PURPOSE: The unique nutrient requirements of premature infants necessitate knowledge of the composition of human milk produced by mothers of such infants. We investigated longitudinal changes in iron concentration of preterm human milk and compared to those observed in human milk of mothers of 1-week old term infants to determine optimal iron supplementation guidelines when preterm infants are nourished exclusively by breast feeding. METHODS: Human milk samples were collected at 1, 2, 4, 6, 8 and 12 weeks postpartum from 103 mothers who delivered infants of gestational age <34 weeks or weighing <1,800 g. Term human milk samples were collected at 1 week postpartum from 24 mothers. RESULTS: There were no significant differences in the iron concentrations of preterm human milk obtained at 2 to 8 weeks postpartum (36.3+/-23.1 to 45.8+/-26.0 microg/dL), but these concentrations were higher than those noted at 1 week in preterm (23.1+/-14.6 microg/dL) and term (25.2+/-7.55 microg/dL) infants. The iron concentration in preterm human milk obtained at corrected term age (42.2+/-19.4 microg/dL) was significantly higher than that of mature term human milk (25.2+/-7.55 microg/dL). CONCLUSION: The concentration of iron in preterm human milk was consistently low during the first 3 months of lactation. Supplementation with iron of at least 2 mg/kg/day should be considered for preterm infants who are exclusively breastfed and who have low body iron stores, to meet the minimum enteral iron requirements recommended by AAP-CON (2004).
Breast ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Iron ; Lactation ; Longitudinal Studies ; Milk, Human ; Mothers ; Postpartum Period ; Premature Birth ; Term Birth

PURPOSE: Although infants with bronchopulmonary dysplasia (BPD) are at risk of developing secondary pulmonary hypertension (PH), which is associated with significant morbidity and mortality, little has been reported about the incidence, clinical course and prognosis of PH secondary to BPD in premature infants. This study was done to investigate the incidence, risk factors, clinical course, and the ultimate prognosis of PH developed secondary to BPD in very low birth weight infants (<1,500 g). METHODS: Medical records of very low birth weight infant (VLBWI) admitted to Samsung Medical Center NICU from January 2000 to July 2007 were reviewed retrospectively. BPD was defined by Jobe's classification. The diagnosis of pulmonary hypertension was established as velocity of tricuspid valve regurgitation (TR) > or =3 m/s and a flattening of the intraventricular septum by conducting Doppler echocardiography. RESULTS: The incidence of pulmonary hypertension was 6% in VLBWI with BPD and it developed in moderate to severe BPD. The diagnosis of pulmonary hypertension was made on postnatal 133 days (range 40-224 days) and the risk factors related to developing pulmonary hypertension were severe BPD, small for gestational age and outborn infants. The mortality rate was 57% and especially higher in severe BPD (70%). The time to recovery spent 3 months (range 1-10 months) in survived patients. CONCLUSION: Based on the results of this research, pulmonary hypertension secondary to BPD in VLBWI related to severity of BPD and had a poor prognosis. We expect that regular long-term echocardiography may be helpful in treating reversible in VLBWI with moderate to severe BPD.
Bronchopulmonary Dysplasia ; Echocardiography ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Medical Records ; Prognosis ; Retrospective Studies ; Risk Factors ; Tricuspid Valve Insufficiency

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; <1,250 g) infants. METHODS: We retrospectively reviewed the medical records of 55 VLBW infants admitted between January 2006 and December 2009 to the neonatal intensive care unit of Wonkwang University Hospital and who survived over 7 days. Serum sodium concentration, sodium intake, fluid and weight loss, as suggested risk factors of hypernatremia, and the incidence of IVH were evaluated. The infants were divided into a hypernatremia group (> or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.
Hemorrhage ; Humans ; Hypernatremia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Parturition ; Retrospective Studies ; Risk Factors ; Sodium ; Weight Loss

PURPOSE: This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes. METHODS: Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively. RESULTS: Gestational age was 27.8+/-2.5 weeks and birth weight was 1,110+/-307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19+/-7 day, 30.6+/-2.4 weeks, 1,285+/-365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2+/-0.7 days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6+/-4.1 mg/dL. Mean blood pressure increased from 25.0+/-5.4 mmHg to 35.0+/-5.3 mmHg, 38.3+/-8.0 mmHg and 41.9+/-6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9+/-0.6 mL/kg/hr to 4.1+/-3.4 mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0+/-2.9 microg/kg/min to 8.0+/-2.3 microg/kg/min, and to 5.5+/-3.4 microg/kg/min after 24 hours. Serum sodium concentration was increased from 130+/-4 mEq/L to 136+/-4 mEq/L, serum potassium concentration was decreased from 6.1+/-1.1 mEq/L to 4.6+/-0.6 mEq/L before and 12 hours after hydrocortisone administration. CONCLUSION: In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.
Adrenal Insufficiency ; Birth Weight ; Blood Pressure ; Cardiovascular System ; Dopamine ; Gestational Age ; Humans ; Hydrocortisone ; Hypotension ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Potassium ; Sodium

PURPOSE: The object of this study was to evaluate the efficacy of early total parenteral nutrition with early amino acid in extremely low birth weight infant (ELBWI). METHODS: We retrospectively analyzed the medical records of all ELBWIs who were born and admitted to Samsung Medical Center from January 2003 to December 2003 and January 2009 to December 2009 and alive at the time of discharge. Data for nutritional status and morbidities were compared between period 1 (2003, n=22), in which parenteral nutritional support was started gradually over several days and period 2 (2009, n=38), in which parenteral nutrition with amino acid was started as soon as possible after birth. RESULTS: Compared to period 1, birth weight and Apgar score were lower in period 2. The intake amount of glucose, amino acid and total calorie was higher and the level of blood urea nitrogen was increased more from 7th day to 14th day after birth in period 2 when compared than period 1. The weight gain velocity was faster at 7th and 14th postnatal day in period 2. There were no differences in the incidence of necrotizing enterocolitis, moderate to severe bronchopulmonary dysplasia, and severe intraventricular hemorrhage (> or = Gr III) between two periods but, the incidence of periventricular leukomalacia(PVL) was significantly lower in period 2. CONCLUSION: Early initiation of total parenteral nutrition with early amino acid in ELBWIs was beneficial at weight gain with lowering catabolism and increasing anabolism. And it could be related with reducing the incidence of PVL.
Apgar Score ; Birth Weight ; Blood Urea Nitrogen ; Bronchopulmonary Dysplasia ; Enterocolitis, Necrotizing ; Glucose ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Parturition ; Retrospective Studies ; Weight Gain

PURPOSE: Recently, the incidence of preterm and low birth weight infants (LBWI) is increasing, even though the birth rate is continuously low in Korea. Despite that change, there continues to be a deficit of beds in the neonatal intensive care unit (NICU). This study is based on the 2009 Korean Statistical Information Service that examined the development of a Korean NICU service and the survival rate of preterm infants by regionally analyzing the rate of total live births, preterm infants, LBWI, and NICU beds in Korea. METHODS: Data were obtained from the Korean Health Insurance Review and Assessment Service and Korean Statistical Information Service. We confirmed the regional total live birth rate, number of LBWI, and preterm infants and NICU numbers, and all of the results were compared to the average value to determine deficient areas of NICU beds. RESULTS: There were 25,374 (5.7%) preterm infants and 21,954 (4.9%) LBWI in the total number of live births (444,849) in 2009, and regions of high proportion compared to the mean value were Busan, Daegu, and Ulsan. Total NICU beds totaled 1,284, and regions of high rates preterm infants and LBWI per 1 NICU bed compared to the mean value were Incheon, Daegu, Ulsan, etc. The NICU holding rate was 87.5% (1,284/1,468), which was increased from 2005. However, there were still shortages of 184 NICU beds (12.5%), especially in Gyeonggi-do, which lacked 157 beds. CONCLUSION: High risk neonates difficult to transfer, and they need immediate and continuous treatment. As a result, a foundation of well-balanced, national NICU regionalization is necessary. This study suggested that more NICU facilities must be implemented, and clinicians should realize the continuing deficiency of NICU beds in cities and provinces.
Birth Rate ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Information Services ; Insurance, Health ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Korea ; Live Birth ; Survival Rate

PURPOSE: Current studies have demonstrated the neuroprotective effects of 6-cyano-7-nitroquinoxalin-2,3-dione (CNQX) in many animal models of brain injury, including hypoxic-ischemic (HI) encephlopathy, trauma and excitotoxicity, but limited data are available for those during the neonatal periods. Here we investigated whether CNQX can protect the developing rat brain from HI injury via mediation of nitric oxide synthase. METHODS: In an in vivo model, left carotid artery ligation was done in 7-day-old Sprague-Dawley (SD) rat pups. The animals were divided into six groups; normoxia (N), hypoxia (H), hypoxia with sham-operation (HS), hypoxia with operation (HO), HO treated with vehicle (HV), and HO treated with CNQX at a dose of 10 mg/kg (HC). Hypoxia was made by exposure to a 2 hr period in the hypoxic chamber (92% N2, 8% O2). In an in vitro model, embryonic cortical neuronal cell culture of SD rats at 18-day gestation was done. The cultured cells were divided into three groups: normoxia (N), hypoxia (H), and hypoxia treated with CNQX (HC). The N group was prepared in 5% CO2 incubators and the other groups were placed in 1% O2 incubators (94% N2, 5% CO2) for 16 hr. RESULTS: In the in vitvo and in vivo models, the expressions of iNOS and eNOS were reduced in the hypoxia group when compared to the normoxia group, whereas they were increased in the CNQX-treated group compared to the hypoxia group. In contrast, the expression of nNOS was showed reversely. CONCLUSION: CNQX has neuroprotective property over perinatal HI brain injury via mediation of nitric oxide synthase.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Animals ; Anoxia ; Brain ; Brain Injuries ; Brain Ischemia ; Carotid Arteries ; Cell Culture Techniques ; Cells, Cultured ; Incubators ; Ligation ; Models, Animal ; Negotiating ; Neurons ; Neuroprotective Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Pregnancy ; Rats

PURPOSE: The purpose of this study was to evaluate the relationship between cord blood adiponectin and insulin-like growth factor (IGF)-I and their effect on fetal growth and insulin resistance in mothers with gestational diabetes mellitus (GDM). METHODS: Cord blood adiponectin and IGF-I were compared between mothers with GDM (GDM group, N=53) and controls (non-GDM group, N=101). Neonates were classified into three groups of small for gestational age (SGA, N=26), appropriate for gestational age (AGA, N=97), and large for gestational age (LGA, N=31) by birth weight. The association between cord adiponectin and IGF-I levels was evaluated in relation to maternal and neonatal clinical data. RESULTS: Cord adiponectin was lower in the GDM group than in the non-GDM group (P<0.001). There was no significant difference in cord adiponectin among the SGA, AGA, and LGA groups in the GDM group (P=0.228). The cord adiponectin of AGA in the GDM group was significantly lower than that in the non-GDM group (P<0.001). The most powerful predictor affecting cord adiponectin was the result of maternal 75 g oral glucose tolerance test. The cord IGF-I values between the GDM group and the non-GDM group were not different (P=0.834). Neonates with the heavier birth weight had the higher cord IGF-I levels. The most powerful predictor affecting cord IGF-I was birth weight and the next was maternal parity. CONCLUSION: Both cord blood adiponectin and IGF-I were associated with fetal growth, but IGF-I was a more general and direct factor affecting fetal body size, and adiponectin seemed to have more association with insulin sensitivity than growth.
Adiponectin ; Birth Weight ; Body Size ; Diabetes, Gestational ; Female ; Fetal Blood ; Fetal Development ; Gestational Age ; Glucose Tolerance Test ; Humans ; Infant, Newborn ; Insulin Resistance ; Insulin-Like Growth Factor I ; Mothers ; Pregnancy

PURPOSE: Several factors including prolonged inflammatory response are thought to contribute to the pathogenesis of bronchopulmonary dysplasia (BPD). The clinical findings can be explained by an increased production of proinflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha). We investigated the relationship between susceptibility to BPD and TNF-alpha promoter polymorphisms to identify genetic factors of the disease. METHODS: Thirty-eight preterm infants who had developed BPD and 55 controlled infants with a birth weight <1,500 g were analyzed for TNF-alpha genotypes. The alleles of five promoter sites (-1031/-863/-857/-308/-238) of TNF-alpha gene were determined using Taqman(R)-based allelic discrimination assays. RESULTS: Gestational age (27(+5)+/-2(+0) wk vs. 29(+2)+/-1(+4) wk, P<0.0001) and birth weight (990+/-270 g vs. 1,220+/-230 g, P<0.0001) were lower in the BPD group compared to the control group. The incidence of respiratory distress syndrome (71.1% vs. 49.1%, P=0.035) and patent ductus arteriosus (71.1% vs. 50.9%, P=0.052) was higher in the BPD group compared to the control group. The frequencies of the alleles and genotypes of five promoter sites (-1031/-863/-857/-308/-238) of TNF-alpha gene did not show differences between the BPD group and the control group. CONCLUSION: TNF-alpha promoter polymorphisms are not associated with susceptibility to BPD in Korean preterm infants.
Alleles ; Birth Weight ; Bronchopulmonary Dysplasia ; Cytokines ; Discrimination (Psychology) ; Ductus Arteriosus, Patent ; Genotype ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Polymorphism, Genetic ; Tumor Necrosis Factor-alpha

Neonatal coagulation disorders and thromboembolism require timely management. Failure to treat these conditions at the appropriate time may lead to death or the development of significant long-term sequelae. However, most current guidelines for managing neonatal coagulation disorders and thromboembolism are empiric and not based on randomized clinical trials. Thus, it is not easy to choose an appropriate management strategy for these conditions in clinical settings. In this review, therapeutic guidelines currently utilized in clinics and novel therapeutic options still under investigation are presented and reviewed.
Humans ; Infant, Newborn ; Thromboembolism ; Thrombolytic Therapy