No abstract available.
Humans ; Infant* ; Infant, Very Low Birth Weight* ; Lung Diseases* ; Lung* ; Vitamin A* ; Vitamins*

OBJECTIVES: To investigate the validity of newborn hearing screening protocol using automated auditory brainstem response (AABR) with a confirmation method using click auditory brainstem response (ABR) and to evaluate changes in hearing status of infants with confirmed congenital hearing loss. METHODS: Neonates in the well-baby nursery were screened by staged AABR. Subjects whose final AABR result was "refer" were tested by diagnostic click ABR and 226 Hz tympanometry within 3 months of age. Changes in hearing status of subjects with confirmed hearing loss were analyzed by follow-up ABR at 3-6 month intervals. RESULTS: Of the 12,193 healthy babies born during this period, 10,879 (89.22%) were screened by AABR. Of 10,879 neonates screened by AABR, 148 (1.36%) were "referred"; of these, 45 subjects showed ABR thresholds over 30 dB nHL in at least one ear. Thirty-four subjects underwent serial follow-up ABR tests, with 11 (32.4%) found to have normal ABR thresholds. Most subjects with mild to moderate hearing loss were found to be normal before 1 year of age, whereas all infants with severe or profound hearing loss were identified as having congenital hearing loss. CONCLUSION: The referral rate and the positive predictive value of our protocol were acceptable. We have also found here that substantial temporary hearing loss can be included in the first confirmative diagnosis. Temporary hearing loss of our study on follow-up give emphasis to need of further differentiation using the testing for bone conduction and middle ear status.
Acoustic Impedance Tests ; Bone Conduction ; Ear ; Ear, Middle ; Evoked Potentials, Auditory, Brain Stem ; Follow-Up Studies ; Hearing ; Hearing Loss ; Hearing Tests ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Neonatal Screening ; Nurseries ; Referral and Consultation

This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage > or = 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage > or = 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage > or = 3 in VLBW infants.
Antibodies/therapeutic use ; Birth Weight ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; *Infant, Very Low Birth Weight ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Retinopathy of Prematurity/drug therapy/*epidemiology/mortality ; Retrospective Studies ; Risk Factors ; Vascular Endothelial Growth Factor A/immunology

Methotrexate (MTX) is used in the reproductive aged females for the management of medical conditions such as ectopic pregnancy, autoimmune diseases and malignancies. Because of its antimetabolite effect, exposure to MTX during the fetal period can cause multiple anomalies. The most common anomalies related to intrauterine MTX exposure include growth retardation, craniofacial dysmorphism, central nervous system anomalies, cardiac anomalies and skeletal defects. We report a premature baby boy born after 27(+5) weeks of gestation who presented intrauterine growth restriction, single umbilical artery, small chest and anomalies of rib and thoracic vertebra. His mother had received 50 mg of MTX for the treatment of misdiagnosed ectopic pregnancy at 5th week of gestation. During the hospitalization, he was ventilator dependent and pulmonary hypertension persisted despite medical treatment including nitric oxide and sildenafil. Open lung biopsy revealed nonspecific findings suggestive of lung hypoplasia. He died at 141 days after birth due to respiratory failure.
Aged ; Autoimmune Diseases ; Biopsy ; Central Nervous System ; Female ; Hospitalization ; Humans ; Hypertension, Pulmonary ; Infant, Newborn ; Infant, Premature ; Lung ; Methotrexate ; Mothers ; Nitric Oxide ; Parturition ; Piperazines ; Pregnancy ; Pregnancy, Ectopic ; Purines ; Respiratory Insufficiency ; Ribs ; Single Umbilical Artery ; Spine ; Sulfones ; Thorax ; Ventilators, Mechanical ; Sildenafil Citrate

OBJECTIVES: To determine the clinical characteristics and perinatal risk factors of infants with bronchopulmonary dysplasia (BPD) among premature infants less than 32 weeks' gestation and access the role of ventilatory indices and maternal factors that may predispose preterm infants to the development of chronic lung disease (CLD). 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, 58 (27.4%) had CLD. Predisposing neonatal factors for developing CLD included lower gestational age, lower birth weight, Apgar score at 1 and 5 minute, occlusion of PDA after day 4 of age, birth weight nadir and the duration reached to it, serum level of total white blood cell (WBC) at birth, and the level of IgM over 30 mg/dL within 7 days after birth. Maternal factors for developing CLD in their infants included maternal age, mode of delivery, use of antenatal corticosteroid, and the level of WBC count in amniotic fluid (>50/mm3). FiO2 at day 2, PIP at day 2-7 and 10, MAP at day 2, 3, 5 and 10, and oxygenation index at day 2, 3, 5-7, and 10 were significant risk factors in development of CLD. Furthermore, PIP per birth weight, MAP per birth weight, and modified oxygenation index far better predicted the development of CLD than PIP, MAP and oxygenation index per se at any ages of all infants included in the study. CONCLUSION: In addition to neonatal factors, maternal factors including age, mode of delivery, use of antenatal corticosteroid, and the level of WBC count in amniotic fluid (>30/mm3) can be used as risk factors in predicting the development of CLD in their infants. Variable ventilatory indices (PIP, MAP, oxygenation index) in relation to birth weight could better predict the development of CLD in infants less than 32 weeks' gestation.
Amniotic Fluid ; Apgar Score ; Birth Weight ; Bronchopulmonary Dysplasia* ; Female ; Gestational Age ; Humans ; Immunoglobulin M ; Infant ; Infant, Newborn ; Infant, Premature* ; Leukocytes ; Lung Diseases ; Maternal Age ; Mothers ; Oxygen ; Parturition ; Pregnancy* ; Retrospective Studies ; Risk Factors*

PURPOSE: To determine whether serum uric acid levels in the first 7 days of life can predict development of severe intraventricular hemorrhage (IVH) among very low birth weight (VLBW) infants. METHODS: VLBW infants admitted to the neonatal intensive care unit of Asan Medical Center between January 2009 and December 2012 were selected for chart review. Infants were divided into groups with and without severe IVH (grade> or =3). To determine whether uric acid is a predictor of severe IVH, uric acid levels on the first day (within 24 hours of birth), peak uric acid levels (during the first 7 days for infants without severe IVH, prior to IVH documentation by cranial sonogram for infants with severe IVH, and trend in uric acid levels were analyzed for both groups. Various antenatal and postnatal factors were compared between the groups, and risk factors associated with severe IVH were identified. RESULTS: A total of 397 VLBW infants were included, with mean birth weight of 1,075+/-292 g and a mean gestational age of 29.6+/-3.3 weeks. Higher levels of uric acid on day 1, higher peak levels, and rising uric acid levels were all found to be associated with the development of severe IVH on univariate analysis. Multivariate analysis confirmed that rising uric acid levels predicted subsequent development of severe IVH. Other factors associated with development of severe IVH included higher sodium, higher potassium, higher PaCO2, higher lactic acid, and lower PaO2. CONCLUSION: Careful attention to uric acid levels, which are easily measured, may be useful in predicting subsequent development of severe IVH among VLBW infants.
Birth Weight ; Chungcheongnam-do ; Gestational Age ; Hemorrhage* ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Lactic Acid ; Multivariate Analysis ; Potassium ; Risk Factors ; Sodium ; Uric Acid*

PURPOSE: The purpose of this study was to assess the efficacy of antenatal thyrotropin-releasing hormone(TRH) given to mothers at risk for preterm delivery and assess various neonatal outcomes in infants born to these mothers. METHODS: Sixty-one mothers(TRH+Dexamethasone(D):30, D:31) with preterm labor at 26-34 weeks of gestational age were randomized into a study group which received 400microgram of TRH at 8 hour interval intravenously(maximum doses of 6) along with 6 mg of D at 12 hour interval intravenously(maximum doses of 4) and into a control group that received the same regimen of D only. Among 61 mothers, 17 mothers(TRH+D:8, D:9) underwent amniocentesis to document changes in L/S ratio and lamellar body count before and after TRH and or D therapy. Thyroid function tests(TFT's) were obtained from infants born at/shortly after birth, near first week and second week of life. RESULTS: Incidences of respiratory distress syndrome(42% vs 30%) and chronic lung disease(56% vs 44%) were not statistically different between the two groups. In fact, greater risk for ventilation at 28 days was observed in infants born within 24 hours of TRH treatment. All other neonatal outcomes except pulmonary hemorrhage(0% vs. 16%) were similar between TRH+D and D groups. TFT of infants born to mothers who received the last mean duration of TRH at 178 hours were similar between the two groups. CONCLUSION: Antenatal administration of TRH in addition to D did not have any additional beneficial effects compared to giving D alone.
Amniocentesis ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Lung ; Mothers ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Thyroid Gland ; Thyrotropin-Releasing Hormone* ; Ventilation

PURPOSE: To determine incidence, characteristics and risk factors associated with delayed intraventricular hemorrage (IVH) in infants under 34 weeks old. METHODS: The medical records of infants with IVH admitted to neonatal intensive care unit of Asan Medical Center from January 1999 to December 2001 were reviewed retrospectively. Infants whose IVH was detected within 7 days of life and after 21 days of life were defined as "early hemorrahge group" and "delayed hemorrhage group", respectively. Various antenatal and neonatal factors were compared between these groups and risk factors leading to delayed IVH were identified. RESULTS: The incidence of delayed IVH was 28/103 (27.2%). The mean gestational age in delayed hemorrhage was 29.2+/-2.8 weeks. Lower birth weight, higher use of postnatal dexamethasone, antenatal dexamethasone and umbilical venous lines were noted in delayed hemorrhage group. Laboratory values associated with delayed IVH included lower platelet counts and hematocrit. Risk factors associated with delayed IVH included low hematocrit and elevated uric acid. Severe IVH (grade III, IV) occurred more in early hemorrhage group and subsequent 12 months follow-up showed developmental delay in 3 (4.0%) and 1 (3.6%) in early and delayed hemorrhage group, respectively. CONCLUSION: Frequent delayed hemorrhage may occur in infants under 34 weeks old. Although degree of delayed IVH is relatively milder than early hemorrhage group, its association with developmental delay merits follow-up head ultrasonogram up to at least 1 month of age or even longer.
Birth Weight ; Chungcheongnam-do ; Dexamethasone ; Follow-Up Studies ; Gestational Age ; Head ; Hematocrit ; Hemorrhage* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Medical Records ; Platelet Count ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Uric Acid

PURPOSE: To determine incidence, characteristics and risk factors associated with delayed intraventricular hemorrage (IVH) in infants under 34 weeks old. METHODS: The medical records of infants with IVH admitted to neonatal intensive care unit of Asan Medical Center from January 1999 to December 2001 were reviewed retrospectively. Infants whose IVH was detected within 7 days of life and after 21 days of life were defined as "early hemorrahge group" and "delayed hemorrhage group", respectively. Various antenatal and neonatal factors were compared between these groups and risk factors leading to delayed IVH were identified. RESULTS: The incidence of delayed IVH was 28/103 (27.2%). The mean gestational age in delayed hemorrhage was 29.2+/-2.8 weeks. Lower birth weight, higher use of postnatal dexamethasone, antenatal dexamethasone and umbilical venous lines were noted in delayed hemorrhage group. Laboratory values associated with delayed IVH included lower platelet counts and hematocrit. Risk factors associated with delayed IVH included low hematocrit and elevated uric acid. Severe IVH (grade III, IV) occurred more in early hemorrhage group and subsequent 12 months follow-up showed developmental delay in 3 (4.0%) and 1 (3.6%) in early and delayed hemorrhage group, respectively. CONCLUSION: Frequent delayed hemorrhage may occur in infants under 34 weeks old. Although degree of delayed IVH is relatively milder than early hemorrhage group, its association with developmental delay merits follow-up head ultrasonogram up to at least 1 month of age or even longer.
Birth Weight ; Chungcheongnam-do ; Dexamethasone ; Follow-Up Studies ; Gestational Age ; Head ; Hematocrit ; Hemorrhage* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Medical Records ; Platelet Count ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Uric Acid

PURPOSE: To investigate the relationship between placental pathology and neurodevelopmental outcomes among extremely low birth weight (ELBW) infants. METHODS: Pathology of placentas from ELBW infants born at a tertiary neonatal intensive care unit from January 2007 to December 2012 were reviewed and placental histology was grouped into 3 categories by a designated pathologist: acute chorioamnionitis (ACA), maternal vascular underperfusion (MVU), and control group. Matched ELBW infants were tested for significant neurodevelopmental delays defined as mental developmental index (MDI) or psychomotor developmental index (PDI) <70, using Bayley Scales of Infant Development-II (BSID-II). RESULTS: The mean gestational age and birth weight of 175 infants were 27.1+/-2.5 weeks and 764.7+/-152.3 g respectively. Placental histology revealed MVU (48.0%), ACA (25.1%) and control (26.9%) in distribution. There were less significant patent ductus arteriosus in MVU group than in control group [adjusted odds ratio (OR)=0.331, P=0.011]. The frequencies of other neonatal diseases and mortality were similar in 3 groups. Sixty four of 175 infants were examined for BSID-II at mean corrected 19.9+/-3.2 months. MVU was associated with significant mental developmental delay (OR=5.185, P=0.036), but after adjustment for head circumference/weight at birth, the statistically significance of association disappeared (adjusted OR=4.391, P=0.075). ACA did not affect neonatal and neurodevelopmental outcomes. CONCLUSION: The result of placenta biopsy could be a useful tool in counseling parents for future neurodevelopmental outcome, however, further studies are required to define definitive association in between placenta biopsy and neurodevelopmental outcomes.
Biopsy ; Birth Weight ; Chorioamnionitis ; Counseling ; Ductus Arteriosus, Patent ; Female ; Gestational Age ; Head ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Mortality ; Odds Ratio ; Parents ; Parturition ; Pathology* ; Placenta ; Pregnancy ; Weights and Measures