The survival rates of high-risk infants and premature infants have increased, and the morbidity rates among survivors have decreased with the recent developments in neonatal intensive care. However, in the real neonatal care practice, many drugs, medical devices and treatment protocols have been used based on results of studies in adults or older children, despite their lack of proven safety and efficacy in neonates. In the Western developed countries, although pediatric clinical trials have been activated by several efforts of the government or national union, clinical trials targeting newborn or premature infants remains a challenge. Recently, political movements and efforts to promote pediatric clinical trials have been started in Korea, increasing the number of clinical trials conducted among children. However, neonatal clinical trials account for only a small percentage of these trials. Performing neonatal clinical trials has many obstacles in terms of not only ethical and technical issues, but also the specific metabolic and physiological characteristics of neonates. Nevertheless, neonatal clinical trials are definitely needed to assure that safe and optimal evidence-based-therapies are applied in this special population.
Adult ; Child ; Developed Countries ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Korea* ; Survival Rate ; Survivors

Proteus mirabilis (P. mirabilis) meningitis in a neonate is rare, but its recognition is important because the disease progresses rapidly and has poor prognosis. A 4-day-old premature female infant born at 36 weeks and 5 days of gestation presented with symptoms of fever and icteric skin. Initial cerebrospinal fluid findings suggested bacterial meningitis, and treatment with antibiotics was started. On the third day, P. mirabilis growth was found in both blood and cerebrospinal fluid cultures and brain computed tomography revealed normal findings. The patient showed improved clinical symptoms, but brain magnetic resonance imaging on hospital day 18 revealed a brain abscess measuring 4.5×3.1×3.1 cm in the right frontal lobe. Cyst drainage was performed immediately and a catheter was inserted. Follow-up computed tomography revealed a tiny abscess remaining in the right frontal lobe, and follow-up magnetic resonance imaging later demonstrated marked interval regression in the size of the abscess. The patient was discharged on day 57 of hospitalization in good condition. Serial brain imaging should be considered in neonatal cases of P. mirabilis meningitis.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Catheters ; Cerebrospinal Fluid ; Drainage ; Female ; Fever ; Follow-Up Studies ; Frontal Lobe ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Meningitis* ; Meningitis, Bacterial ; Mirabilis ; Neuroimaging ; Pregnancy ; Prognosis ; Proteus mirabilis* ; Proteus* ; Skin

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.
Abdomen, Acute* ; Abdominal Pain ; Estrogens, Conjugated (USP)* ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Ligaments* ; Myoma ; Ovary ; Parovarian Cyst* ; Ultrasonography

PURPOSE: The purpose of this study was to determine if timing of enterostomy repair described in terms of postmenstrual age (PMA) could influence postoperative course, complications, and growth. METHODS: Under the Institutional Review Board approval, records of preterm infants who underwent enterostomy and subsequent repair from 2007 to 2013 at Seoul national university children's hospital were reviewed. Records of infants with congenital anomalies were excluded. Data collected included baseline characteristics, PMA, weight at enterostomy and enterostomy repair, postoperative course, enterostomy repair-related complications, and follow-up growth after repair. For analysis, patients were divided into 2 groups: group 1 with enterostomy repaired before PMA 40 weeks; and group 2 with enterostomy repaired since PMA 40 weeks. RESULTS: There were 54 infants: 16 in group 1 and 38 in group 2. The median weight at the time of enterostomy repair was greater in group 2 compared to those of group 1. Group 1 infants had more complications and had to be ventilated longer after enterostomy repair. They required longer periods of total parenteral nutrition and took longer to reach full enteral feeding. Group 1 infants also needed longer hospital stay after enterostomy repair. No statistical difference was observed in growth after discharge. CONCLUSION: The timing of enterostomy repair influences postoperative course and complications significantly. Therefore, it is recommended that enterostomy repair should be withheld until PMA 40 weeks. For predicting long term prognosis, more studies will be required.
Enteral Nutrition ; Enterostomy* ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parenteral Nutrition, Total ; Prognosis ; Seoul

As prevalence of metabolic syndrome has rapidly increased over the past decade, lifestyle changes including dietary habits are considered as a therapeutic cornerstone for metabolic syndrome, cardiovascular complications and type 2 diabetes. We evaluated the effectiveness of a telephone-delivered nutrition education to improve metabolic parameters compared with a single-visit with a dietitian in subjects with metabolic syndrome. A total of seventy-one adults who met diagnostic criteria for the metabolic syndrome were randomly assigned to either the single-visit group or the in-depth nutrition education group during a 3-month intervention study period. The in-depth telephone-delivered nutrition education group had an initial visit with a dietitian and additional two telephone counseling during the first 4 weeks of the study periods. Sixty-six subjects completed a 3-month intervention study. The trial examined participant's anthropometric changes and dietary intakes as well as changes in the metabolic syndrome factors. At the end of the trial, the in-depth nutrition education group showed significantly higher reduction in weight, body fat and abdominal circumference compared with the other group (p < 0.05). In the in-depth nutrition groups, the prevalence of metabolic syndrome was decreased to 45.5%, while 69.7% of the subjects were metabolic syndrome patients in the single-visit group (p < 0.05). These results demonstrate that the telephone-intervention counseling is a feasible mean to deliver dietary intervention in patients with metabolic syndrome.
Adult ; Body Weight ; Counseling ; Education* ; Food Habits ; Humans ; Clinical Trial ; Life Style ; Nutrition Therapy ; Prevalence ; Telephone

With focused ultrasound (FUS) and microbubbles, BBB can be transiently disrupted with a localized and non-invasive approach. BBB disruption induced by FUS has made progressions to move forward on delivery of therapeutic agents into a brain in a specific area of brain for better treatment of neurological diseases. In addition to be used as an improvement of drug delivery, BBB disruption has been found to induce biological effects such as a clearance of protein aggregation which cause Alzheimer's disease, regulation of proteins which facilitate drug uptake, and modulation of neuronal function and neurogenesis. In this review, we discuss overview about the principles of BBB opening with FUS and milestones in these biological effects of FUS-induced BBB disruption.
Alzheimer Disease ; Brain ; Microbubbles ; Neurogenesis ; Neurons ; Ultrasonography*

Background: Premature infants are at high risk for acute kidney injury (AKI). Serum creatinine (Cr) has limitations for evaluating kidney function in premature infants. We evaluated whether urine biomarkers could be used to monitor AKI in premature infants. Methods: A prospective cohort study was conducted among infants born at < 37 weeks. Urine biomarkers and serum Cr were measured on postnatal days 1, 3, 5, 7, 10, and 14. Infants were divided into 3 groups according to gestational age (GA); < 28, 28 to < 32 and 32 to < 37 weeks. Results: AKI occurred in 17 of 83 (20.5%) recruited infants at a median age of 7 (interquartile range 5–10) days. While the most common cause of AKI was hemodynamically significant patent ductus arteriosus (53.8%) in infants of GA < 28 weeks, necrotizing enterocolitis was the leading cause (50.0%) in infants of GA 28 to < 32 weeks. Urinary levels of neutrophil-gelatinase-associated lipocalin/Cr were higher and epidermal growth factor/Cr were lower in AKI group before the onset of AKI in infants of GA < 28 weeks. In infants of GA 28 to < 32 weeks, urinary interleukin-8/Cr levels were higher in AKI group at approximately the time of AKI onset. Conclusion Several urine biomarkers were significantly different between AKI and no AKI groups, and some had changed before the onset of AKI. These groups were distinct according to causative factors of AKI and GA. Urine biomarkers could be useful for monitoring the development of AKI in premature infants.

PURPOSE: Capillary hemangiomas occur more frequently in preterm infants. We aimed to describe the clinical course of capillary hemangiomas in preterm infants. METHODS: The records of preterm infants with a gestational age (GA) of <35 weeks who were admitted to two tertiary neonatal intensive care units from January 2004 to December 2013 and had capillary hemangiomas were reviewed retrospectively. Subgroup analysis of between infants of GA <30 weeks and GA 30-34+6 weeks were done and ad hoc analysis comparing study population and matched preterm infants without hemangioma for investigation of differences in clinical characteristics. RESULTS: Of the 2,772 preterm infants, 112 (4%) infants developed capillary hemangiomas. The majority (91.9 %) of them had a solitary hemangiomas with the trunk was the most commonly involved site (43%). Three quarters of the patients were treated with topical corticosteroid, propranolol or laser treatment. When we divided this population as who were born before or after GA 30 weeks, there was no difference at postmenstrual age (PMA) of onset of capillary hemangiomas (median [IQR], 36(+4) [30(+5)-40(+5)] vs. 36+2 [33(+6)-41(+1)] weeks, P = 0.275). The age at involution of capillary hemangiomas was also not differ between two groups (median [IQR], 7.75 [3.75-12.25] vs. 7.5 [4-13.75] months, P=0.425). There were no statistical differences between preterm infants with capillary hemangiomas and their age, weight and sex matched control preterm infants without hemangiomas in the neonatal and maternal factors. CONCLUSION: The development of capillary hemangiomas occurred at approximately 36 to 37 weeks of PMA regardless of prematurity in preterm infants. Capillary hemangiomas of preterm infants resolved spontaneously and disappear completely by around 7 months of corrected age.
Capillaries* ; Gestational Age ; Hemangioma ; Hemangioma, Capillary* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units, Neonatal ; Propranolol ; Retrospective Studies

Anomalies of the fetal venous system are rare. Major portion of fetal venous anomalies are malformation of umbilical vein and ductus venosus. Abnormal umbilico-systemic shunt, bypassing the ductus venosus makes direct connection between the high-pressure umbilical system and the low-pressure systemic system. And it makes adverse to the fetal hemodynamics. Fetal hemodynamic distress may induce fetal growth retardation, hepatomegaly, cardiomegaly, hydrops fetalis and fetal death. We report a case of non-immune hydrops fetalis which was associated with abnormal umbilical vein pathway. Our patient had bifurcated umbilical veins. Main branch of umbilical vein was drained directly to the left internal iliac vein and another branch was drained to the portal vein. After birth, extrahepatic shunt through main branch of umbilical vein that bypassed the portal system was persisted and thrombocytopenia was combined due to consumption in thrombus of a dilated anomalous umbilical vein. Later this case was diagnosed as Noonan syndrome with a genetic testing.
Cardiomegaly ; Fetal Death ; Fetal Growth Retardation ; Fetus ; Genetic Testing ; Hemodynamics ; Hepatomegaly ; Humans ; Hydrops Fetalis* ; Iliac Vein ; Noonan Syndrome* ; Parturition ; Portal System ; Portal Vein ; Thrombocytopenia ; Thrombosis ; Umbilical Veins ; Vascular Malformations

PURPOSE: We evaluate respiratory morbidities in infants beyond 35 weeks of gestation born via elective cesarean section by gestational age. METHODS: This is a retrospective study of 443 infants who were born at Seoul National University Hospital by elective cesarean section beyond 35 weeks of gestation from January 2011 to December 2012. We compared respiratory morbidities in four groups classified by gestational age (35(+0)-36(+6) weeks, 37(+0)-37(+6) weeks, 38(+0)-38(+6) weeks, 39(+0)-40(+6) weeks). RESULTS: There were significantly lower Apgar scores in the late-preterm infant group (35-36 weeks) compared to other term infant groups and the proportion of infants born from mothers with preeclampsia gradually decreased as gestational age increased. There were significant differences in O2 supplement, duration of O2 (>24 hours), checked chest radiography, transient tachypnea of newborn (TTN), transfer to neonatal intensive care unit (NICU), endotracheal intubation, and ventilator uses including nasal continuous positive airway pressure in four groups (P<0.05). By logistic regression analysis, compared to births at 38 weeks, births at 35-36 weeks and at 37 weeks were associated with an increased risk of respiratory morbidities [odds ratios (OR) and 95% confidence intervals (CI) for births at 35-36 weeks, 122.5 (17.4-863.4) for TTN; 54.0 (10.1-289.4) for transfer to NICU; 99.5 (14.9-666.2) for ventilator apply; OR and 95% CI for births at 37 weeks, 8.8 (1.6-50.1) for TTN; 5.3 (1.1-24.7) for transfer to NICU; 8.4 (1.5-47.7) for ventilator apply; P<0.05]. There were no significant differences in respiratory morbidities between births at 38 weeks and births at 39-40 weeks. CONCLUSION: Postponing the timing of elective cesarean section to beyond 38 weeks of gestation would be helpful in reducing the neonatal respiratory morbidities.
Cesarean Section* ; Continuous Positive Airway Pressure ; Female ; Gestational Age* ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Logistic Models ; Mothers ; Parturition ; Pre-Eclampsia ; Pregnancy ; Pregnancy* ; Radiography ; Respiration Disorders ; Retrospective Studies ; Seoul ; Term Birth ; Thorax ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical