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Correlation between Cephalhematomas and Intracranial Hematomas.

Journal of the Korean Society of Neonatology.2008;15(2):160-165.

PURPOSE: Cephalhematomas rarely lead to serious complications, such as skull fractures and intracranial hematomas, so CT and/or MRI scans are indicated only in cases in which depressed fractures are suspected or neurologic symptoms develop. Nevertheless, we have experienced several cases of cephalhematomas associated with intracranial hematomas in the absence of remarkable neurologic symptoms. The aim of this study was to evaluate the correlation between cephalhematomas and intracranial hematomas and determine the need for neuroimaging in infants with cephalhematomas. METHODS: Infants who were admitted to the NICU with cephalhematomas and underwent neuroimaging (CT and/or MRI) between January 2002 and July 2006 were evaluated. Neuroimaging was done when the symptoms suggested the development of an intracranial hematoma. RESULTS: Among 54 infants with cephalhematomas, 18 infants underwent neuroimaging. Six of 18 infants (33.3%) had intracranial hematomas, 4 infants had epidural hematomas, and 2 infants had subdural hematomas. Four of these 6 infants had neurologic symptoms or depressed skull fractures; 2 infants had no neurologic symptoms or depressed skull fractures. The neuroimaging was done to evaluate the cause of an excessive elevation of serum bilirubin and unexplained anemia. There were no remarkable differences between the infants with and without intracranial hematomas with respect to gestational age, birth weight, head circumference, diameter of the cephalhematoma, neurologic symptoms, and other clinical signs and symptoms. CONCLUSION: Based on this study, intracranial hematomas are common complications of cephalhematomas, thus more careful inspection and neuroimaging may be needed in cases of cephalhematomas in newborns.
Anemia ; Bilirubin ; Birth Weight ; Gestational Age ; Head ; Hematoma ; Hematoma, Subdural ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Manifestations ; Skull ; Skull Fracture, Depressed ; Skull Fractures

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Analysis of Prenatal and Postnatal Factors Associated with Complications and Prognosis in Premature Infants with Leukemoid Reaction.

Se Ho KWON ; Byoung Kook LEE ; Heun Ji LEE ; So Young NA ; Jung Ha LEE ; Su Yeon PARK ; Eun Kyeung KANG ; Do Hyeon KIM ; Kwan LEE ; Hee Sup KIM

Journal of the Korean Society of Neonatology.2008;15(2):151-159.

PURPOSE: This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and low birth weights (<2,500 g) who were admitted immediately after birth to the neonatal intensive care unit at the Dongguk University Ilsan Hospital between June 2005 and July 2006. A leukemoid reaction was defined as an absolute neutrophil count (ANC) >30,000/mm3. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. RESULTS: Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. CONCLUSION: Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.
Apgar Score ; Birth Weight ; Bronchopulmonary Dysplasia ; C-Reactive Protein ; Chorioamnionitis ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intensive Care, Neonatal ; Leukemoid Reaction ; Medical Records ; Mothers ; Neutrophils ; Parturition ; Pregnancy ; Prognosis ; Retinopathy of Prematurity ; Retrospective Studies ; Steroids ; Ventilators, Mechanical

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Comparison of the Therapeutic Effects of Curosurf(R) and Newfactan(R) in Respiratory Distress Syndrome.

Suk Woo HONG ; Eun Ho LEE ; Seung Yeon KIM ; Ho Jin PARK

Journal of the Korean Society of Neonatology.2008;15(2):142-150.

PURPOSE: The aim of this study was to compare the clinical effects of modified porcine (Curosurf(R)) and bovine (Newfactan(R)) surfactants in the treatment of neonatal respiratory distress syndrome. METHODS: Between April 2004 and December 2006, 65 neonates (birth weight < or =2,500 g and gestational age < or =35 weeks) with neonatal respiratory distress syndrome were treated in our neonatal intensive care unit with surfactant. Thirty-one neonates received Curosurf(R) and 34 neonates received Newfactan(R). The neonates were not enrolled if they had major congenital anomalies or meconium aspiration syndrome. We compared the changes in respiratory parameters after surfactant instillation, the incidences of acute and chronic complications, and the mortality between the two treatment groups. RESULTS: Neonatal and maternal demographic characteristics were not different between the groups. The patterns of change in the respiratory parameters after surfactant instillation were not statistically different between the groups. The incidences of surfactant reinstillation and acute complications, such as pneumothorax, patent ductus arteriosus, pulmonary hemorrhage, and grade 3-4 intraventricular hemorrhage, were not different between the neonates who received Curosurf(R) and the neonates who received Newfactan(R). There were no statistically significant differences in the duration of mechanical ventilation, oxygen therapy, hospitalization, prevalence of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and mortality between the groups. CONCLUSION: In the present comparative study, no significant differences in the clinical effects of Curosurf(R) and Newfactan(R) were observed.
Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Meconium Aspiration Syndrome ; Oxygen ; Pneumothorax ; Prevalence ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Retinopathy of Prematurity ; Surface-Active Agents

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Oxygen Desaturation during Nutritive Sucking in Premature Infants with Bronchopulmonary Dysplasia: Its Effect on Feeding and Growth until 4 Months of Corrected Age.

Chang Hwan LIM ; Joo Young LEE ; Hyun Seung LEE ; Jung Hyun LEE ; So Young KIM ; In Kyung SUNG ; Chung Sik CHUN

Journal of the Korean Society of Neonatology.2008;15(2):134-141.

PURPOSE: This study examined the occurrence of oxygen desaturation events during nutritive sucking in premature infants with bronchopulmonary dysplasia (BPD) and its effects on feeding and growth outcomes until 4 months of corrected age (CA). METHODS: Thirty-four premature infants with BPD free from major cardiac, gastrointestinal, respiratory anomalies were included. By reviewing medical records, clinical characteristics, feeding conditions at 36 weeks of postmenstrual age (PMA), we focused on oxygen desaturation, and short-term outcomes in 14 infants with no or mild desaturation (group A) and in 20 infants with moderate or severe desaturation (group B). RESULTS: Group B had lower birth weight and shorter gestational age at birth, longer duration of hospitalization, was discharged at higher weeks of PMA, and needed ventilatory assist and oxygen supplementation longer than group A (P<0.05). Group B started nutritive sucking later, with a greater decrease in SpO2 during sucking, being more indicative of feeding problems at 40 weeks of PMA, but not at 4 months of CA. Percent of infant needing oxygen supplementation and percent of infants with growth failure were not different between groups at 40 weeks of PMA and 4 months of CA. Body weight and growth velocity differences noted at 40 weeks of PMA became insignificant at 4 months of CA. CONCLUSION: The severity of desaturation during nutritive sucking in premature infants with BPD influenced the infant's feeding and growth at 40 weeks of PMA. However, it disappeared at 4 months of CA.
Birth Weight ; Body Weight ; Bronchopulmonary Dysplasia ; Gestational Age ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Medical Records ; Oxygen ; Parturition

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Outcomes of Extremely Low Birth Weight Infants at the Asan Medical Center between 2003 and 2006.

Mee Rim PARK ; Byong Sop LEE ; Ellen A KIM ; Ki Soo KIM ; Soo Young PI

Journal of the Korean Society of Neonatology.2008;15(2):123-133.

PURPOSE: The purpose of this study was to determine the outcomes of extremely low birth weight infants (ELBWI) who were born at the Asan Medical Center and evaluate the recent status of neonatal intensive care and associated problems. METHODS: We retrospectively evaluated 120 inborn ELBWI who were admitted to the NICU of the Asan Medical Center between 2003 and 2006. The survival rate, neurodevelopmental outcomes, maternal and infant factors, and infant mordibities were evaluated and the relationships with survival and catch-up growth were investigated. RESULTS: The survival rate of the ELBWI was 82% at a mean gestational age of 27+2 weeks, and with a mean birth weight of 801.3+/-129.0 g. The duration of hospitalization was 85.7+/-27.2 days, the duration of O2 use was 43.9+/-35.4 days, and the duration of ventilatory support was 20.9+/-20.9 days among the survivors. The incidence of respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, and periventricular leukomalacia were 41.8%, 61.2%, 3%, and 4%, respectively. The mean mental developmental index and psychomotor development index of Bailey Scales of Infant Development (II) at follow-up were 83.4+/-18.2 and 83.3+/-20.3, respectively. Among the infants who had >18 months of follow-up, 50.8% had catch-up growth at 12 months. CONCLUSION: The survival rate of ELBWI has improved; however, the morbidities remain high, thus indicating further efforts must be implemented to reduce morbidity and improve neurodevelopmental outcomes.
Birth Weight ; Child ; Child Development ; Follow-Up Studies ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Lung Diseases ; Retrospective Studies ; Survival Rate ; Survivors ; Weights and Measures

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Good Clinical Practice in Neonatal Clinical Research.

Min Soo PARK

Journal of the Korean Society of Neonatology.2008;15(2):119-122.

Clinical research is a necessity, not an option, for developing better and new medicines and therapeutic modalities. But in the course of clinical research, there are rules and guidelines that should be followed to ensure the due respect for persons, beneficence, and justice for persons who voluntarily participate in the research as described in the Belmont Report. Good Clinical Practice (GCP) is an "international scientific and ethical quality standard for designing, conducting, recording, and reporting" clinical trials. The main purposes of GCP would be to protect rights, safety, and well-being of trial subjects, in compliance with the principles of Declaration of Helsinki, and to assure that the data obtained from clinical trials are credible. In order to achieve these, investigators must be fully aware of the meanings as well as actual procedures involved in the research and should make the best effort to comply with GCP. For those individuals who belong to vulnerable populations, such as neonates, in addition to the general principles of GCP, further measures to ensure added protection should be implemented. It is our duty to develop and provide better care through clinical research even for neonates. But in doing so, we have to make sure that the importance of protecting the rights, safety, and well-being of the subjects supersede the interests of science and society.
Beneficence ; Compliance ; Dietary Sucrose ; Helsinki Declaration ; Human Rights ; Humans ; Infant, Newborn ; Research Personnel ; Social Justice ; Vulnerable Populations

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Current Status and Importance of Clinical Research Involving Neonates.

Su Jin CHO

Journal of the Korean Society of Neonatology.2008;15(2):113-118.

Clinical trials in neonates of different gestational age, birth weight, postnatal age and general health status are needed to assure safe and optimal evidence-based-therapy to this special population. Pharmacodynamic maturation must be considered in grouping the neonates for clinical trials. Informed consent from the parents, protection of the neonates participating in the clinical trials, adherence to good clinical practice guidelines, and designation of short term and long term outcomes must be taken into consideration from the beginning of the trials. Collaboration between centers will be helpful in overcoming the problem with small patient size. Many of these challenges are surmountable and an well-designed clinical trial will improve the mortality and morbidity in these very small children.
Birth Weight ; Child ; Cooperative Behavior ; Gestational Age ; Humans ; Infant, Newborn ; Informed Consent ; Parents

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A Case of Kasabach-Merritt Syndrome with Disseminated Intravascular Coagulopathy Treated with Interferon alfa-2a.

Seok Gang YUN ; Pan Joo LIM ; Seong Hwan BAN ; Dong Hwan LEE

Journal of the Korean Society of Neonatology.2000;7(1):72-75.

We have recently encountered a case of Kasabach-Merritt syndrome which was characterized by hemangioma, thrombocytopenia, and Disseminated Intravascular Coagulation. The baby was delivered at 35 weeks gestation. A large hemangioma covered right forearm. He received interferon alfa-2a for 120 days after 20 day steroid treatment failure. Blood platelet count increased to acceptable range (>20,000/mm3) after 8weeks of interferon alfa-2alpha treatment and the size of hemangioma decreased.
Disseminated Intravascular Coagulation ; Forearm ; Hemangioma ; Interferons* ; Kasabach-Merritt Syndrome* ; Platelet Count ; Pregnancy ; Thrombocytopenia ; Treatment Failure

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A Case of Deletion 9p Syndrome.

Jeong Hee KIM ; Chun Soo KIM ; Un Seok NHO ; Eun Jeong KIM ; Chur Woo YOO ; Chul Kyu KIM

Journal of the Korean Society of Neonatology.2000;7(1):68-71.

Since Alfi et al. first described the 9p deletion syndrome in 1973, approximately 40 cases with deletion of the chromosome 9p have been reported. These patients have multiple anomalies in craniofacies, limbs, and cardiovascular system, and mental retardation. In most cases, the breakpoint is located at the band 9p22 and the deletion is de novo. We report a neonate with 9p deletion syndrome diagnosed by clinical features and chromosomal analysis. He had multiple anomalies such as up slanting of palpebral fissures, epicanthal folds, arched eyebrows, anteverted nares, cleft palate, micrognathia, pectus excavatum, widely spaced nipples, cryptorchidism, atrial septal defect, tricuspid regurgitation (grade : III) and persistent muscle hypotonia.
Cardiovascular System ; Cleft Palate ; Cryptorchidism ; Extremities ; Eyebrows ; Funnel Chest ; Heart Septal Defects, Atrial ; Humans ; Infant, Newborn ; Intellectual Disability ; Male ; Muscle Hypotonia ; Nipples ; Tricuspid Valve Insufficiency

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A Case of 2q-Syndrome 46, XX, del (2) (q33q35).

Dong Hyeon CHOI ; Eun Yeong SEOL ; Moon Ki CHO ; Chel SHON

Journal of the Korean Society of Neonatology.2000;7(1):64-67.

A long arm deletion of chromosome 2 is very rarely reported. Particular deletion uniformly resulted in developmental delays, craniofacial changes, and occasionally resulted in microcephaly, low set ears, and hand and foot abnormalities. We experienced a case of partial monosomy 2 in a 5-months-old girl, who showed low set ears, hypertelorism, low nasal bridges, small mouth, cleft palate, inguinal hernia. Chromosome analysis on a G banding with high resolution showed a deletion of the long arm of chromosome 2. Her karyotype was designated as 46, XX, del (2) (q33q35). A brief review of the literature is also presented.
Arm ; Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 2 ; Cleft Palate ; Ear ; Female ; Foot ; Hand ; Hernia, Inguinal ; Humans ; Hypertelorism ; Karyotype ; Microcephaly ; Mouth

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