Journal Detail Information

1

Cite

Share

Acute Kidney Injury in Neonates with Hypoxic-Ischemic Encephalopathy Under going Therapeutic Hypothermia

Perinatology.2024;35(4):134-139. doi:10.14734/PN.2024.35.4.134

Objective: Hypoxic-ischemic encephalopathy (HIE) frequently leads to neurological complications, such as seizures and developmental disorders. In addition to these challenges, many infants with HIE experience multi-organ dysfunction, and HIE is a major cause of acute kidney injury (AKI) during the neonatal period. This study aimed to investigate the risk factors for AKI in neonates treated with therapeutic hypothermia (TH) for HIE. Methods: We retrospectively reviewed neonates who received TH for HIE at a single center between January 2015 and August 2024. AKI was defined according to the neonatal modified Kidney Disease Improving Global Outcome criteria. Initial blood gas analysis, seizures, severity of HIE, neurologic studies, and mortality were compared between infants with and without AKI. Results: Among 288 neonates with HIE, TH was performed on 60 neonates, of which 3 were ex cluded, resulting in a total of 57 neonates. A total of 25 patients (43.9%) developed AKI, of whom 10 had stage 1 AKI, 6 had stage 2 AKI, and 9 had stage 3 AKI. In stage 3 AKI, one patient (1.8%) needed renal replacement therapy. Initial pH (P=0.040) and base excess (BE) (P=0.008) were significantly lower in the AKI group compared to the non-AKI group. AKI patients had a significantly higher rate of severe HIE (P=0.018), convulsions (P=0.022), and mortality (P=0.017). In logistic regression analysis, low initial BE and the presence of convulsion were independently associated with an increased risk of AKI, with odds ratios of 1.16 and 3.95, respectively. Conclusion AKI remains common in neonates with HIE treated with TH. Low BE and convulsion were identified as independent risk factors for the development of AKI.

2

Cite

Share

A Review of the Roles of Placental Chorio nic Trophoblasts and Macrophages and Trends in Perinatal Research

Seung-Woo YANG ; Young-Sun KANG ; Han-Sung HWANG

Perinatology.2024;35(4):113-119. doi:10.14734/PN.2024.35.4.113

Trophoblasts and macrophages, the 2 major fetal-derived cells that comprise the placenta, play important roles in placental development and pregnancy maintenance. In response to hypoxia in early pregnancy, placental trophoblasts are required to differentiate into extravillous trophoblasts to ensure a good blood supply from the mother, and then into fused trophoblasts, which secrete placental hormones that contribute to placental growth. Placental Hofbauer cells are tissue macrophages found in the placenta throughout pregnancy. As phenotypically and functionally M2 macrophages, they have a wide range of roles, including phagocytosis of inflammatory substances in the placenta, angiogenesis for placental growth, and maintenance of immune tolerance in the placenta. In this review, we will discuss the functions and characteristics of trophoblasts and Hofbauer cells in the maintenance of immune tolerance of the placental villi and their applicability in perinatal research.

3

Cite

Share

The Usefulness of Gestation Corrected Hy peruricemia as Predictors of the Recurrence of Preeclampsia and Obstetric Outcomes on Subsequent Pregnancy: A Single Center Retrospective Study in South Korea

Hee Young BANG ; Jong Woon KIM ; Yoon Ha KIM ; Myeong Gyun CHOI ; Tae Young KIM ; Tae Ho PARK

Perinatology.2024;35(4):128-133. doi:10.14734/PN.2024.35.4.128

Objective: Hyperuricemia has been described commonly in preeclamptic pregnancies, often prece ding the diagnosis of preeclampsia and historically was used as a diagnostic marker of preeclampsia.The aim of this study was to determine the usefulness of gestation corrected hyperuricemia (GCH) to predict the recurrence of preeclampsia on subsequent pregnancy. Methods: The retrospective study of 64 women who had previous preeclampsia and checked serum uric acid was analyzed. GCH was defined as being one standard deviation above the gestation-specific mean. And we used uric acid z-scores ([serum uric acid value-gestation specific mean]/standard deviation of the population) to account for gestation-specific alterations in uric acid and tested this as a continuous variable. The relationship between GCH and recurrence of preeclampsia on subsequent pregnancy was analyzed. Obstetric outcomes were reviewed according to absence or presence of GCH. P<0.05 was considered as significant. Results: Of 64 women, seventeen had the development of recurrent preeclampsia (26.6%). The absence or presence of GCH was not associated with the recurrence of preeclampsia on subsequent pregnancy (P=0.267). And gestation-specific uric acid z-score as a continuous variable did not show any association with the prediction of preeclampsia on subsequent pregnancy (P=0.427). GCH was associated with the small for gestational age (P=0.010). Conclusion GCH does not predict the recurrence of preeclampsia on subsequent pregnancy.

4

Cite

Share

Outcomes of Heterotopic Pregnancies in a Single Tertiary Hospital: A Retrospective Study

Ah-La CHO ; En Och HONG ; Yun Young NA ; Jong Woon KIM ; Myeong Gyun CHOI ; Yoon Ha KIM

Perinatology.2024;35(4):120-127. doi:10.14734/PN.2024.35.4.120

Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

5

Cite

Share

A Case Report of Alobar Holoprosencepha ly with Cyclopia and Arrhinia: The Long est-Surviving Infant without Life-Sustain ing Interventions

Yejun LEE ; Misun YANG ; So Yoon AHN ; Se In SUNG ; Yun Sil CHANG

Perinatology.2024;35(4):146-151. doi:10.14734/PN.2024.35.4.146

Holoprosencephaly (HPE) is a rare congenital disorder characterized by the incomplete separation of the prosencephalon. The clinical spectrum of HPE depends on the subtypes observed on imaging, which includes lobar, semilobar, and alobar variants. Cyclopia, the most severe form of alobar HPE, is typically associated with early postnatal death within a few days. We report the case of a female infant was born at 38 weeks and 6 days of gestation, weighing 2,410 g, to a 39-year-old mother via vaginal delivery. She was the second baby of dichorionic-diamniotic twins. The neonate was born with multiple defects including facial anomalies such as cyclopia and arrhinia and was diagnosed with alobar HPE with cyclopia. This condition was suspected prenatally at 17 weeks of gestation and confirmed postnatally using brain magnetic resonance imaging. The cause of death in our patient was aspiration pneumonia with aggravated central apnea, and she survived for 8 months (240 days) with comfort care alone, without aggressive life support. This is the first report of an infant with alobar HPE, cyclopia, and arrhinia surviving for 240 days with only comfort care, marking the longest documented survival for this typically lethal condition without invasive interventions.

6

Cite

Share

Implementation of Novel Fetal Intervention for Fetal Lower Urinary Tract Obstruction and the Importance of Candidate Selection:A Case Report

Won Shik CHOI ; So Yun AHN ; Na Mi LEE ; Na Li YU ; Sooji HAM ; Gwang Jun KIM

Perinatology.2024;35(4):140-145. doi:10.14734/PN.2024.35.4.140

Fetal lower urinary tract obstruction (LUTO) is a congenital condition in which the bladder fails to excrete urine through the urethra. The primary goal of prenatal treatment for LUTO is the prevention of renal impairment and pulmonary hypoplasia. Vesico-amniotic shunt (VAS) has been the fetal intervention of choice; however, VAS has some limitations, including excretion of urine through an unphysiologic bypass and the need for postnatal corrective reoperation. In this study, we present a novel fetal intervention, a “retro-cystoscopic urethral approach,” performed on a male fetus at 20 weeks gestation diagnosed with enlarged bladder and bilateral hydronephrosis. This approach aims to dilate the narrowed urethra by inserting a urinary catheter using guidewire through a fetal cysto scope. The whole procedure was monitored under real-time ultrasonographic guidance. Despite prenatal intervention, the fetus required multiple cystocenteses, and the bladder dilation persisted.Postnatally, he was diagnosed with megacystis microcolon intestinal hypoperistalsis syndrome, a non-obstructive condition which is relatively rare in male infants. Our case emphasizes the compl exity of diagnosing LUTO during the prenatal period. Further studies exploring novel prenatal interven tions should pay more attention to candidate selection. Additionally, a thorough evaluation of organ systems beyond the urinary tract is necessary.

7

Cite

Share

Congenital Hemophilia B, Rare Mutation c.368T>G, Presenting with Delayed Massive Expansion of Non-Traumatic Cephalhema toma

Sejin AHN ; Heui Seung JO

Perinatology.2024;35(2):81-84. doi:10.14734/PN.2024.35.2.80

Cephalhematoma is one of the common birth traumas; 0.4% to 2.5% of newborns are reported have cephalhematoma after birth. Most of these lesions improve spontaneously without any medical intervention. Cephalhematoma occurs by the injury of subperiosteal vessels of the skull. In cases related to genetic coagulation factor deficiency, where there were no recruitment of instruments, such as, forceps or vacuums during delivery, only 2% of newborns were diagnosed with cerebral hemorrhage, which are types of intracranial or subgaleal hemorrhage. Here, we have reported the case of newborn with hemophilia B. This patient was born without any issues during vaginal delivery, and was discharged on the 3rd day after birth. Three days later, on the sixth day after birth, the patient was admitted due to neonatal jaundice, anemia and worsened cephalhematoma.

8

Cite

Share

Cervical Cerclage: What Is the Current Evidence?

Soo-young OH

Perinatology.2024;35(2):27-37. doi:10.14734/PN.2024.35.2.27

During pregnancy, cervical incompetence has an incidence of approximately 0.5%, accounting for about 8% of mid-trimester miscarriages or stillbirths. Cervical cerclage is a crucial intervention to save fetuses at the periviable period, but it remains a contentious area due to insufficient evidence and susceptibility to selection bias. The American College of Obstetricians and Gynecologists’ guidelines from 2014 were not revised, while the United Kingdom updated its recommendations in 2022 based on the 2011 guidelines, and Canada revised its guidelines in 2019 from those issued in 2013. In 2021, the International Federation of Gynecology and Obstetrics emphasized the importance of evidencebased medicine and released recommendations for cervical cerclage surgery. This review aims to examine the evidence for cervical cerclage, focusing on indications, timing of the procedure, its application in twin pregnancies from the four international guidelines, and to update recent metaanalyses and clinical research results about cervical cerclage.

9

Cite

Share

Various Types of Fetal Arrhythmias and Assessment of the Cardiac Function in a Fetus with a Cardiac Capillary Hemangioma: A Case Report

Jihye KOH ; Myung Shin SHIN ; Byeol HAN ; Jinha LEE ; Hye-Sung WON

Perinatology.2024;35(2):76-80. doi:10.14734/PN.2024.35.2.75

We present a case of fetal cardiac hemangioma that caused fetal arrhythmia and reduced ventricular contractibility. At 31 weeks and 1 day of gestation, a 29-year-old primiparous mother was referred to our institution due to an abnormal ultrasound finding, suspicious of a fetal cardiac mass occupying the right atrium (RA). The blood flow from the RA to the right ventricle (RV) was decreased. Additional evaluation through FetalHQ (GE Healthcare Korea) revealed diminished RV contractility. At gestational age 35 weeks and 1 day, the fetus had developed paroxysmal supraventricular tachycardia. We decided to perform an emergency cesarean section to prevent further impairment in fetal cardiac circulation. Postnatal echocardiography showed a pedunculated mass on the free wall of the RA, and the cardiac movements were affected with atrial flutter. Immediate mass excision was performed.Pathological analysis confirmed that the mass was a juvenile capillary hemangioma. The newborn stayed admitted for postoperative care and recovered healthy without any signs of cardiac arrhythmia.

10

Cite

Share

Evolution of the Definition of Bronchopul monary Dysplasia and Its Long-Term Out comes

Ga Won JEON

Perinatology.2024;35(2):38-43. doi:10.14734/PN.2024.35.2.38

Bronchopulmonary dysplasia (BPD) remains a significant concern in neonatal care despite advance ments in intensive care for preterm infants, as its incidence continues to rise. This chronic complica tion of prematurity not only affects respiratory function but also has impacts on growth and neuro development into childhood and adolescence. The evolution of BPD definitions reflects the changing landscape of neonatal care, aiming to better predict long-term outcomes and guide early interven tions. While the National Institute of Child Health and Human Development (NICHD) 2001 definition set a standard for classifying BPD severity, its limitations in capturing diverse respiratory support and predicting long-term outcomes have prompted the development of newer definitions, such as the NICHD 2018 and Neonatal Research Network 2019 definitions. These updated definitions offer improvements by considering a broader range of respiratory support criteria and enhancing predic tive value for mortality, respiratory morbidity, growth, and neurodevelopmental impairment. The primary goal of defining BPD and grading its severity is to identify high-risk infants early, enabling targeted interventions to improve long-term outcomes. Future efforts should focus on refining BPD definitions to best predict these outcomes and optimize care for this vulnerable population.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share