PURPOSE: Brain magnetic resonance imaging (MRI) scans have become increasingly popular as a predictive tool for neurodevelopmental outcome in preterm infants, while serial brain ultrasonograms remain as a standard evaluation modality for neonatal brain. The aim of this study was to determine whether brain MRI taken at term-equivalent age could give us further information over serial brain ultrasonograms taken during admission. METHODS: We analyzed 225 preterm infant (<32 weeks gestational age) who were admitted to NICU at Seoul National University Bundang Hospital from January 2006 to June 2011. The 28 infants with chromosomal abnormalities or major congenital anomalies were excluded. We compared abnormal findings between brain MRI scan taken at term-equivalent age and serial brain ultrasonograms taken during admission in 197 preterm infants. RESULTS: The brain MRI scans taken at term-equivalent age showed normal findings in 142 out of 197 (72%) infants and abnormal findings in 55 out of 197 (28%) infants. The brain ultrasonograms during admission revealed 82 intraventricular hemorrhages, 90 periventricular leukomalacias, 7 brain parenchymal lesions, 3 ischemic lesions. Brain MRI scans discovered 30 intraventricular hemorrhages, 10 periventricular leukomalacias, 12 brain parenchymal lesions, 3 ischemic lesions. Ventriculomegaly was discovered only by the brain ultrasonography. Five brain parenchymal lesions and 9 cerebellar lesions were appeared only on the brain MRI scans. Brain MRI scans taken at term-equivalent age detected grade 1 or 2 intraventricular hemorrhages which were not discovered by last brain ultrasonograms. CONCLUSION: In compare to the serial brain ultrasonograms, the brain MRI scan taken at term-equivalent age is advantageous in discovering brain parenchymal lesions and cerebellar lesions and precise grading of intraventricular hemorrhage in preterm infants.
Brain ; Chromosome Aberrations ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Neuroimaging

PURPOSE: This study was aimed to evaluate the neonatal mortality and morbidity of infants affected by twin-twin transfusion syndrome (TTTS) compared to the control twins matched for gestational age. Also the perinatal outcomes of donor parts of TTTS twins with their counterpart recipients were compared. METHODS: A retrospective case-control study was conducted from infants born at Seoul National University Children's Hospital and Seoul National University Bundang Hospital between April 2005 and July 2011. Eighteen pairs of TTTS infants were allocated to the TTTS group. The control group consisted of 36 pairs of twin infants unaffected by TTTS who were matched for gestational age. Neonatal deaths and morbidities were recorded. RESULTS: The mortality in TTTS group was significantly higher than control group (27.8% vs. 4.2%, P=0.001). The incidence of acute renal failure (41.2% vs. 9.7%, P<0.001), cardiac ventricular hypertrophy (31.3% vs. 2.9%, P<0.001), congestive heart failure (45.7% vs. 5.6%, P<0.001), grade > or =2 intraventricular hemorrhage (33.3% vs. 11.1%, P=0.012) and grade > or =2 periventricular leukomalacia (24.2% vs. 2.8%, P=0.001) were significantly higher in TTTS group than control group. There was no significant difference in mortality and morbidities between donors and recipients except significantly higher incidence of acute renal failure in donors (70.6% vs. 11.8%, P=0.001). CONCLUSION: Twin infants affected by TTTS have higher risk of neonatal death and several severe morbidities. These results indicate that alert monitoring and checking about possible morbidities are very important in newborns with TTTS and early intervention is critical for improving the overall outcome of the affected infants.
Acute Kidney Injury ; Case-Control Studies ; Early Intervention (Education) ; Gestational Age ; Heart Failure ; Hemorrhage ; Humans ; Hypertrophy ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Retrospective Studies ; Tissue Donors

PURPOSE: With conventional methods it has been difficult to maintain a normal body temperature in the case of premature infants born between 23 and 24 weeks of gestation (23/24W). The aim of the present study involves the evaluation of the efficacy of novel clinical strategies to prevent the initial symptoms of hypothermia in 23/24W. METHODS: We retrospectively analyzed the medical records of all 23/24W who were born and admitted to Samsung Medical Center from January 2007 to July 2010 (Period 1) and from August 2010 to May 2011 (Period 2). Data collected from medical charts included body temperature, admission delay time intervals, blood gas analysis, and estimated insensible water loss(IWL). The measurements from three days after birth were compared to those obtained during period 1 (P1), in which conventional support was applied to infants and period 2 (P2), in which new clinical strategies including 1. Elevation of the environmental temperature of the delivery room 2. NICU baby-wrapping, 3. Decreased delays in time intervals from delivery to admission, and 4. Initiation of procedures following the stabilization of body temperature. RESULTS: The body temperature upon admission was significantly higher in P2 than P1 (P1 34.7+/-0.9 vs. P2 35.3+/-0.6degrees C, P=0.011). After the initial procedure, following NICU admission, the body temperature was also significantly higher in P2 than in P1 (P1. 34.9+/-0.8 vs. P2 35.5+/-0.4, P<0.001). The IWL of the first and second day was significantly decreased in infants in the P2 group. Subjects in the P2 group demonstrated significantly improved initial blood gas results of base deficits and bicarbonate concentration, as compared to the P1 group. CONCLUSION: New strategies for the prevention of hypothermia were beneficial for decreasing the recorded incidence of hypothermia and improving the IWL, and base deficits of the initial blood gas analysis in 23/24W.
Blood Gas Analysis ; Body Temperature ; Body Temperature Regulation ; Delivery Rooms ; Hot Temperature ; Humans ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Medical Records ; Parturition ; Pregnancy ; Retrospective Studies

PURPOSE: To report the follow-up status and neurodevelopmental outcomes of extremely low birth weight (ELBW) survivors at 18 months' corrected age (CA). METHOD: We performed a retrospective study of 130 ELBW infants admitted to neonatal intensive care unit of Seoul National University Children's Hospital between January 2005 and May 2009. The follow-up status and neurodevelopmental outcomes were evaluated until the CA of 18 months. The assessment of outcomes included cerebral palsy, cognitive developmental delay, blindness, deafness and catch-up growth. Clinical data were collected to identify the factors influencing neurodevelopmental disability. RESULTS: Of the 130 survivors at discharge, 122 (93.8%) participated in the follow-up at 18 months' CA. Study characteristics included a mean birth weight of 783 g and a mean gestation of 27 weeks. One hundred and eleven infants (85.4%) were evaluated for cerebral palsy (CP) and 11 (9.9%) were identified with CP. Eighty five infants (74.6%) were assessed with the Bayley Scales of Infant Development-III (BSID-III) at 8 months' CA and 2 (2.4%) had a cognitive scale <70. Fifty four infants (41.9%) were assessed with BSID-III at 18 months' CA and 2 (3.7%) had a cognitive scale <70. There were 2 (1.2%) cases of blindness and the case of deafness was not present in this study. The failure of catch-up growth was seen in 40 (32.8%) infants. Severe intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus and shunt insertion were the most important risk factors for neurologic abnormality. CONCLUSION: In our institution, neurodevelopmental outcomes of ELBW survivors were comparable to recent reports from the USA. ELBW infants need to be monitored on multidisciplinary follow-up programs and more efforts should be made to improve the follow-up.
Birth Weight ; Blindness ; Cerebral Palsy ; Deafness ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Outpatients ; Pregnancy ; Retrospective Studies ; Risk Factors ; Survivors ; Weights and Measures

Necrotizing enterocolitis (NEC) is the most common serious disease of the gastrointestinal tract in preterm infants. Although the pathogenesis of NEC is completely unknown, enteral bacterial growth plays in such disease. The immature development of the preterm gut and the exposure to the neonatal intensive care unit environment along with associated treatments promotes inappropriate intestinal colonization with a predominance of pathogenic organisms. Probiotics are the dietary supplements, containing potentially beneficial bacteria or yeast and may offer potential benefits for preterm infants by increasing mucosal barrier function, improving nutrition, up-regulation of the immune system, reducing mucosal colonization by potential pathogens, and altering the key components of intestinal inflammation. Large randomized controlled trials have shown its effectiveness in the probiotics of the prophylaxis for NEC and mortality. However, important questions remain in establishing the clinical applications for the probiotics, including the optimal duration of administration as well as preferred probiotics dose and species. Further, there is a need to understand the interaction of the probiotics and gut. More additional clinical studies are needed to determine the safety and efficacy of the probiotics in the prophylaxis of NEC.
Bacteria ; Colon ; Dietary Supplements ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Humans ; Immune System ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intensive Care, Neonatal ; Intestines ; Probiotics ; Up-Regulation ; Yeasts

With developing information technology, hospital information systems such as computerized provider order entry system (CPOE) and picture archiving and communication system (PACS) are being increasingly used by many hospitals. The hospital information systems improve the efficiency of hospital management and patient care. Currently, electronic medical records (EMR) are not used as much as CPOE and PACS. However, EMR will soon be the cornerstone of hospital patient care systems. Because EMR for the neonatal intensive care unit (NICU) is different from that for adult care unit, neonatologists should have a basic knowledge of EMR and should play an important role in implementing EMR system in NICU.
Adult ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Order Entry Systems ; Patient Care

Acquired ileal atresia is a rare but life-threatening complication that can occur after recovery from necrotizing enterocolitis in premature infants. We present an unusual case of acquired ileal atresia in the distal ileum injured by ischemia after intestinal perforation in an extremely low-birth-weight infant. A 900 g (25 weeks gestation) premature infant developed a pneumoperitoneum without the radiologic manifestations of necrotizing enterocolitis on day 9 of life. Primary peritoneal drainage without further need for surgery was performed in the neonatal intensive care facility. Gastrointestinal gastrografin studies confirmed normal intestinal continuity and regular stools. Several weeks later, while the patient was receiving all nutrition orally with no medical problems, the patient's condition suddenly deteriorated, along with clinical signs of intestinal obstruction including emesis of bilious contents and stools. Laparotomy (on day 45 of life) revealed ileal atresia with V-shaped gap mesenteric defect.
Diatrizoate Meglumine ; Drainage ; Enterocolitis, Necrotizing ; Humans ; Ileum ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Intestinal Obstruction ; Intestinal Perforation ; Ischemia ; Laparotomy ; Pneumoperitoneum ; Vomiting

Acquired ileal atresia is a rare but life-threatening complication that can occur after recovery from necrotizing enterocolitis in premature infants. We present an unusual case of acquired ileal atresia in the distal ileum injured by ischemia after intestinal perforation in an extremely low-birth-weight infant. A 900 g (25 weeks gestation) premature infant developed a pneumoperitoneum without the radiologic manifestations of necrotizing enterocolitis on day 9 of life. Primary peritoneal drainage without further need for surgery was performed in the neonatal intensive care facility. Gastrointestinal gastrografin studies confirmed normal intestinal continuity and regular stools. Several weeks later, while the patient was receiving all nutrition orally with no medical problems, the patient's condition suddenly deteriorated, along with clinical signs of intestinal obstruction including emesis of bilious contents and stools. Laparotomy (on day 45 of life) revealed ileal atresia with V-shaped gap mesenteric defect.
Diatrizoate Meglumine ; Drainage ; Enterocolitis, Necrotizing ; Humans ; Ileum ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Intestinal Obstruction ; Intestinal Perforation ; Ischemia ; Laparotomy ; Pneumoperitoneum ; Vomiting

PURPOSE: The main postnatal risk factors of retinopathy of prematurity (ROP) were described as prolonged oxygen therapy and lower gestational age. Recent data suggest poor early weight gain during the first weeks of life, which can be an additional predictor of severe ROP. We aimed to analyze the risk factors associated with requiring operation for ROP in preterm infants with very low birth weight (VLBW). METHODS: In a retrospective case control study, from January 2004 to June 2010, 140 VLBW infants diagnosed as ROP by the International classification of ROP were recruited. There were 14% of infants with stage 1 disease, 65.7% stage 2, and 20% stage 3 or more. A group requiring a laser surgery for ROP was 66 infants, and a group not requiring surgery was 74 infants. RESULTS: By a univariate analysis, antenatal steroid, chorioamnionitis, gestational age, birth weight, days on oxygen, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalasia and sepsis were significantly associated with ROP requiring surgery. Weight differences between birth and each from 4 to 12 weeks were significantly lower in the infants requiring surgery (P<0.05). However, after adjustment for gestational age in logistic regression, weight difference between birth and 8th week was a significant predictive factor for the requirement of surgery in infants with ROP (OR, 0.998; 95% CI, 0.996-0.999, P=0.013). CONCLUSION: We suggest that careful monitoring of weight change and aggresive nutritional support for poorly growing infants, during the first 8 weeks of life, may possibly prevent laser surgery of ROP in preterm VLBW infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Case-Control Studies ; Chorioamnionitis ; Diterpenes ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Laser Therapy ; Logistic Models ; Nutritional Support ; Oxygen ; Parturition ; Pregnancy ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors ; Sepsis ; Weight Gain

In addition to antibiotic therapy, the administration of supportive care is of utmost importance in sepsis deteriorating to septic shock. Close attention to cardiovascular, respiratory, fluid and electrolyte, hematological, renal and metabolic/nutritional support is essential to optimize the outcome. Firstly, fluid resuscitation is important to attain appropriate heart rate, blood pressure, and refill time. In case of nonresponse to fluid resuscitation, inotropes are used to increase cardiac output, and to improve perfusion of the tissues. Ideally, vasoactive agents, including epinephrine, should be administered by a secure central venous route, but in an emergency, it may be infused through a peripheral route. To improve the imbalance between the need for oxygen and consumption, early intubation and mechanical ventilation should be considered. In newborns with inadequate urine output, hepatomegaly, rale, and 10% weight gain, despite other supportive cares, dialysis or continuous renal replacement therapy should be performed, while on the extracorporeal membrane oxygenation circuit. Central venous access and arterial pressure monitoring are recommended in infants with fluid-refractory shock. Hemodynamic support directed to goals of mixed venous saturation, and cardiac index in newborns is associated with improved survival and neurologic function.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Dialysis ; Emergencies ; Epinephrine ; Extracorporeal Membrane Oxygenation ; Heart Rate ; Hemodynamics ; Hepatomegaly ; Humans ; Infant ; Infant, Newborn ; Intubation ; Oxygen ; Perfusion ; Renal Replacement Therapy ; Respiration, Artificial ; Respiratory Sounds ; Resuscitation ; Sepsis ; Shock ; Shock, Septic ; Weight Gain