No abstract available.
Diagnosis* ; Infant, Newborn ; Meconium Aspiration Syndrome* ; Meconium*

OBJECTIVES: To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF). METHODS: A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF. RESULTS: Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×10⁹/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05). CONCLUSIONS Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.
Amniotic Fluid/chemistry* ; Female ; Humans ; Infant, Newborn ; Interleukin-6 ; Lactates ; Meconium ; Meconium Aspiration Syndrome/diagnosis* ; Pregnancy ; Retrospective Studies

PURPOSE: The development of postnatal pneumothorax and its common causes and clinical aspects were studied to promote early diagnosis and proper management. METHODS: A retrospective study of neonates who were hospitalized in the neonatal intensive care unit at Soonchunhyang University Bucheon Hospital from 2001 to 2010 was performed. Term neonates were divided into a spontaneous pneumothorax group and a secondary pneumothorax group. The secondary group was divided into term and preterm groups. RESULTS: Of 4,414 inpatients, 57 (1.3%) were diagnosed with pneumothorax. Of term newborn patients, 28 (80%) had a secondary pneumothorax, and seven (20%) had a spontaneous pneumothorax. No differences were observed for gender, birth weight, resuscitation, or duration of admission between the spontaneous and control groups. The duration of treatment with a thoracostomy (20 patients, 57%) was longer in the spontaneous group (5.4+/-2.9 days vs. 2.7+/-2.0 days) than that in the control group. Patients with respiratory distress syndrome (RDS) developed a pneumothorax 22.8 hours after surfactant treatment, whereas patients with transient tachypnea of the newborn (TTN), pneumonia, and meconium aspiration syndrome (MAS) developed pneumothorax after 16.6 hours. Of 50 patients with a secondary pneumothorax, 19 (38%) had RDS, 11 (22%) had MAS, 7 (14%) had TTN, and six (12%) had pneumonia. Among term newborns, 42.9% were treated only with 100% oxygen. Among preterm newborns, 72.6% and 27.3% needed a thoracostomy or ventilator care, respectively. CONCLUSION: A pneumothorax is likely to develop when pulmonary disease occurs in neonates. Therefore, it is important to carefully identify pneumothorax and provide appropriate treatment.
Birth Weight ; Early Diagnosis ; Humans ; Infant, Newborn ; Inpatients ; Intensive Care, Neonatal ; Lung Diseases ; Meconium Aspiration Syndrome ; Oxygen ; Pneumonia ; Pneumothorax ; Resuscitation ; Retrospective Studies ; Thoracostomy ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical

PURPOSE: To compare the efficacy of conventional strategy versus high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) for the treatment of full term neonates with persistent pulmonary hypertension (PPHN). METHODS: Full term infants admitted with diagnosis of PPHN to neonatal intensive care units of Asan Medical Center from a period of 1994 to 2001 were included. The major exclusion criteria included congenital anomalies and pulmonary hypoplasia caused by various etiologies. Demographic, therapeutic responses and outcomes were compared between two study phases depending upon treatment modalities used: phase 1 (January 1994-July 1997) using conventional strategy and phase II (July 1997-December 2001) using either conventional strategy or/with iNO or HFOV with iNO. RESULTS: A total of 16 patients and 32 patients were enrolled in phase I and phase II studies, respectively. The primary diagnosis for PPHN included idiopathic (n=12), hyaline membrane disease (n=16), meconium aspiration syndrome (n=11), and sepsis (n=10). Statistically significant improvements were noted in survival, oxygenation index and alveolar- arterial oxygen tension difference during phase II than phase I study period. 75% of those infants treated with iNO showed good responses. Improvements in duration of ventilator use, oxygen supplementation, hospitalization were noted during phase II study period, however, not statistically significant compared to phase I study period. The impairments in neurodevelopmental outcomes were noted in 1 and 2 patients during phase I and phase II study periods, respectively. CONCLUSION: We conclude that HFOV and iNO are more efficacious and safe rescue mode of treatment than conventional strategy for full term infants with PPHN.
Chungcheongnam-do ; Diagnosis ; Hospitalization ; Humans ; Hyaline Membrane Disease ; Hypertension, Pulmonary* ; Infant ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Meconium Aspiration Syndrome ; Nitric Oxide ; Oxygen ; Sepsis ; Ventilation ; Ventilators, Mechanical

Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of MAS. Most aspiration of meconium probably occurs before birth. Following aspiration, meconium may migrate to the peripheral airway, usually take about 2 hours as demonstrated in animal experiment, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diagnosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the management of MAS. Recent studies suggest that avoidance of post-term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso-and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction at birth is considered a controversial procedure and only reserved for infants who have severe retraction at birth suggesting an upper airway obstruction. High frequency oscillatory ventilation with nitric oxide or surfactant may improve mortality. Mortality of MAS has improved; the causes of death are related primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.
Acidosis ; Airway Obstruction ; Amniotic Fluid ; Animal Experimentation ; Anoxia ; Cause of Death ; Diagnosis ; Female ; Humans ; Hypercapnia ; Hypertension, Pulmonary ; Incidence ; Infant ; Infant, Newborn ; Meconium Aspiration Syndrome* ; Meconium* ; Mortality ; Nitric Oxide ; Parturition ; Pneumonia ; Respiratory Insufficiency ; Resuscitation* ; Suction ; Vasoconstriction ; Ventilation

Intraventricular hemorrhage (IVH) is common in the premature infants and occurs mainly in subependymal germinal matrix. In contrast, IVH in the term infants is rare and different in pathogenesis and bleeding sites from those of the premature infants. Most studies of IVH in term infants have been studied by computerized tomography and postmortem examination. Brain ultrasonography which has become a frequently used diagnostic tool of IVH in the premature infants is reported to be also effective in diagnosis in the term infants. The study population comprised 11 term neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital between July 1989 and June 1991, in whom IVH was diagnosed by ultrasonography. We analysed severity of birth asphyxia. ultrasonographic findings and clinical manifestations to investigate severity, timing, risk factors, and pathogenesis of IVH in the term neonates. 1) Apgar scores were available in 7 cases with severe asphyxia (Apgar at 1 min: less than 3), 1 cases with mild asphyxia (Apgar at 1 min: between 5~7), and 2 cases without asphyxia. 2) Clinically, 4 cases had fetal distress, and 3 cases had meconium aspiration pneumonia. 3) Bleeding sites by ultrasonography were subependymal germinal matrix in all 11 cases. IVH of choroid plexus was combined in 2 cases. Severity of IVH were grade I in 9 cases, grade II in 2 cases by Papile's classification. 4) There were no correlations between the grade of IVH and severity of perinatal asphyxia. In conclusion, ultrasonography is very useful in diagnosis and follow-up of IVH in term neonates. Subependymal germinal matrix could be common site of IVH in term neonates because germinal matrix still remains in term neonates despite of its regression. Also this can explain why IVH in our cases is not severe.
Asphyxia ; Autopsy ; Brain ; Choroid Plexus ; Classification ; Diagnosis ; Fetal Distress ; Follow-Up Studies ; Hemorrhage* ; Humans ; Infant* ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome ; Parturition ; Pneumonia ; Risk Factors ; Seoul ; Ultrasonography

PURPOSE: This study aimed to identify the risk factors of persistent pulmonary hypertension of the newborn (PPHN) in neonates with respiratory diseases. METHODS: We retrospectively analyzed 58 term newborn infants with respiratory diseases who were admitted to the neonatal intensive care unit of the Seoul Eulji Hospital between January 2008 and July 2014 and required airway intubation and mechanical ventilation within 24 hours of admission. The infants were divided into a PPHN group and a non-PPHN group. Their clinical characteristics; diagnoses at admission; initial blood test results; and changes in vital signs, blood gas analysis results, and ventilator parameters that occurred within 48 hours of admission were investigated. RESULTS: There were 16 infants in the PPHN group and 42 infants in the non-PPHN group. The incidence of secondary PPHN was 27.6%. The incidence of PPHN was significantly higher in infants with respiratory distress syndrome (RDS) associated with extrapulmonary air leakage and meconium aspiration syndrome (MAS) with secondary RDS as the cause. Respiratory rate over 80 breaths/min (P=0.032, OR 11.3, 95%, CI 1.23-103.57) and FiO2 over 0.8 (P=0.013, OR 16.8, 95% CI 1.82-154.68), when measured 6 hours after admission, were found to be statistically significant risk factors. CONCLUSION: The results suggest that there is an increased risk of PPHN during treatment of respiratory diseases when aggravation of tachypnea and increase in ventilator parameters are observed after 6 hours of admission.
Blood Gas Analysis ; Diagnosis ; Hematologic Tests ; Humans ; Hypertension, Pulmonary* ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Intubation ; Meconium Aspiration Syndrome ; Respiration, Artificial ; Respiratory Rate ; Retrospective Studies ; Risk Factors* ; Seoul ; Tachypnea ; Ventilators, Mechanical ; Vital Signs

Fetal alcohol syndrome can be suspected in infants born to mothers with a prenatal history of alcohol abuse if the child exhibits characteristic facial features, together with intrauterine growth retardation, multiple neurological abnormalities, and multiorgan defects. If only a few of the above criteria are satisfied, the term fetal alcohol effects is used. We experienced a neonate who presented with hydrocephalus, low birth weight, seizure, right renal agenesis, characteristic facial features and a maternal history of alcohol abuse, and diagnosed him as fetal alcohol syndrome(FAS), with accompanying meconium aspiration syndrome, and persistent pulmonary hypertension of the newborn. There is no definite cure for FAS, but it can be prevented by maternal abstinence from drinking; thus maternal education, understanding and early diagnosis of those affected are of importance.
Alcoholism ; Child ; Drinking ; Early Diagnosis ; Education ; Fetal Alcohol Spectrum Disorders* ; Fetal Growth Retardation ; Humans ; Hydrocephalus ; Hypertension, Pulmonary* ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Meconium Aspiration Syndrome ; Mothers ; Seizures

BACKGROUND: This study was conducted to investigate the epidemiological features, clinical courses, and diagnoses of neonates who are transferred to neonatal intensive care unit of Yeungnam University Hospital due to tachypnea soon after birth. METHODS: Based on medical records, we performed a retrospective study of neonatal intensive care unit admissions due to tachypnea from January 2010 to December 2013. RESULTS: A total of 311 neonates were included in this study. The patient characteristics showed male predominance at 2.65:1. Among the 311 neonates with tachypnea, 127 (40.8%) neonates needed oxygen supply, and 54 (17.4%) neonates needed assisted mechanical ventilation. Transient tachypnea of the newborns (TTN) (158, 50.8%) showed the highest incidence, followed by pneumonia (63, 20.3%), extrapulmonary infection (37, 11.9%), respiratory distress syndrome (21, 6.8%), air leak (16, 5.1%), meconium aspiration syndrome (12, 3.9%), congenital heart disease (5, 1.6%), metabolic acidosis (3, 1%), primary pulmonary hypertension of newborns (2, 0.6%) and anemia (2, 0.6%). CONCLUSION: Although the neonates with tachypnea showed no other respiratory distress symptom, clinicians should be aware of the possibility of other pulmonary diseases as well as TTN and their extra-pulmonary causes. If tachypnea does not improve within a few hours, the clinician should consider further evaluation and management as soon as possible.
Acidosis ; Anemia ; Diagnosis* ; Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary ; Incidence ; Infant, Newborn* ; Intensive Care, Neonatal ; Lung Diseases ; Male ; Meconium Aspiration Syndrome ; Medical Records ; Oxygen ; Parturition* ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn

OBJECTIVE: To evaluate the response of sodium nitroprusside(SNP) in the treatment of persistent pulmonary hypertension of the newborn(PPHN). METHODS: Among neonates with PPHN who were admitted at the NICU of the Department of Pediatrics of Dongsan Medical Center, Keimyung University between June 1996 and May 1999, 10 cases were treated with SNP. The diagnosis of PPHN was made by echocardiography, and SNP was administered by continuous infusion via peripheral or central vein, and the initial dose was 0.5microgram/kg/min. The rate of infusion was subsequently titrated, by repeatedly increasing the rate of infusion, until a desired or adverse effect was observed, the maximal rate of SNP infusion did not exceed 0.5microgram /kg/min. Serial vital signs, arterial blood gases, platelet counts, and oxygenation index(OI) were measured before and after SNP infusion periodically. Statistical analyses were assessed by ANOVA test using SAS package. Significance was assumed at P<0.05. RESULTS: All the patients were outborn. And fullterm, c-section delivery neonates were more common. Common associated diseases were pneumonia(including meconium aspiration syndrome, 50%), perinatal asphyxia(30%) and respiratory distress syndrome(30%). And 8 cases(80%) were improved(responsive group), 2 cases were not improved(nonresponsive group). Between both groups, there were not noted signigicant difference in mean 1-& 5-min Apgar score, arterial pH, PO2 and PCO2, maximal infusion rate and duration of SNP. Mean baseline OIs were 55.2 in responsive group and 57.9 in nonresponsive group. After SNP therapy, OI of the former was reduced significantly(p<0.005), but OI of the latter didn't change significantly. During SNP therapy, transient hypotension was developed in 3 cases, and pulmonary hemorrhage in three, and one case with necrotizing enterocolitis, thrombocytopenia, or periventricular leukomalacia was noted. CONCLUSION: It was concluded that SNP can be used as a non-aggressive and low-cost primary treatment for the patient with PPHN.
Apgar Score ; Diagnosis ; Echocardiography ; Enterocolitis, Necrotizing ; Gases ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Infant, Newborn* ; Leukomalacia, Periventricular ; Meconium Aspiration Syndrome ; Nitroprusside* ; Oxygen ; Pediatrics ; Platelet Count ; Sodium* ; Thrombocytopenia ; Veins ; Vital Signs