoms and signs associated with pain at heel stick and intramuscular injection were measured with the premature Infant Pain Profile (PIPP) scale. Results: There was no significant difference in the PIPP score between intramuscular injected group control and heel stick group control (P=0.07). The mean PIPP score of Group 1A (control) 10.6+/-2.4, Group 1B 5.5+/-2.0, Group 1C 5.2+/-1.8. The mean PIPP score 1B and 1C were significantly lower than control (1B P<0.001, 1C P<0.001). The mean PIPP score of Group 2A (control) 12.5+/-1.4, Group 2B 7.0+/-1.7, Group 2C 6.4+/-1.6. The mean PIPP score 2B and 2C were significantly lower than control (2B P<0.001, 2C P<0.001). Conclusion: The antinociceptive effect of vapocoolant sparay is as effective as 30% oral glucose solution for pain control. So this study support the use of vapocoolant spray for reducing pain during painful procedure in the neonatal intensive care units.
Glucose ; Heel ; Humans ; Infant, Newborn ; Infant, Premature ; Injections, Intramuscular ; Intensive Care Units, Neonatal

The 1q terminal deletion syndrome is a rare chromosomal disorder which was first reported by Mankinen et al. in 1976. This disorder has shown to have broad and diverse clinical phenotypes. Specific phenotypes of 1q terminal deletion syndrome include microcephaly, seizures, psychomotor retardation, growth retardation, abnormalities of extremities, corpus callosum, heart and genitalia. Although this disorder has diverse clinical manifestations, almost all cases of 1q44 deletion syndrome have growth, psychomotor, and mental retardation and progressive microcephaly. The first diagnosis of 1q44 deletion syndrome in Korea was made by fluorescent in situ hybridization analysis in a 4-month-old girl with craniofacial anomalies, multiple congenital anomalies, and growth and psychomotor retardation. We report the second domestic case of 1q44 deletion syndrome with cleft palate, facial dysmorphism, single umbilical artery, foot abnormality, progressive microcephaly, growth and psychomotor retardation which was confirmed by microarray for comparative genomic hybridization. We also compare this case with previously reported cases of 1q44 deletion syndrome.
Chromosome Disorders ; Chromosomes, Human, Pair 1 ; Cleft Palate ; Comparative Genomic Hybridization ; Corpus Callosum ; Developmental Disabilities ; Diagnosis ; Extremities ; Female ; Foot ; Genitalia ; Heart ; Humans ; In Situ Hybridization, Fluorescence ; Infant ; Intellectual Disability ; Korea ; Microcephaly* ; Oligonucleotide Array Sequence Analysis ; Phenotype ; Seizures ; Single Umbilical Artery

PURPOSE: The purpose of this study was to investigate the clinical features of neonatal seizures and to identify prognostic factors of neurodevelopmental outcome in term infants who experienced clinical seizures. METHODS: A retrospective analysis was performed on 153full term and preterm infants with seizures from January 2008 to December 2013. Binary logistic regression analysis was applied to assess risk factors associated with neurological adverse outcomes using variables that were found to be significant on univariate analysis. RESULTS: During the study period, 102 (66.7%) term and 51 (33.3%) preterminfants were enrolled. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (24.5%) in term infants and intracranial hemorrhage (74.5%) in preterm infants. The most common type of seizure was focal clonic seizure. Generalized tonic seizure was more commonly observed in preterm than in term infants. 39 out of 56 term infants with at least 12 months of neurologic follow-up showed normal outcomes while only one preterm infant showed normal development.Prognostic factors related to adverse neurodevelopmental outcomes in term infants were perinatal history of fetal distress, etiology of hypoxic ischemic encephalopathy, severity of EEG(Electroencephalogram) abnormality, evidence of hypoxic ischemic encephalopathy on brain magnetic resonance imaging, and the need for multiple antiepileptic drugs for seizure control. CONCLUSION: Preterm infants showed poorer neurodevelopmental outcomes compared to term infants. The etiology of seizures, treatment response, neuroimaging and electroencephalographic findings were important in predicting the developmental outcome in term infants with seizures.
Anticonvulsants ; Brain ; Epilepsy, Partial, Motor ; Fetal Distress ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; Logistic Models ; Magnetic Resonance Imaging ; Neuroimaging ; Prognosis ; Retrospective Studies ; Risk Factors ; Seizures*

During summer and fall months (from June to November), enteroviral infection is more common than group B streptococcal infection or herpes simplex viral infection in neonates. Enteroviruses are divided into polioviruses, coxsackieviruses A, coxsackieviruses B, and echoviruses. Enteroviruses can cause a wide spectrum of acute illnesses ranging from non-specific febrile illness, upper respiratory tract infection or gastroenteritis, to severe diseases such as myocarditis, and encephalitis. Coxsackieviruses B are important neonatal pathogens, which can cause meningoencephalitis, disseminated intravascular coagulopathy, and cardiomyopathy. Transplacental transmission of coxsackievirus or perinatal transmission by inhalation or swallowing of cervical secretion or feces during delivery causes more severe diseases than postnatal transmission by horizontal transmission in nursery or neonatal intensive care unit, due to larger load of viruses. Four preterm infants had severe coxsackieviral B infection with thrombocytopenia, meningitis, disseminated intravascular coagulopathy, and myocarditis within seven days of age during this June. Coxsackieviruses B were detected from their feces, cerebrospinal fluid, and blood. Viruses might be transmitted prenatally through placenta from mother to fetus, which caused severe disease. Coxsackieviruses B infections have to be considered in the neonates with sepsis-like illness during summer and fall months, or enteroviral seasons.
Cardiomyopathies ; Cerebrospinal Fluid ; Deglutition ; Encephalitis ; Enterovirus ; Enterovirus B, Human ; Feces ; Fetus ; Gastroenteritis ; Herpes Simplex ; Humans ; Infant, Newborn ; Infant, Premature ; Inhalation ; Intensive Care, Neonatal ; Meningitis ; Meningoencephalitis ; Mothers ; Myocarditis ; Nurseries ; Placenta ; Poliovirus ; Respiratory Tract Infections ; Seasons ; Streptococcal Infections ; Thrombocytopenia

PURPOSE: This study investigated the effects of early enteral feeding on the morbidities of extremely low birth weight infants (ELBWI) weighing less than 1,000 g. METHODS: We conducted a retrospective review of the medical records of sixty one ELBWI who were admitted to the neonatal intensive care unit of Inje University Busan Paik Hospital from January 2007 to October 2009. ELBWI were divided into two groups; the control group included ELBWI from January 2007 to March 2008, for whom enteral feeding was started beyond 3 days and the early feeding group included ELBWI from April 2008 to October 2009, for whom enteral feeding was started within 3 days. RESULTS: Gestational age and birth weight did not differ between the two groups. In the early feeding group, start day of enteral feeding (control group vs. early feeding group; 7+/-2days vs. 2+/-1days), time to achieve full enteral feeding (68+/-6 days vs. 22+/-2 days), and the duration of parenteral nutrition (58+/-6 days vs. 22+/-2 days) were significantly shorter, and weight gain at postnatal day 28 was significantly higher than that of the control group (P<0.001). No differences were observed in the incidence of sepsis and necrotizing enterocolitis and duration of hospitalization; however, the incidence of total parenteral nutrition induced cholestasis (44% vs. 7%) and bronchopulmonary dysplsia (78% vs. 24%) was significantly lower in the early feeding group. CONCLUSION: Early enteral feeding in ELBWI shortened the time to achieve full enteral feeding, improved weight gain, and decreased the incidence of brochopulmonay dysplasia and cholestasis.
Birth Weight ; Cholestasis ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Retrospective Studies ; Sepsis ; Weight Gain