PURPOSE: Ureaplasma colonization is related with perinatal complications in preterm infants. Little is known about the difference in virulence among various Ureaplasma urealyticum serovars. The aim of this study was to determine U. urealyticum serovars of preterm infants in order to assess whether any of the serovars were associated with bronchopulmonary dysplasia (BPD). METHODS: Three hundred forty-four preterm infants with a gestational age less than 34 weeks admitted to Gangnam Severance Hospital neonatal intensive care unit from July 2011 to December 2012 were included in this study. Tracheal and gastric aspirations were conducted on infants to confirm Ureaplasma colonization. Ureaplasma colonization was confirmed in 9% of infants, of these, serovars were determined by real-time polymerase chain reaction. RESULTS: A total of 31 infants (gestational age, 29.3+/-3.1 weeks; birth weight, 1,170+/-790 g) were U. urealyticum positive. The Ureaplasma positive group treated for more days with oxygen and ventilation than the negative group (P<0.05). Histologic chorioamnionitis and moderate to severe BPD were more frequent in the Ureaplasma positive group than in the negative group (P<0.05). U. urealyticum isolates were either found to be a mixture of multiple serovars (32%), serovar 9 alone or combined with other serovars (39%), serovar 11 (26%), 2 (13%), 8 (10%), 10 (13%), and 13 (25%). No individual serovars were significantly associated with moderate to severe BPD and chorioamnionitis. CONCLUSION: This is the first study to describe the distribution of U. urealyticum serovars from Korean preterm infants. Ureaplasma-colonized infants showed higher incidence of BPD and chorioamnionitis.
Aspirations (Psychology) ; Birth Weight ; Bronchopulmonary Dysplasia ; Chorioamnionitis ; Colon ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Oxygen ; Pregnancy ; Ureaplasma urealyticum* ; Ureaplasma* ; Ventilation ; Virulence

PURPOSE: The ophthalmologic screening examination in extremely low birth weight (ELBW) infants shoud be done at a postconceptional age (PCA) of 31 to 33 weeks or the chronological age (CA) of 4 to 6 weeks. If the first ophthalmologic examination in ELBW infants is perfomed at 31 to 33 weeks PCA, there is a risk of threshold retinopathy of prematurity (ROP) having already developed on the first examination. The risk of a visual loss is high if threshold ROP has already developed before the initial screening examination of ROP. Therefore, we investigated the ideal timing of the initial ophthalmologic screening examination based on PCA and CA in ELBW infants. SUBJECTS: The medical records of 38 ELBW infants (<1000 g at birth) admitted to neonatal intensive care unit of Severance hospital between January 1991 and December 2000, whose follow-up ophthalmologic examinations were available, were reviewed retrospectively. We investigated the PCA and CA at the diagnosis of prethreshold ROP and threshold ROP. RESULTS: Sixty-five percent of subjects was diagnosed with prethreshold ROP and 64% of the infants progressed to threshold ROP. The median time of progression from prethreshold ROP to threshold ROP was 14 days (2-33). Twenty-four percent was diagnosed with prethreshold ROP on the first eye examination. Prethreshold ROP was diagnosed as early as 33 weeks PCA and threshold ROP was diagnosed as early as 35 weeks PCA. Prethreshold ROP was diagnosed as early as 4 weeks CA and threshold ROP was diagnosed as early as 6 weeks CA. CONCLUSION: We suggest that the initial screening examination for ROP should be performed by CA or PCA in ELBW infants, whichever is earlier, to detect prethreshold ROP before its progression to threshold ROP.
Diagnosis ; Follow-Up Studies ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Mass Screening* ; Medical Records ; Passive Cutaneous Anaphylaxis ; Retinopathy of Prematurity* ; Retrospective Studies

PURPOSE: The vancomycin dosage regimen is regularly modified according to the patient's glomerular filtration rate (GFR). In the present study, we aimed to assess the usefulness of serum cystatin C (Cys-C) concentration, compared with serum creatinine (SCr) concentration, for predicting vancomycin clearance (CLvcm) in neonates. METHODS: We retrospectively analyzed the laboratory data of 50 term neonates who were admitted to the neonatal intensive care unit and received intravenous vancomycin, and assessed the pharmacokinetic profiles. Creatinine clearance (CLcr) and GFR based on Cys-C (GFRcys-c) were estimated using the Schwartz and Larsson formulas, respectively. RESULTS: The mean CLvcm (+/-standard deviation) was 74.52+/-31.17 L/hr, the volume of distribution of vancomycin was 0.67+/-0.14 L, and vancomycin half-life was 9.16+/-17.42 hours. The SCr was 0.46+/-0.25 mg/dL and serum Cys-C was 1.43+/-0.34 mg/L. The peak and trough concentrations of vancomycin were 24.65+/-14.84 and 8.10+/-5.35 mcg/mL, respectively. The calculated GFR based on serum creatinine concentration (GFR-Cr) and GFRcys-c were 70.2+/-9.45 and 63.6+/-30.18 mL/min, respectively. The correlation constant for CLvcm and the reciprocal of Cys-C (0.479, P=0.001) was significantly higher than that for CLvcm and the reciprocal of SCr (0.286, P=0.044). GFRcys-c was strongly correlated with CLvcm (P=0.001), and the correlation constant was significantly higher than that for CLvcm and CLcr (0.496, P=0.001). Linear regression analysis showed that only GFRcys-c was independently and positively correlated with CLvcm (F=41.9, P<0.001). CONCLUSION: The use of serum Cys-C as a marker of CLvcm could be beneficial for more reliable predictions of serum vancomycin concentrations, particularly in neonates.
Creatinine ; Cystatin C* ; Glomerular Filtration Rate ; Half-Life ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Linear Models ; Retrospective Studies ; Vancomycin*

Most of the gastric outlet obstruction symptoms like vomiting and abdominal distension were caused by congenital anatomical abnormality in a neonate. Abnormal structures associated with congenital gastric outlet obstruction have been categorized by its site and extent of obstruction. We report one case of persisting vomiting in a premature infant caused by serosal fibrous band in gastric outlet lesion, excluded from the category of congenital gastric outlet obstruction.
Fibrosis ; Gastric Outlet Obstruction* ; Humans ; Infant, Newborn ; Infant, Premature ; Vomiting

Objective: To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionalityeuroticism scale (odds ratio=1.152, p<0.001). Conclusion The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.

Congenital intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. Their clinical manifestations tend to vary according to age, with pediatric populations being more likely to have symptoms like congestive cardiac failure and seizures because of arteriovenous shunting; hemorrhage is the major presentation in adult populations. Pediatric populations, especially newborn infants, seldom experience a hemorrhagic event. Here, we report two rare cases of neonates with congenital pial AVF presenting as intraventricular and subdural hemorrhage, respectively, which were treated with endovascular embolization.
Adult ; Arteriovenous Fistula* ; Brain* ; Embolization, Therapeutic ; Estrogens, Conjugated (USP) ; Heart Failure ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant ; Infant, Newborn* ; Intracranial Hemorrhages* ; Seizures

PURPOSE: Patent ductus arteriosus (PDA) is common in preterm infants, and about 30% of preterm infants undergo surgical ligation of the PDA. Cardiopulmonary instability, defined as hypotension and respiratory failure after PDA ligation, is reported to occur at a frequency of 40-50%. This study investigated the factors affecting cardiopulmonary instability after PDA ligation in preterm infants. METHODS: The medical records of 45 very low birth weight (VLBW) infants who underwent PDA ligation in the neonatal intensive care unit from January 2009 to December 2013 were analyzed retrospectively. PDA ligation was only performed when medical treatment for hemodynamically significant PDA failed or was contraindicated. The cases were categorized into the hemodynamic instability (n=20) and control (n=25) groups. RESULTS: Patients underwent ligation at the mean age of 14.3+/-13.3 days. There were no significant differences between groups in mortality or weaning from ventilation after PDA ligation. In the hemodynamic instability group, birth weight was significantly lower (P=0.046) and the pre-operation C-reactive protein (CRP) level was significantly higher (P=0.042) than in the control group. The use of high-frequency ventilation was higher in the hemodynamic instability group (P=0.033). There were no differences in use of inotropics, mean airway pressure at ligation, timing of ligation, or PDA size between groups. The birth weight and pre-operation CRP level at the time of ligation remained a significant risk factor for cardiopulmonary instability on multiple logistic regression analysis. CONCLUSION: In VLBW infants, lower birth weight and a higher pre-operation CRP level are related to unstable conditions after PDA ligation.
Birth Weight ; C-Reactive Protein ; Ductus Arteriosus, Patent* ; Hemodynamics ; High-Frequency Ventilation ; Humans ; Hypotension ; Infant* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Ligation* ; Logistic Models ; Medical Records ; Mortality ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors* ; Ventilation ; Weaning

PURPOSE: This study aimed to analyze the risk factors for the development of rickets of prematurity in extremely low birth weight (ELBW) infants. METHODS: We retrospectively reviewed the data of 57 ELBW infants. Nineteen infants were diagnosed with rickets and 38 infants without rickets were recruited. On radiologic evaluation, 47% of infants had grade I, 37% had grade II, and 16% had grade III rickets. RESULTS: In ELBW infants with rickets, the durations of oxygen administration, mechanical ventilation, parenteral nutrition, and hospitalization were significantly longer compared to those of the control group. The number of days for achieving an enteral caloric intake of 80 kcal/kg/d and the number of days for regaining birth weight were significantly longer compared to those of the control group. Serial weight changes from birth weight during 8 weeks after birth was significantly lower in the rickets group than in the control group. Retinopathy of prematurity was significantly higher in the rickets group than in the control group. After adjustment for birth weight, rickets of prematurity was correlated with days for regaining birth weight (odds ratio [OR], 1.316; P=0.010), and with weight changes from birth weight at 4 weeks of age (OR, 0.964; P=0.033). CONCLUSION: In ELBW infants, the risk factors for rickets of prematurity were days for regaining birth weight from birth and the weight changes at 4 weeks of age. Early aggressive nutrition for regaining birth weight earlier may reduce the development of rickets of prematurity.
Birth Weight ; Body Weight Changes ; Energy Intake ; Enteral Nutrition ; Hospitalization ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Oxygen ; Parenteral Nutrition ; Parturition ; Respiration, Artificial ; Retinopathy of Prematurity ; Retrospective Studies ; Rickets* ; Risk Factors*

PURPOSE: Meconium-related ileus (MRI) is one of the major causes of bowel obstruction in extremely low-birth weight newborn infants (ELBWI). Hyperosmolar water-soluble contrast (HWSC) enemas been recognized to be an effective treatment for MRI. The purpose of this study is to observe clinical findings of MRI accompanied by ELBWI and evaluate the therapeutic efficacy and complications of HWSC enemas. METHODS: A total of 15 ELBWI with MRI were treated with HWSC enemas under the guidance of ultrasonography at the bedside in the NICU between 2008 and 2011. Clinical findings of 15 patients were reviewed and compared with those of 48 ELBWI without MRI administered to NICU during the same period. Radiological findings, therapeutic efficacy and complications of HWSC enemas in patients with MRI were also reviewed. RESULTS: Patients with MRI, compared to those without MRI, showed the following significantly lower Apgar score at 1 minute, higher incidence of preeclampsia, bronchopulmonary dysplasia and sepsis, and longer duration of the first meconium passing and non-feeding per oral. Fourteen patients with MRI had resolved bowel obstruction successfully following 1-2 trials of enema. One case was not relieved following 3 trials of enema, showed no clinical improvement, and died of severe intraventricular hemorrhage and multi-organ failure at 45 days old. No complications associated with HWSC enemas were observed in all cases. CONCLUSION: Administration of HWSC enemas under the guidance of abdomen ultrasonography in the NICU is safe and efficacious for the rapid diagnosis and treatment of MRI even accompanied by ELBWI.
Abdomen ; Apgar Score ; Bronchopulmonary Dysplasia ; Enema ; Hemorrhage ; Humans ; Ileus ; Incidence ; Infant, Newborn ; Meconium ; Pre-Eclampsia ; Sepsis

Autosomal recessive polycystic kidney disease (ARPKD) is a severe form of polycystic kidney disease that is characterized by enlarged kidneys and congenital hepatic fibrosis. The clinical spectrum of this condition shows wide variation. Approximately 30-50% of affected individuals die in the neonatal period, while others survive into adulthood. ARPKD is caused by mutations in the polycystic kidney and hepatic disease 1 (PKHD1) gene on chromosome 6p12, which consists of 86 exons variably assembled into many alternatively spliced transcripts. We report a case of a pathogenic PKHD1 frameshift mutation, c.889_931del43, which was identified using direct full sequencing, associated with enlarged cystic kidneys and dilatation of intrahepatic bile duct, as observed on imaging studies.
Bile Ducts, Intrahepatic ; Dilatation ; Exons ; Fibrosis ; Frameshift Mutation ; Kidney ; Kidney Diseases, Cystic ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Recessive*