Acute kidney injury (AKI), formerly referred to as acute renal failure (ARF) is defined as the sudden impairment of kidney function (estimated from the glomerular filtration rate [GFR]) that results in the lack of excretion of waste products. More than 30 definitions of AKI exist in the literature, most of which are based on serum creatinine. Lack of a uniform and multidimensional AKI definition has led to failure to recognize significant renal injury, delays in treatment, and inability to generalize single-study results. The RIFLE criteria were developed to standardize the diagnosis of ARF and in the process the term AKI has been proposed to encompass the entire spectrum of the syndrome from minor changes in renal function to requirement for renal replacement therapy. Large prospective studies are needed to test definitions and to better understand risk factors, incidence, independent outcomes, and mechanisms that lead to poor short- and long-term outcomes. Early biomarkers of AKI need to be explored in critically ill neonates.
Acute Kidney Injury ; Biomarkers ; Creatinine ; Critical Illness ; Glomerular Filtration Rate ; Humans ; Incidence ; Infant, Newborn ; Kidney ; Renal Replacement Therapy ; Risk Factors ; Waste Products

Metabolic acidosis is commonly encountered issues in the management of critically ill neonates and especially of preterm infants during early neonatal days. In extremely premature infants, low glomerular filtration rate and immaturity of renal tubules to produce new bicarbonate causes renal bicarbonate loss. Higher intake of amino acids, relatively greater contribution of protein to the energy metabolism and mineralization process in growing bones are also responsible for higher acid load in premature infant than in adult. Despite widespread use of sodium bicarbonate in the management of severe metabolic acidosis, use of sodium bicarbonate in premature infants should be restricted to a reasonable but unproven exception such as ongoing renal loss. Despite concern about the low pH value (<7.2) which can compromise cellular metabolic function, no treatment guideline has been established regarding the management of metabolic acidosis in premature infants. Appropriately powered randomized controlled trials of base therapy to treat metabolic acidosis in critically ill newborn infants are demanding.
Acid-Base Equilibrium ; Acid-Base Imbalance ; Acidosis ; Adult ; Amino Acids ; Critical Illness ; Energy Metabolism ; Glomerular Filtration Rate ; Humans ; Hydrogen-Ion Concentration ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature ; Sodium Bicarbonate

PURPOSE: This study was designed to evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. METHODS: Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration > or =13.0 mg/dL) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied : group A, formula-fed infants; group B, breast-fed infants; group C, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentration had decreased to less than 10.0 mg/dL. RESULTS: A total of 163 infants were studied. Phototherapy was highly effective in reducing the bilirubin concentration in all three groups, however, its efficacy of in group B was poorer compared with the other two groups. The duration of photopherapy and weight loss during phototherapy were not significantly different in the three groups. Decrease rates of bilirubin concentration during phototherapy in group A and C were significantly faster than that of group B. CONCLUSION: The response to phototherapy of group B infants was significantly slower than those of group A and C infants. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast feeding, would enhance the efficacy of phototherapy and reduce exposure time.
Bilirubin ; Breast Feeding ; Humans ; Hyperbilirubinemia* ; Hyperbilirubinemia, Neonatal ; Infant* ; Milk, Human ; Parturition ; Phototherapy* ; Weight Loss

PURPOSE: Spontaneous neonatal gastric perforation is a rare neonatal event which is associated with high mortality. The aim of this retrospective study is to investigate the diagnosis and the treatment of neonatal spontaneous gastric perforation. METHODS: From January 1991 to December 2000, eight cases of neonatal gastric perforation were presented at Keimyung University Dongsan Medical Center. RESULTS: Among 8 neonates (7 males and 1 females), 2 were premature infants. 7 cases (87.5%) had symptoms onset in first 4 days of life. The most presenting signs were abdominal distension, vomiting, and respiratory difficulty. The most common X-ray finding was pneumoperitoneum (87.5%) and the most common site of perforation was greater curvature (75%). The combined congenital anomalies were malrotation of small intestine, teratoma, and partial duodenal obstruction. The predisposing causes may be associated with congenital intestinal anomaly, necrotizing enterocolitis, and too fast increased formula. All the cases underwent surgical repairs. The mortality rate was 37.5%, and the surgical procedure performed 24 hours after presumed disease onset represented poor outcome (mortality rate 67%). CONCLUSION: This report suggests that early diagnosis and early management before clinical deterioration of metabolic status may improve the prognosis for neonatal spontaneous gastric perforation patient.
Diagnosis ; Duodenal Obstruction ; Early Diagnosis ; Enterocolitis, Necrotizing ; Humans ; Infant, Newborn ; Infant, Premature ; Intestine, Small ; Male ; Mortality ; Pneumoperitoneum ; Prognosis ; Retrospective Studies ; Teratoma ; Vomiting

PURPOSE: Recently, Candida has become an increasingly significant neonatal pathogen, and may result in serious morbidity and mortality in the neonatal intensive care units. The purpose of this study was to describe and analyze our 8-year experiences with a review of the related literature, and to contribute to the improvement of the survival rate in the neonatal intensive care unit. METHODS: We retrospectively reviewed the medical records of 20 patients who were diagnosed as systemic candidiasis in the neonatal intensive care unit of Seoul National University Children's Hospital between January 1993 and December 2000. We then analyzed demographics, clinical presentations, diagnostic features, risk factors, antifungal therapy, and outcomes. RESULTS: Twenty-one systemic candidial infections occurred in 20 patients representing 0.85% of all NICU patients during the study period, among which 13 were very low birth weight (VLBW) infants (2.85% of total 456 VLBW infants). The mean gestational age and birth weight were 30.4 weeks and 1,430 gm, respectively. The common Candida species were C. albicans (61.9%), C. parapsilosis (38.1%), and the others such as C. glabrata (4.8%), C. tropicalis (4.8%), and C. famata (4.8%). The rates of culture positivity of blood, urine, and tracheal aspirates were 95.2%, 42.9%, and 9.5%, respectively. Each of candidial endocarditis, peritonitis, and renal fungus ball developed in a different patient. The most common presenting clinical signs were respiratory deterioration, abdominal distension, and apnea/bradycardia. All patients were treated with amphotericin B, alone in 9 cases or in combination with 5-flucytosine (7 cases) and with fluconazole (4 cases). Systemic candidiasis contributed to the deaths of 6 patients (30%). CONCLUSION: In the neonatal intensive care unit of Seoul National University Children's Hospital, systemic candidiasis was a serious infection associated with high mortality and the diverse clinical features. Early diagnosis and appropriate antifungal therapy, combined with the elimination of the risk factors, may guarantee lower morbidity and mortality in the neonatal systemic candidiasis.
Amphotericin B ; Birth Weight ; Candida ; Candidiasis* ; Demography ; Early Diagnosis ; Endocarditis ; Fluconazole ; Fungi ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal* ; Medical Records ; Mortality ; Peritonitis ; Retrospective Studies ; Risk Factors ; Seoul ; Survival Rate

PURPOSE: Extended spectrum beta-lactamase (ESBLs) producing Klebsiella pneumoniae has recently been increasingly responsible for infections. Considering the characteristics of the neonatal intensive care unit (NICU), the increase in such colonies is to be an important factor in the treatment and outcome of neonatal patients. Therefore, we performed this study in order to investigate the incidence of this colony and the clinical characteristics that are helpful in diagnosing these infections. METHODS: We performed a double disk synergy test and randomly amplified polymorphic DNA (RAPD) analysis of which 12 was resistant or intermediate to cefotaxime, and 4 colonies isolated from rectal swab taken in 14 patients between July and August, 1997. Also, we compared the annual isolation rate of K. pneumoniae, from those admitted to the Soonchunhyang University Chunan Hospital NICU from July, 1997 to June, 2000. We retrospectively studied the medical records and the clinical characteristics of those 79 cases from whom 110 colonies were isolated. RESULTS: From July to August, 1997, there was a K. pneumoniae outbreak in the NICU. Fifteen out of a total of sixteen isolates were positive in the double disk synergy test and turned out to be ESBL producing K. pneumoniae. Also the RAPD analysis of thirteen isolates which were from the NICU proved eleven isolates to have similar band pattern on RAPD typing. In those who were admitted to our NICU from July, 1997 to June, 2000, 110 colonies of K. pneumoniae resistant or intermediate to cefotaxime were isolated from 79 patients. Though patient group infected by the ESBLs producing K. pneumoniae had significantly no difference in gestational age or birth weight, they had a longer hospitalization period compared to the control group. CONCLUSION: It is possible that ESBLs producing K. pneumoniae be responsible for outbreaks in the NICU. The emerging of these can affect the morbidity in neonates and also can put great limits in the choice of antibiotics.
Anti-Bacterial Agents ; beta-Lactamases* ; Birth Weight ; Cefotaxime ; Chungcheongnam-do ; Disease Outbreaks ; DNA ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal* ; Klebsiella pneumoniae* ; Klebsiella* ; Medical Records ; Pneumonia ; Retrospective Studies

PURPOSE: To evaluate the function of Trp-Lys-Tyr-Met-Val-D-Met (WKYMVm) in human neonatal monocytes. METHODS: The peptide, Trp-Lys-Tyr-Met-Val-D-Met (WKYMVm), was synthesized, purified, and prepared in the Peptide Library Support Facility at Pohang University of Science and Technology. Female Sprague-Dawley rats (200+/-10 g) were preinfected with S. aureus and treated with WKYMVm through femoral vein. At various time points, blood samples were obtained by puncture of femoral artery and the serum was plated on the nutrient agar plate. The number of viable bacteria was determined by counting the number of bacterial colonies. In addition, using S. aureus and C. albicans, we evaluated the bactericidal and fungicidal activities of neonatal monocytes, which were separated from umbilical cord blood by Ficoll gradient. RESULTS: The numbers of bacteria in the blood of WKYMVm-treated rats were rapidly decreased with time, as compared with those of the untreated rats. The peptide treatment enhanced the bactericidal activity in vivo within 10 minutes. In neonatal monocytes, WKYMVm stimulated the intracellular killing of S. aureus in a dose dependent manner, showing the maximum effect at 100 nM. WKYMVm stimulated the phagocytic and fungicidal activities against C. albicans in a dose dependent manner, with the maximum effect at the 100 nM. CONCLUSION: These results suggest that WKYMVm may be an effective agent against the neonatal infections.
Agar ; Animals ; Bacteria ; Female ; Femoral Artery ; Femoral Vein ; Fetal Blood ; Ficoll ; Gyeongsangbuk-do ; Homicide ; Humans ; Monocytes* ; Peptide Library ; Punctures ; Rats ; Rats, Sprague-Dawley

PURPOSE: We investigated the factors influencing the time to reach full enteral feeding in very low birth weight infants. We compared the days of life to start tube or oral feeding, to regain birth weight, and to establish full enteral feeding in very low birth weight infants and determined the risk factors delaying full enteral feeding. METHODS: We reviewed the medical records of 214 newborn infants less than 1,500 g at birth, who were delivered at Chonnam National University Hospital from January 1, 1997 to May 31, 2000. These infants were divided into three groups by birth weight (less than 1,000 g, 1,000-1,249 g, and 1,250-1,499 g). Gestational age, birth weight, the days of life to start first tube or oral feeding, to regain bith weight and to reach full enteral feeding, and the possible risk factors delaying the progress of enteral feeding were analyzed. RESULTS: The gestational age was 29.69+/-2.33 weeks and the birth weight was 1,212+/-194.3 g. The time to start tube or oral feeding, to regain birth weight, and to establish full enteral feeding were significantly later and longer in the lower birth weight group. The time to reach full enteral feeding was related to the duration of mechanical ventilation and oxygen therapy, and was significantly longer in the infants with severe respiratory distress syndrome (RDS), chronic lung disease (CLD), apnea, intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, sepsis/disseminated intravascular coagulopathy, ricketts, and total parenteral nutrition. CONCLUSION: The time to reach full enteral feeding was inversely related to the birth weight, and the risk factors for delayed full enteral feeding were the presence and/or the severity of diseases related to the prematurity such as the duration of mechanical ventilation and oxygen therapy, RDS, CLD, apnea, IVH, and sepsis.
Apnea ; Birth Weight ; Enteral Nutrition* ; Gestational Age ; Hemorrhage ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Jeollanam-do ; Leukomalacia, Periventricular ; Lung Diseases ; Medical Records ; Oxygen ; Parenteral Nutrition, Total ; Parturition ; Respiration, Artificial ; Risk Factors ; Sepsis

PURPOSE: An online system concerning bed and equipment availability in the referral centers was developed to prevent any delay in the transport of newborn infants to a referral center with adequate equipments. METHODS: A program using web user interface was developed by Developer 2000 and Oracle database under UNIX system. The availability of equipments in the NICU, patient's medical information, user's information were included. The program was tested on the server of the Yeungnam University Medical Center with personal computers as clients. RESULTS: The program consisted of six menus : bed and equipment availability, updating the data, contact numbers, patients' informations, users informations, others. After login, availability of beds and equipments were shown according to the selected area which was chosen by the user. Phone numbers of physicians at the referral center appear on a window newly opened by clicking on the hospital name where newborn patient will be transferred. Medical information about patients can be transmitted to the referral center. The data can be updated by the webmaster of the individual hospital, and new hospital, delivery mode, treatment modality can be added by the system operator. It took 5.1+/-0.7 seconds from connection to execution of the program when it was connected through local area network in the medical center, and 10.2+/-0.2 seconds after 15+/-0.9 seconds' connection time if it was connected by 56K dial-up modem. Conclusion : This program will be very useful if connection time were shortened, and shortage of the neonatal intensive care beds nationwide were resolved.
Academic Medical Centers ; Emergency Medical Service Communication Systems ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Local Area Networks ; Microcomputers ; Modems ; Online Systems* ; Referral and Consultation* ; Transportation of Patients

Aplasia cutis congenita is a rare disorder characterized by localized or generalized absence of skin at birth. Group 4 in Friden's classification, which is associated with embryologic malformations including myelomeningocele, encephalomeningocele, omphalocele, gastroschisis. The authors have experienced a case of aplasia cutis congenita of right frontal scalp associated with bony defect, forming encephalocele in a newborn. We reported this case with brief review of literatures.
Classification ; Ectodermal Dysplasia* ; Encephalocele ; Gastroschisis ; Hernia, Umbilical ; Humans ; Infant, Newborn ; Meningomyelocele ; Parturition ; Scalp ; Skin