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

Vascular cannulation is an invasive procedure that carries the risk of complications such as pseudoaneurysms. Hemophilia, the most common severe bleeding disorder of inheritance, increases the risk of such complications through underlying hypocoagulability. Although surgical ligation has been considered the gold standard treatment, less invasive options are currently available. Here we present 2 hemophiliac neonates for whom clotting factor replacement and ultrasound (US)-guided compression were successfully used. A 3-week-old male infant and a 4-week-old male infant presented with masses in the left antecubital area and the radial aspects of both wrists, respectively, after arterial punctures. The US confirmed the presence of pseudoaneurysms located at the left brachial artery and right radial artery. US-guided compressions with clotting factor administration initially attempted while confirming a thrombus inside the pseudoaneurysm sac indicated successful management. Arterial cannulation and other procedures in hemophiliac neonates must be attempted with caution because pseudoaneurysms or uncontrolled bleeding may occur. If laboratory analyses or invasive procedures are needed for neonates with a bleeding tendency or a suspected hemophiliac disorder, arterial or venous cannulation requires more caution or should be avoided if possible. This case report suggests that US-guided compression and clotting factor administration are suitable modalities for the treatment of small pseudoaneurysms in hemophilia patients.
Aneurysm, False* ; Blood Coagulation Factors ; Brachial Artery ; Catheterization ; Hemophilia A* ; Hemorrhage ; Humans ; Infant ; Infant, Newborn* ; Ligation ; Male ; Punctures ; Radial Artery ; Thrombosis ; Ultrasonography ; Ultrasonography, Interventional ; Wills ; Wrist

Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants' systemic manifestations were mild or absent, and all of them completely recovered within 2-3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC.
Abdomen ; Blood Platelets ; Colitis ; Diagnosis ; Enterocolitis, Necrotizing* ; Gastrointestinal Hemorrhage ; Humans ; Hypersensitivity ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Milk Proteins ; Mortality

PURPOSE: To determine the effects of pre-discharge education for the correct use of child occupant restraints (CORs). METHODS: Between January and August 2012, education for the correct use of CORs was provided to parents at the time of discharge of their newborns from our neonatal intensive care unit. A cross-sectional survey using self-report questionnaires or telephone interviews was conducted when the children were 6 to 12 months of age, and the acquired data were compared with data from a control group. RESULTS: The overall percentage of children using CORs was 73.4% for the COR educated group and 69.9% for the control group. However, the percentage of children who correctly used CORs was 42.2% for COR educated group and 44.3% for the control group. There was no statistically significant difference in parental awareness and perception of the correct use of CORs between the two groups. CONCLUSION: The correct use rate of CORs in our community is still low, and no difference in the correct use of CORs was observed between parents who were educated before discharge of their newborns and those who were not. Therefore, an alternative strategy, such as a strong enforcement program, is needed to increase the correct use of CORs.
Child Restraint Systems ; Child* ; Cross-Sectional Studies ; Education* ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Interviews as Topic ; Parents ; Surveys and Questionnaires

PURPOSE: To understand the incidence of retinopathy of prematurity (ROP) in preterm infants with birth weights more than 1,500 g or gestational age 30 weeks, and/or unstable clinical course, we investigated the highest gestational age and birth weight of preterm infants who require ROP treatment and those who do not. METHODS: The subjects were preterm infants admitted in Samsung medical center between January 1, 2000 and December 31, 2013. We retrospectively reviewed the medical records of 847 premature infants whose birth weights were more than 1,000 g. RESULTS: Of the 847 infants, 105 (12.4%) had stage 1 ROP, 54 (6.4%) had stage 2, 31 (3.7%) had stage 3, 0 had stage 4, and 2 (0.2%) had stage 5 ROP. Thirty-three (3.9%) of the 847 infants developed stage 3-5 ROP. Twenty (2.4%) of these 33 (3.9%) stage 3-5 ROP infants required treatment. Among the stage 1-3 ROP infants who did not require treatment, the highest gestational age was 37(+1) weeks (stage 1) and birth weight was 2,362 g (stage 1). Among the stage 3-5 ROP infants who needed treatment, the highest gestational age was 32 weeks and birth weight was 1,495 g. CONCLUSIONS: Newborn infants with gestational age more than 38 weeks or birth weight more than 2,400 g did not develop ROP even if they had an unstable clinical course. In our study, no preterm infants with gestational age more than 33 weeks or birth weight more than 1,500 g required ROP treatment.
Birth Weight* ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Premature ; Medical Records ; Retinopathy of Prematurity* ; Retrospective Studies

PURPOSE: In the present study, we aimed to determine the risk factors for the development of cystic periventricular leukomalacia (CPVL) in very low birth weight (VLBW) infants. METHODS: We reviewed the medical records of 309 infants weighing less than 1,500 g who were admitted to the neonatal intensive care unit at Hanyang University Medical Center, Seoul from April 2007 to December 2012. Thirty-nine infants died within 28 days of birth. Of the remaining 270 infants, 21 with CPVL established by cranial ultrasonography, and 63 without CPVL, who were matched for gestational age, were enrolled in this study. Univariate and multivariate analyses of maternal, perinatal, and neonatal risk factors for CPVL were performed through retrospective assessment of data collected from the medical records. RESULTS: Necrotizing enterocolitis (NEC > or =stage II: 42.9% vs. 9.5%, P=0.002), culture-proven sepsis (66.7% vs. 34.9%, P=0.021), hypotension with sepsis (33.3% vs. 6.3%, P=0.004), and severe intraventricular hemorrhage (> or =grade III: 61.9% vs. 22.2%, P=0.002) were associated with the development of CPVL on univariate analysis. Using multivariate logistic regression analysis, two variables were found to be statistically significant independent risk factors: NEC (> or =stage II: adjusted OR, 5.12; 95% CI, 1.219-21.514; P=0.026) and hypotension with sepsis (adjusted OR, 8.23; 95% CI, 1.194-56.713; P=0.032). CONCLUSION: NEC (> or =stage II) and hypotension with sepsis were associated with an increased risk of developing CPVL in VLBW infants.
Academic Medical Centers ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Humans ; Hypotension ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Logistic Models ; Medical Records ; Multivariate Analysis ; Parturition ; Retrospective Studies ; Risk Factors* ; Seoul ; Sepsis ; Ultrasonography

PURPOSE: Persistent pulmonary hypertension (PPHN) is considered an important prognostic factor in meconium aspiration syndrome (MAS). The aim of this study was to determine the comorbid risk factors for PPHN in infants with MAS. METHODS: We retrospectively analyzed 60 infants diagnosed with MAS and admitted to the neonatal intensive care unit of the Sanggye Paik Hospital from January 2007 to April 2013. There were 28 infants (47%) with PPHN and 32 infants (53%) without PPHN. Clinical characteristics, laboratory findings within 24 hours after birth, and initial capillary blood gas analysis results were compared between infants with and without PPHN. RESULTS: Incidence of PPHN was associated with the severity of MAS (P<0.001). The PPHN group had a greater incidence of hypotension and hypoxic-ischemic encephalopathy within 24 hours of birth compared to the non-PPHN group. The PPHN group also had a lower initial pH. However, there was no significant difference for laboratory findings within 24 hours of birth and initial capillary blood gas analysis. In the multivariate analysis, hypotension within 24 hours of birth (P=0.046, odds ratio 11.494, 95% confidence interval 1.048-125.00) was found to be a significant comorbid factor for PPHN in infants with MAS. CONCLUSION: Infants with MAS who develop hypotension within 24 hours of birth should be closely monitored for development of PPHN.
Blood Gas Analysis ; Capillaries ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Hypoxia-Ischemia, Brain ; Incidence ; Infant* ; Infant, Newborn* ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome* ; Multivariate Analysis ; Odds Ratio ; Parturition ; Retrospective Studies ; Risk Factors*

PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.
Aminophylline ; Continuous Positive Airway Pressure* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation* ; Intubation ; Pilot Projects* ; Positive-Pressure Respiration ; Prospective Studies* ; Respiration ; Ventilation ; Ventilators, Mechanical

PURPOSE: Birthmarks are commonly observed during neonatal period and its prevalence varies between races and countries. Most skin lesions are transient and not require medical treatment. But some birthmarks have potential medical significance and may be the first sign of systemic medical problems. We carried out a prospective study to determine the prevalence of birthmarks in Korean newborn infants. METHODS: From October 2012 to January 2013, 1,964 Korean newborn infants who were born in Cheil General Hospital, Kwandong University College of Medicine were evaluated for the presence of birthmarks within 48 hours after birth. RESULTS: Among 1,964 newborn infants, 980 (49.9%) infants were male and 984 (50.1%) were female. The most common pigmentary birthmark was Mongolian spot (97.1%), which was mostly presented on sacrogluteal area, and was followed by nevocellular nevi (0.8%), cafe-au-lait spot (0.8%), and sebaceous nevi (0.2%). Among vascular birthmarks, the most common lesion was salmon patch (30.8%), and followed by port-wine stain (0.2%) and hemangioma (0.2%). The common other lesions were sebaceous hyperplasia (37.4%), erythema toxicum neonatorum (10.2%), milia (4.1%), skin appendage (2.6%), anal dimple (1.2%), auricular pit (0.9%), miliaria (0.5%), aplasia cutis congenita (0.2%) in the order of frequency. CONCLUSION: We studied the prevalence of the birthmarks in Korean newborn infants. The most common pigmentary birth mark was mongolian spot, and the most common vascular birthmark was salmon patch in Korean newborn infants.
Cafe-au-Lait Spots ; Continental Population Groups ; Ectodermal Dysplasia ; Erythema ; Female ; Hemangioma ; Hospitals, General ; Humans ; Hyperplasia ; Incidence* ; Infant ; Infant, Newborn* ; Male ; Miliaria ; Mongolian Spot ; Nevus ; Parturition ; Port-Wine Stain ; Prevalence ; Prospective Studies ; Salmon ; Skin

Neonatal hypocalcemia is not uncommon, especially in premature neonates. It is usually treated by intravenous calcium gluconate administration. However, complications caused by the extravasation of intravenous calcium gluconate include calcinosis cutis, calcium deposition in the dermis, which is irritating to soft tissues and can produce tissue necrosis. We report a case of iatrogenic calcinosis cutis in a 27-day-old preterm baby following the extravasation of calcium gluconate. In this case, calcinosis cutis occurred along the venous pathway in a rare vascular calcification pattern but spontaneously resolved 2 months later. Although iatrogenic calcinosis cutis is generally benign, early recognition of the extravasation of calcium gluconate is important to avoid severe complications. This report aimed to provide a warning about the risks associated with intravenous calcium gluconate and information about the course of a rare presentation of the common disease calcinosis cutis with vascular calcification.
Calcinosis* ; Calcium ; Calcium Gluconate* ; Dermis ; Humans ; Hypocalcemia ; Infant, Newborn ; Necrosis ; Vascular Calcification