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Causative Agents and Antimicrobial Sensitivity of Neonatal Sepsis: Ten-year Experience in One Neonatal Intensive Care Unit.

Hye Won PARK ; Gina LIM ; So Eun KOO ; Byong Sop LEE ; Ki Soo KIM ; Soo Young PI ; Ai Rhan KIM

Journal of the Korean Society of Neonatology.2009;16(2):172-181.

PURPOSE:To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. METHODS:We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. RESULTS:Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. CONCLUSION:The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Cefotaxime ; Ciprofloxacin ; Cloaca ; Coagulase ; Enterobacter ; Gram-Negative Bacteria ; Humans ; Imipenem ; Incidence ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Penicillins ; Pneumonia ; Retrospective Studies ; Sepsis ; Staphylococcus

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Pathogens and Prognotic Factors for Early Onset Sepsis in Very Low Birth Weight Infants.

Yi Sun KIM ; Jin Kyu KIM ; Hye Soo YOO ; So Yoon AHN ; Hyun Ju SEO ; Seo Heui CHOI ; Soo Kyung PARK ; Yu Jin JUNG ; Myo Jing KIM ; Ga Won JEON ; Soo Hyun KOO ; Kyung Hoon LEE ; Yun Sil CHANG ; Won Soon PARK

Journal of the Korean Society of Neonatology.2009;16(2):163-171.

PURPOSE: This study was conducted to determine the incidence, causative pathogens, risk factors and mortality for early onset sepsis in the first three days in very low birth weight infants. METHODS: The medical records of 1,124 very low birth weight infants admitted to the neonatal intensive care unit of Samsung Medical Center between November 1994 and December 2008 were retrospectively reviewed. The incidence, causative pathogens, risk factors, and mortality for early onset sepsis in the first 3 days of life in very low birth weight infants were evaluated. RESULTS: Early onset sepsis, as confirmed by positive blood cultures, was present in 17 of 1,124 infants (1.5%). Sixty-four percent of the isolated pathogens were gram-positive bacteria and 35% of the isolated pathogens were gram-negative bacteria. The dominant pathogens of early onset sepsis included Staphylococcus aureus (23.5%), Esherichia coli (23.5%), and Enterococcus (17.6%). Vaginal delivery (adjusted odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.3; P=0.01) was associated with early onset sepsis. The overall mortality (adjusted hazard ratio, 3.0; 95% CI, 1.4-6.5; adjusted P=0.0039) and mortality within 72 hours of life (adjusted hazard ratio, 6.5; 95% CI, 2.2-18.9; adjusted P=0.0005) of infants with early onset sepsis were higher than that of uninfected infants. CONCLUSION: Early onset sepsis remains an uncommon, but potentially lethal problem among very low birth weight infants. Knowledge of the likely causative organisms and risk factors for early onset sepsis can aid in instituting prompt and appropriate therapy, in order to minimize mortality.
Enterococcus ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sepsis ; Staphylococcus aureus

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Death in the Neonatal Intensive Care Unit.

So Eun KOO ; Heeyoung KIM ; Kyoung A PARK ; Gina LIM ; Hyewon PARK ; Byoung Sop LEE ; Ellen Ai Rhan KIM ; Ki Soo KIM ; Soo Young PI

Journal of the Korean Society of Neonatology.2009;16(2):154-162.

PURPOSE: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. METHODS: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. RESULTS: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. CONCLUSION: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.
Birth Weight ; Cause of Death ; Critical Period (Psychology) ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parents ; Premature Birth ; Retrospective Studies ; Sepsis

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Current Use of Dexamethasone Rescue Therapy for Bronchopulmonary Dysplasia.

Euiseok JUNG ; Yo Han AHN ; Ju Young LEE ; Yoon Joo KIM ; Se hyung SON ; Jin A SOHN ; Eunhee LEE ; Eun Jin CHOI ; Eun Sun KIM ; Hyun Ju LEE ; Jin A LEE ; Chang Won CHOI ; Ee Kyung KIM ; Han Suk KIM ; Beyong Il KIM ; Jung Hwan CHOI

Journal of the Korean Society of Neonatology.2009;16(2):146-153.

PURPOSE: The aim of this study is to investigate the current use of dexamethasone rescue therapy (DRT) for bronchopulmonary dysplasia (BPD). METHODS: This is a retrospective study of 251 BPD patients managed in the neonatal intensive care units at Seoul National University Childrens Hospital and Seoul National University Bundang Hospital between March 2004 and August 2008. The demographic data and clinical characteristics of the mothers and infants were analyzed. The infants were compared based on DRT responsiveness. The DRT complications were investigated. RESLUTS: Ninety-three patients (37.1%) were classified with severe BPD, DRT was only given to patients with severe BPD. Dexamethasone was administered to 24 patients (9.6%) whose respiratory status had precluded extubation, which indicated that conventional BPD management had failed. Fourteen patients (58.3%) who received DRT were responsive. DRT non-responders required more oxygenation and more complicated with pulmonary arterial hypertension (PAH). Responder had shorter length's of hospitalization and lower mortality rates. High dose dexamethasone was no more effective in weaning neonates from the ventilatior than low dose dexamethasone. Sepsis was the most common complication of DRT. CONCLUSION: DRT is a valuable treatment for severe BPD ahead of PAH development. DRT should not be performed in BPD patients with PAH due to the possibility of complications.
Bronchopulmonary Dysplasia ; Child ; Dexamethasone ; Hospitalization ; Humans ; Hypertension ; Hypertension, Pulmonary ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Mothers ; Oxygen ; Retrospective Studies ; Sepsis ; Weaning

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Association between Maternal and Cord Blood Interleukin-10 (-819T/C and -592A/C) Gene Polymorphisms and Respiratory Distress Syndrome in Preterm Korean Infants.

Eun Ae PARK ; Su Jin CHO ; Young Ju KIM ; Hye Sook PARK ; Eunhee HA ; Young Ju SUH

Journal of the Korean Society of Neonatology.2009;16(2):137-145.

PURPOSE: The aim of this study was to determine the genotype frequencies of interleukin 10 (IL-10) gene polymorphisms and to investigate their association with the risk of respiratory distress syndrome (RDS) in preterm Korean infants. METHODS: Two hundred fourteen preterm infants born at Ewha Womans University Mok Dong Hospital between November 2003 and July 2008 were studied. The cord blood of preterm neonates and the corresponding maternal blood were analyzed by PCR for IL-10 gene (IL-10 -1082A/G, -819T/C, and -592A/C) polymorphisms. The clinical data of patients were collected retrospectively by chart review. RESULTS: The genotype frequencies of IL-10 genes in Korean mothers with preterm infants differ from other reports. The prevalence of two promoter SNPs of the IL-10 cytokine gene was similar but none had the IL-10-1082GG homozygote. Multiple logistic regression analysis demonstrated the risk of RDS to be significantly lower in the infants of the mothers with an IL-10-592AC/CC genotype than in those with an AA genotype (P= 0.033). The risk of RDS was significantly lower in the mother with an IL-10-819TC/CC genotype than in those with a TT genotype (P=0.030). However, IL-10 polymorphisms in the cord blood were not significantly different in preterm infants with RDS compared with the preterm infants without RDS. When we compared the incidence of RDS and each IL-10 A-1082G/T-819C/A-592C haplotype, the ACC haplotype had a protective effect on RDS (P=0.007). CONCLUSION: We conclude that the maternal IL-10-592A/C and IL-10-819T/C polymorphisms may have a role in the development of the RDS in preterm infants.
Female ; Fetal Blood ; Genotype ; Haplotypes ; Homozygote ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Interleukin-10 ; Logistic Models ; Mothers ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prevalence ; Retrospective Studies

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Post-discharge Nutrition.

Ee Kyung KIM

Journal of the Korean Society of Neonatology.2009;16(2):131-136.

Preterm infants are frequently discharged from the hospital with growth retardation. Given the potentially lifelong effects of growth impairmnet during a critical time of development, considerable effort should be focused on improving growth after discharge. Growth monitoring must be based on regular measurements of weight, length, and head circumference to identify those preterm infants with poor growth that may need additional nutritional support. Although prior studies vary in design and the intervention used, the evidence supports the use of fortified formulas in formula-fed preterm infants after discharge. The situation for infants fed human milk is much less clear, it seems prudent to concentrate our efforts on the encouragement of breast-feeding in this population. Catch up growth may have many benefits, and may lead to improved development. However, its long-term metabolic consequences are currently unclear. Understanding the optimal means of providing nutrition after discharge is an ongoing process.
Head ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Milk, Human ; Nutritional Support

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Enteral Feeding for Preterm Infants-Benefits and Risks.

Jong Beom SIN

Journal of the Korean Society of Neonatology.2009;16(2):121-130.

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Milk ; Milk, Human ; Mothers ; Parenteral Nutrition, Total

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Early Effective Parenteral Nutrition for Preterm Infants.

Byong Sop LEE

Journal of the Korean Society of Neonatology.2009;16(2):110-120.

Mimicking fetal nutrition is the goal of early paretneral nutrition (PN) in very low birth weight infants, however the limited metabolic capacity of immature organs raises concern about the toxicity of metabolites to the developing brain. Starting parenteral amino acids from the first day of life, with a rate of 1.0 to 1.5 g/kg/day, is generally recommended to prevent endogenous protein breakdown by maintaining a positive nitrogen balance. A greater of amino acid infusion rate in the range of the fetal transfer rate (3.5-4.0 g/kg/day) is well tolerated during the early days after birth in VLBWI, however the influence on growth and long-term neurodevelopmental outcome remains unknown. Limited data are available from controlled trials regarding the effects of early supplementation with lipid emulsions on neonatal morbidity. Considering the role of long-chain polyunsaturated fatty acids in the neurodevelopment, the choice of an optimal lipid emulsion should be based on the quality as well as the quantity of the lipid contents. Little is known about the clinical benefit of higher rates of glucose infusion by permitting high serum glucose level or co-administration with insulin.
Amino Acids ; Brain ; Emulsions ; Fatty Acids, Unsaturated ; Glucose ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Insulin ; Nitrogen ; Parenteral Nutrition ; Parturition

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The Importance and the Need of Early Pulmonary Surfactant Therapy in Premature Infant with Respiratory Distress Syndrome.

Sung Mi KIM ; Hye Sun YOON ; Ki Soo KIM ; Chong Woo BAE

Journal of the Korean Society of Neonatology.2009;16(2):101-109.

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.
Adrenal Cortex Hormones ; Birth Weight ; Bronchopulmonary Dysplasia ; Consensus ; Emphysema ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Insurance, Health ; Mothers ; Oxygen ; Parturition ; Pneumothorax ; Pregnancy ; Prognosis ; Pulmonary Surfactants ; Respiratory Distress Syndrome, Newborn

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Effect of Cycled Lighting and Auditory Stimulation on Body Weight, Physiological Variables and Behavioral States in Low Birth Weight Infants.

In Sook JUNG ; Chong Woo BAE

Journal of the Korean Society of Neonatology.2007;14(1):11-21.

PURPOSE: This study was aimed at finding the effects of cycled lighting and auditory stimulation on body weight, physiological variables and the behavioral state of low birth weight infants (LBWI) in the neonatal intensive care unit (NICU). METHODS: The subjects were 30 LBWI at 2 NICUs. They were assigned to experimental I, experimental II and control group which consisted of 10 subjects in each of their regular sequence. Cycled lighting was applied to the experimental group I for 10 days, cycled light and auditory stimualtion were applied to the experimental group II. RESULTS: It was certified that the application of cycled lighting and auditory stimulation resulted in increased body weight, decreased heart rate, and stabilization of the behavioral states of the LBWI. However, there was no effect on increase of O2 saturation and decrease of respiration rate. CONCLUSION: The application of cycled lighting and auditory stimulation might be interventions which would in turn have positive effects on the growth and development of LBWI.
Acoustic Stimulation* ; Body Weight* ; Growth and Development ; Heart Rate ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Respiratory Rate

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