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

Advances in neonatal intensive care have improved the chances for survival of extremely low birth weight (ELBW) infants. However, ELBW infants are at high risk of meningitis and resulting neurologic complications. The most common organisms associated with neonatal bacterial meningitis include Listeria monocytogenes, Escherichia coli, and Group B Streptococcus. Bacillus cereus (B. cereus), an organism commonly found in soil, vegetation, and daily products, can sometimes cause meningitis owing to preformed toxins. We report a rare case of meningoencephalitis caused by B. cereus that resulted in a detrimental neurological outcome in an ELBW infant.
Bacillus cereus* ; Escherichia coli ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Listeria monocytogenes ; Meningitis ; Meningitis, Bacterial ; Meningoencephalitis* ; Soil ; Streptococcus

Cell cycle regulating proteins are known to have close relation with the proliferation of the mammalian cells. In injured liver, the number of HSCs is increased from proliferation. However, the expression of cell cycle proteins of HSCs during proliferation remains unevaluated. Therefore, cell cycle protein profiles of HSCs were studied in dimethyl-nitrosamine (DMN)-induced rat liver fibrosis model. Sprague-Dawley rats were intraperitoneally injected of DMN and the animals were sacrificed every week up to 4 weeks. HSCs were separated and the number of the cells in S phase was counted to evaluate the cell proliferation by flow cytometry. The expression of cyclin A, cyclin B, cyclin D1, cdk2, cdk4, cdc2, proliferating cell nuclear antigen (PCNA), p21Cip/WAF1, and p27 was examined with immunoblotting analysis. Portion of S-phase cells peaked 7days after DMN injection. At that time, cyclin A, and PCNA showed significant increase in HSCs compared to untreated HSCs (114% and 116%, respectively, P<0.001). p21Cip/WAF1 was decreased significantly in DMN-treated HSCs compared to control cells (88%, P<0.001). The increase of cyclin A, and PCNA and the decrease of p21Cip/WAF1 seem to play important roles in the proliferation of HSCs during the early period of DMN treatment.
Animals ; Cell Cycle Proteins/*metabolism ; Cell Proliferation ; Dimethylnitrosamine ; Liver/*cytology/metabolism/pathology ; Liver Cirrhosis/chemically induced/*metabolism/pathology ; Male ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; S Phase

PURPOSE: The aims of this study included assessment of molecular-epidemiologic features during an outbreak of colonization of extended spectrum beta-lactamase producing Klebsiella pneumoniae(ESBL-KPN) and re-evaluation of their colonized status one year later. METHODS: Rectal swab cultures for ESBL-KPN from all hospitalized infants and newly admitted infants were obtained during the outbreak of colonization from July to December, 2000. The pattern of XbaI-digested chromosomal DNA of isolates were analyzed by pulsed-field gel electrophoresis. Weekly rectal swab cultures were obtained during the outbreak until patients were either discharged or decolonized. Patients discharged after being colonized had follow up stool cultures a year later. RESULTS: A total of 80 patients(28.5 percent) were colonized. Of those, 53 whose pulsed-field gel electrophoresis(PFGE) was possible only once, were ESBL-KPN grouped into six cluster clones and 10 single clones:28 patients(52.8 percent) were colonized with type A, the most common clone, followed by type B in 11 patients(20.8 percent). Of those 12 patients in whom serial PFGE was done more than twice, type A was predominant. Narrowed-down in strains occurred from types A, B, C, D and three single clones at initiation of the study into types A and type B after three months of strict infection control. Among 75 patients(93.7 percent) who were sent home after being colonized, 30 patients were re-called for stool cultures a year later:All of them were decolonized. CONCLUSION: This study demonstrates the importance of infection control as the diversity of ESBL-KPN strains could be narrowed into fewer strains. Colonization of ESBL-KPN could be reversed upon return to the community.
beta-Lactamases* ; Clone Cells ; Colon* ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal* ; Klebsiella pneumoniae* ; Klebsiella*

PURPOSE: Fetoscopic laser surgery (FLS) is considered an optimal therapeutic strategy for twin-to-twin transfusion syndrome (TTTS). We aimed to determine the clinical outcomes of TTTS patients since the introduction of FLS. METHODS: A retrospective study of TTTS patients born between January 2005 and December 2015 was conducted. Mortality and morbidity were compared in the FLS and non-FLS groups. The FLS group was divided into selective FLS and Solomon technique group, and subgroup analysis was performed. RESULTS: Of 70 pregnancies diagnosed with TTTS during the study period, FLS was performed for 35 (50%). Survival of at least one infant at discharge was achieved in 100% (35/35) of pregnancies in the FLS group and 91.4% (32/35) in the non-FLS group (P=0.028). Subgroup analysis revealed that the Solomon technique group had a higher dual survival rate than the selective FLS group (81.3% vs. 57.9%, P=0.036). Neonatal mortality was significantly lower in the FLS group than in the non-FLS group (1.7% vs. 16.4%, P=0.005). Severe intraventricular hemorrhage more than grade 3 was less frequent in the FLS group than in the non-FLS group (0% vs. 18.2%, P= 0.001). The FLS group showed smaller inter-twin differences in birth weight (24.4% vs. 33.7%, P= 0.032) and lower incidence of twin anemia-polycythemia sequence (0% vs. 43.8%, P<0.001). CONCLUSION: Since the introduction of FLS, the survival rate of TTTS patients has improved. The Solomon technique resulted in better dual survival rates than selective FLS.
Birth Weight ; Female ; Fetofetal Transfusion* ; Fetoscopy ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Laser Therapy* ; Mortality ; Pregnancy ; Retrospective Studies ; Survival Rate ; Twins

PURPOSE: To develop a new scoring method for predicting the mortality at 28 days of life in premature infants. METHODS: From January 2000 to August 2001 (period I), medical records of 138 premature infants less than 32 weeks' gestation admitted at Asan Medical Center were reviewed retrospectively, and a predictive model (named as KCRIB28) was developed based on several steps of regression analysis. From January 2001 to December 2002 (period II), KCRIB28 was validated for 99 premature infants admitted at Ulsan University Hospital using retrospective cohort study, and compared with results of CRIB score for those infants. The primary outcome variable was death at 28 days of life. RESULTS: One hundred twenty seven (92%) of 138 infants during period I and 86 (86.9%) of 99 infants during period II survived over 28 days of life (P=0.07). The mean gestational age and birth weight (+/-SD) were 29.1+/-2.0 weeks and 1.23+/-0.35 kg, respectively, during period I, and 29.6+/-2.0 weeks and 1.37+/-0.46 kg, respectively, during period II. Gestational age, birth weight, 5-min. Apgar score and peak inspiratory pressure divided by birth weight at 12 hours of age were selected as parameters of KCRIB 28. Areas under the receiver operator characteristic curves (AUCs) were 0.84 (SEM, 0.08; 95%CI, 0.77-0.90) during period I and 0.89 (SEM, 0.06; 95%CI, 0.81-0.94) during period II. No differences in AUCs were found between KCRIB 28 and CRIB for patients during period II (P=0.75). CONCLUSION: KCRIB 28 can be used as a valuable measurement to predict the mortality of premature infants at 28 days of life.
Apgar Score ; Area Under Curve ; Birth Weight ; Chungcheongnam-do ; Cohort Studies ; Gestational Age ; Humans ; Infant ; Infant Equipment* ; Infant, Newborn ; Infant, Premature* ; Medical Records ; Mortality* ; Predictive Value of Tests ; Pregnancy ; Research Design* ; Retrospective Studies ; Ulsan

PURPOSE: The extended-spectrum beta-lactamase(ESBL) producing organism have emerged to be an important pathogen in neonatal intensive care unit(NICU). This study was conducted to investigate incidence, characteristics and risk factors associated with ESBL organism among newborns in NICU. METHODS: The subjects included 98 newborns admitted to NICU at Asan Medical Center between September 1998 to July 2002, from whom a total of 177 ESBL organisms were detected. Annual number of isolates, distribution of cultured sites, types of illness and patient profile were retrospectively reviewed and risk factors associated with the infection were identified between control group of 115 non-infected newborns. RESULTS: Of 177 ESBL isolates, 150(84.7%) and 27(15.3%) were ESBL producing K. pneumoniae and E. coli, respectively. The annual number of isolates were 2(1.1%), 23(13.0%), 126(71.2%), 17(9.6%) and 9(5.1%) for years 1998 to 2002. The annual incidence of sepsis due to ESBL organism was 2.9%, 8.2%, 17.8%, 3.1% and 2.8% for years 1998 to 2002:Year 2000 being an outbreak. The ESBL organisms were largely found in bronchial aspirates and urine. The infected patients were younger gestational age. The mean cultivation period was at 29.1+/-2.8 days. The risk factors for infection included, in the order of frequency, total parenteral nutrition, central venous catheterization, ventilator care, respiratory distress syndrome and dexamethasone therapy. CONCLUSION: Awareness of increasing infection due to ESBL producing organism in NICU is important not only for infection control but also placing a great limit in use of antibiotics, especially in premature infants.
Anti-Bacterial Agents ; beta-Lactamases* ; Catheterization, Central Venous ; Central Venous Catheters ; Chungcheongnam-do ; Dexamethasone ; Epidemiologic Studies* ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Infection Control ; Intensive Care, Neonatal* ; Parenteral Nutrition, Total ; Pneumonia ; Retrospective Studies ; Risk Factors ; Sepsis ; Ventilators, Mechanical

BACKGROUND/AIMS: We studied the prevalence of chronic hepatitis B, C and abnormality on liver function among the population in northwest area of Chungnam. METHODS: We have reviewed 40,112 adults who had received medical examination at health promotion center in Dankook university hospital. We studied them retrospectively about HBsAg, HBsAb, anti-HCV, and liver function test (LFT). RESULTS: Among the study subjects, 22,936 men and 17,176 women were involved. The overall seroprevalence of HBsAg was 4.2%. The prevalence in men (4.5%) was higher than that of women (3.7%) (p<0.001). The seroprevalence of HBsAg in their age was 5.1% in the 5th decade, 4.2% in the 2nd decade, 4.1% in the 4th decade, and 4.1% in the 6th decade. The overall seroprevalence of HBsAb was 65.1%. The overall seroprevalence of anti-HCV was 0.7%. After we reexamined them with HCV RNA or RIBA (Recombinant Immunoblot Assay), the prevalence of chronic hepatitis C was 0.09%. The LFT abnormality in total subjects was 11.4%. The LFT abnormality of chronic hepatitis B and C subjects was 21.72% and 63.2%. CONCLUSIONS: The prevalence of chronic hepatitis B and C was lower than that of previous studies. The prevalence of chronic hepatitis B in the 2nd decade was still high.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Hepatitis B Antibodies/blood ; Hepatitis B Surface Antigens/blood ; Hepatitis B, Chronic/*epidemiology/immunology/physiopathology ; Hepatitis C Antibodies/blood ; Hepatitis C, Chronic/*epidemiology/immunology/physiopathology ; Humans ; Korea ; Liver Function Tests ; Male ; Middle Aged ; Prevalence ; RNA, Viral/blood ; Retrospective Studies