PURPOSE: To compare the oral feeding tolerance that reflects a general maturity of organization of behavior and response among preterm twins less than 34 weeks of gestation conceived after in vitro fertilization with/without embryo transfer (IVF-ET) with that of natural conception. METHODS: Medical records of 135 preterm twins less than 34 weeks of gestation (74 twins conceived after IVF-ET and 61 spontaneously conceived twins) admitted to the Neonatal Intensive Care Unit (NICU) of Dong-A Medical Center during the period from January 2003 to December 2010 were used for a retrospective study. The primary study outcomes were perinatal mortality and overall short term morbidity. The secondary study outcome was oral feeding tolerance. RESULTS: There was no difference among the two groups in the gestational age and birth weight. Perinatal mortality rate and morbidity rate was not different between the two groups. In terms of feeding practice, there was no significant difference in terms of the starting date of first enteral feeding (4.1+/-4.5 days vs. 3.5+/-3.6 days, IVF-ET twin group vs. spontaneous twin group), the time it took to reach full enteral feeding (26.7+/-20.5 days vs. 27.6+/-24.3 days), the time it took to reach full oral feeding (34.4+/-21.7 days vs. 34.3+/-24.1 days) and PMA upon full oral feeding (36.0+/-2.2 weeks vs. 36.0+/-1.8 weeks), the duration of total parenteral nutrition (23.1+/-21.0 days vs. 24.9+/-24.3 days), displaying similar oral feeding tolerance. CONCLUSION: There was no difference in oral feeding tolerance between two groups.
Birth Weight ; Embryo Transfer ; Enteral Nutrition ; Fertilization in Vitro ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parenteral Nutrition, Total ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies

PURPOSE: Little is known about the duration of antibiotics for suspected early-onset sepsis (EOS) with negative blood cultures. The purpose of this study is to identify associations between the duration of empirical antibiotics and neonatal outcomes. METHODS: We retrospectively reviewed medical records of very low birth weight infants (VLBW) who admitted to NICU in 2007-2010. We defined empirical antibiotic therapy group as those who started antibiotic therapy in first 3 postnatal days. We compared the neonatal outcomes between short empirical antibiotic therapy (<5 days) and long empirical antibiotic therapy (> or =5 days). RESULTS: Of 122 VLBW, 72 infants were long empirical antibiotic therapy group. In the long empirical antibiotic therapy group, there were lower birth weight, higher rate of out-born, higher rate of vaginal delivery, and had lower Apgar scores. Prolonged antibiotic therapy was associated with delayed start of enteral feeding and incidence of ESBL. CONCLUSION: Prolonged antibiotic therapy may be associated with some adverse neonatal outcomes. Therefore, wide spread agreement regarding the short empirical antibiotic therapy was needed.
Anti-Bacterial Agents ; Birth Weight ; Enteral Nutrition ; Humans ; Incidence ; Infant ; Infant, Very Low Birth Weight ; Medical Records ; Retrospective Studies ; Sepsis

PURPOSE: To evaluate the risk factors for hospital readmission during the neonatal period among late preterm infants who were discharged after nursery care. METHODS: In this retrospective study, we reviewed medical records of 135 late preterm infants readmitted to the neonatal intensive care unit (NICU) during the neonatal period, after discharge from nursery of IL Sin Christian Hospital from January 2003 to December 2008. We compared the risk factors of the hospital readmission group with the control group. RESULTS: The gestational age and birth weight of 135 study infants were 36(+1)+/-0.5 weeks and 2,718.4+/-296.9 gm, respectively. Identified risk factors of hospital readmission were breastfeeding (71.9% vs. 44.4%), short duration of nursery stay (3.3+/-1.6 days vs. 4.1+/-2.0 days), firstborn (60.0% vs. 45.3%), and maternal pregnancy complication (31.9% vs. 18.8%). Jaundice accounted for the majority of hospital readmissions (83.7%), and the age at hospital readmission was 6.2+/-3.6 postnatal days, mostly at 5-6 postnatal days (40.7%). Identified risk factors of hospital readmission due to jaundice were spontaneous normal vaginal delivery (43.4% vs. 1.8%), younger maternal age (29.8+/-3.4 yrs vs. 32.1+/-4.2 yrs), and lower maternal pregnancy complication (28.3% vs. 50%). CONCLUSION: Identified risk factors of hospital readmission were breastfeeding, short duration of nursery stay, firstborn, and maternal pregnancy complication. Jaundice accounted for the majority of hospital readmissions, and the age at hospital readmission was 6.2+/-3.6 postnatal days.
Birth Weight ; Breast Feeding ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Jaundice ; Maternal Age ; Medical Records ; Nurseries ; Patient Readmission ; Pregnancy Complications ; Retrospective Studies ; Risk Factors

Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters.
Energy Intake ; Enteral Nutrition* ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Milk, Human

Spontaneous pneumomediastinum in a term newborn without mechanical ventilation or underlying lung disease is rare. We present a case of a newborn baby who developed respiratory distress after birth and cystic pneumomediastinum which improved spontaneously with thymic hyperplasia as demonstrated on chest radiography, CT and MRI. The combination of cystic pneumomediastinum and thymic hyperplasia in a newborn has not been reported, thus far.
Humans ; Hyperplasia ; Infant, Newborn ; Lung Diseases ; Mediastinal Emphysema ; Parturition ; Respiration, Artificial ; Thorax ; Thymus Gland ; Thymus Hyperplasia

PURPOSE: This study aimed to investigate the respiratory morbidities in term neonates, as well as their relationship with mode of delivery and gestational age. METHODS: Medical records of term infants with respiratory symptoms, who were admitted to the neonatal intensive care unit (NICU) of Dong-A University Hospital from Jan 2008 to Dec 2013, were retrospectively reviewed. Term neonates with respiratory diseases, such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), neonatal pneumonia, meconium aspiration syndrome (MAS), pneumothorax, and persistent pulmonary hypertension of the newborn (PPHN), were included. The respiratory morbidities were investigated according to the gestational age (<39 weeks vs. > or =39 weeks) and/or mode of delivery (with labor vs. without labor). RESULTS: A total of 260 term neonates were enrolled in the study. The average gestational age was 38(+6)+/-1.3 weeks, while the birth weight was 3,233.7+/-462.0 g. The most common respiratory disease encountered in term neonates was TTN (n=98, 37.7%), followed by MAS (n=76, 29.2%), spontaneous pneumothorax (n=27, 10.4%), PPHN (n=24, 9.2%), neonatal pneumonia (n=19, 7.3%), and RDS (n=16, 6.2%). Incidence of TTN and RDS was higher in neonates aged <39 weeks than in those aged > or =39 weeks. Higher incidence of spontaneous pneumothorax and RDS was observed in neonates delivered before the onset of labor. The incidences of TTN, spontaneous pneumothorax, and RDS were higher in the elective cesarean section group before 39 weeks of gestation. CONCLUSION: Respiratory morbidities in term neonates are affected by the gestational age (<39 weeks vs. > or =39 weeks) and/or mode of delivery (with labor vs. without labor).
Birth Weight ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hypertension, Pulmonary ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome ; Medical Records ; Pneumonia ; Pneumothorax ; Pregnancy ; Retrospective Studies ; Transient Tachypnea of the Newborn

Interstitial deletions involving the chromosome band 15q22q24 are very rare and only nine cases have been previously reported. Here, we report on a 12-day-old patient with a de novo 15q22q23 interstitial deletion. He was born by elective cesarean section with a birth weight of 3,120 g at 41.3-week gestation. He presented with hypotonia, sensory and neural hearing loss, dysmorphism with frontal bossing, flat nasal bridge, microretrognathia with normal palate and uvula, thin upper lip in an inverted V-shape, a midline sacral dimple, severe calcanovalgus at admission, and severe global developmental delay at 18 months of age. Fluorescence in situ hybridization findings confirmed that the deleted regions contained at least 15q22. The chromosome analysis revealed a karyotype of 46,XY,del(15) (q22q23). Parental chromosome analysis was performed and results were normal. After reviewing the limited literature on interstitial 15q deletions, we believe that the presented case is the first description of mapping of an interstitial deletion involving the chromosome 15q22q23 segment in Korea. This report adds to the knowledge of the clinical phenotype associated with the 15q22q23 deletion.
Birth Weight ; Cesarean Section ; Developmental Disabilities ; Female ; Fluorescence ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; In Situ Hybridization ; Karyotype ; Korea ; Lip ; Muscle Hypotonia* ; Palate ; Parents ; Phenotype ; Pregnancy ; Uvula

PURPOSE: Transient tachypnea of the newborn (TTN) is a respiratory disorder resulting from delayed clearance of fetal lung fluid. Initiation of empiric antibiotic therapy for possible early-onset sepsis is usually recommended until negative blood cultures for 48 hours. The aim of this study was to compare outcomes of infants with TTN managed with a risk-factor-based restrictive antibiotic use policy. METHODS: A single institution retrospective study was conducted on full-term infants admitted with TTN from January, 2008 to December, 2013. Infants were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics depended upon the covering physician at admission. The clinical and laboratory outcomes were evaluated between two groups. RESULTS: A total of 98 full-term infants diagnosed with TTN were admitted to the neonatal intensive care unit; of them 39 (39.8%) received and 59 (60.2%) did not receive antibiotics. Physicians had tendency to start antibiotics in patient with mild-to-moderate chest retraction, need oxygen therapy, high white blood cell count, segmented neutrophil and positive C-reactive protein. All of them had negative blood cultures, no readmission, and no late-onset sepsis. The duration of hospital stay was longer in patients received antibiotics group (10.7+/-3.0 days vs. 9.0+/-4.4 days, P=0.04). CONCLUSION: This study suggests that empiric antibiotic therapy may not be recommended for full-term infants with classic TTN without perinatal risk factors. With the application of strict criteria for classic TTN and the close observation, the empiric use of antibiotics may be avoidable.
Anti-Bacterial Agents ; C-Reactive Protein ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Length of Stay ; Leukocyte Count ; Lung ; Neutrophils ; Oxygen ; Retrospective Studies ; Risk Factors ; Sepsis ; Thorax ; Transient Tachypnea of the Newborn*

This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA > or = 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.
Cohort Studies ; Databases, Factual ; Ductus Arteriosus, Patent/surgery/*therapy ; Echocardiography ; Gestational Age ; Humans ; Ibuprofen/therapeutic use ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Natriuretic Peptide, Brain/analysis ; Republic of Korea

PURPOSE: Transient tachypnea of the newborn (TTN) is a disorder caused by the delayed clearance of fetal alveolar fluid. beta-adrenergic agonists such as albuterol (salbutamol) are known to catalyze lung fluid absorption. This study examined whether inhalational salbutamol therapy could improve clinical symptoms in TTN. Additional endpoints included the diagnostic and therapeutic efficacy of salbutamol as well as its overall safety. METHODS: From January 2010 through December 2010, we conducted a prospective study of 40 newborns hospitalized with TTN in the neonatal intensive care unit. Patients were given either inhalational salbutamol (28 patients) or placebo (12 patients), and clinical indices were compared. RESULTS: The duration of tachypnea was shorter in patients receiving inhalational salbutamol therapy, although this difference was not statistically significant. The duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment were significantly shorter in the salbutamol-treated group. No adverse effects were observed in either treatment group. CONCLUSIONS: Inhalational salbutamol therapy reduced the duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment, with no adverse effects. However, the time between salbutamol therapy and clinical improvement was too long to allow definitive conclusions to be drawn. Further studies examining a larger number of patients with strict control over dosage and frequency of salbutamol inhalations are necessary to better direct the treatment of TTN.
Absorption ; Adrenergic beta-Agonists ; Albuterol* ; Humans ; Infant, Newborn ; Inhalation ; Intensive Care, Neonatal ; Lung ; Methods ; Oxygen ; Prospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn*