Journal Detail Information

1

Cite

Share

Cystatin C as a Renal Function Marker for Neonates.

Won Ho HAHN ; Joon Hwan SONG ; Myung Ho OH

Neonatal Medicine.2013;20(3):378-386. doi:10.5385/nm.2013.20.3.378

The prediction of acute kidney injury (AKI) is important in the management of neonates, and several renal biomarkers have been tested for clinical application. Cystatin C (CysC) is a promising marker of renal function, and its application in neonatal care showed several benefits. First, CysC levels are not affected by endogenous substances such as bilirubin, hemoglobin, and ketones in laboratory tests. Second, its level is not influenced by inflammation (e.g., sepsis), muscle mass, age, gender, or nutritional status. Third, CysC is not transmitted through the placenta. Fourth, standardized automated measurement methods are available. Fifth, CysC was shown to reflect renal maturation better than creatinine. Lastly, CysC was reported to change with a wider amplitude than creatinine, which allows a more sensitive detection of renal deterioration. Recently, several reference CysC levels for neonates, including premature infants, were reported. In the present review, we summarized information on serum CysC reference values from different studies. Few studies investigated the usefulness of CysC for predicting AKI in neonates with various diseases such as neonatal respiratory distress syndrome, sepsis, and neonatal asphyxia. Recent studies showed an association between serum CysC level and cardiovascular diseases or Alzheimer's disease, indicating that CysC may play a role as a marker for various diseases in the future. Although the use of CysC as a marker in neonatal care showed several benefits, reliable and detailed reference ranges need to be established, including those for neonates with diseases. In addition, other novel renal markers need to be tested in neonates.
Acute Kidney Injury ; Alzheimer Disease ; Asphyxia ; Bilirubin ; Biomarkers ; Cardiovascular Diseases ; Creatinine ; Cystatin C ; Hemoglobins ; Humans ; Infant, Newborn ; Infant, Premature ; Inflammation ; Ketones ; Muscles ; Nutritional Status ; Placenta ; Reference Values ; Respiratory Distress Syndrome, Newborn ; Sepsis

2

Cite

Share

Invasive Candida Infections in Extremely Preterm Infants.

Chun Soo KIM ; Sang Lak LEE

Neonatal Medicine.2013;20(3):369-377. doi:10.5385/nm.2013.20.3.369

Invasive Candida infections (ICI) have become the third most common cause of late-onset infection among extremely preterm infants in the neonatal intensive care unit. Candida colonization of the skin and gastrointestinal tract is an important first step in the pathogenesis of invasive disease. Factors such as exposure to broad spectrum antimicrobials, especially third generation cephalosporin, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery increase the risk of invasive infection. A definite diagnosis of ICI requires isolation the organism from blood or other sterile body fluid. Thrombocytopenia is very common in neonatal candidiasis, but it is also often seen in babies with bacteremia. Candida is capable of invading all vital organs and following candidemia, therefore a thorough evaluation to rule out end organ dissemination is important. Amphotericin-B is the drug of choice for treating ICI. Antifungal susceptibility test is increasingly used to manage ICI, especially in situations refractory to initial antifugal therapy. Invasive candidiasis among extremely preterm infants is associated with chronic lung disease, severe retinopathy of prematurity, and neurodevelopmental impairment at infancy.
Bacteremia ; Body Fluids ; Candida ; Candidemia ; Candidiasis ; Candidiasis, Invasive ; Central Venous Catheters ; Colon ; Gastrointestinal Tract ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Intensive Care, Neonatal ; Lung Diseases ; Parenteral Nutrition ; Resin Cements ; Retinopathy of Prematurity ; Skin ; Thrombocytopenia

3

Cite

Share

Prevention of Fungal Infection in Neonatal Intensive Care Unit.

Young Youn CHOI

Neonatal Medicine.2013;20(3):361-368. doi:10.5385/nm.2013.20.3.361

Although advances in neonatal intensive care have led to an improved survival rate of extremely low birth weight infants, prolonged hospitalization of these critically ill infants has rendered them to be vulnerable to fungal infection in NICU. Because the incidence of fungal infection with related mortality and morbidity is inversely related to gestational age and birth weight, preventive measure is imperative to improve the survival rate and the outcome. There are many evidence-based reports for antifungal prophylaxis with fluconazole target infants <1,000 g and/or < or =27 weeks, because this group has a high infection-related mortality and neurodevelopmental impairment among survivors. However, interventions should begin with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor. Furthermore, policies for restrictive use of third-generation cephalosporins, H2-antagonists, proton pump inhibitors, and postnatal dexamethasone; follow of the guideline for central venous catheter care and removal; and feeding practices, with promotion of early feedings and breast milk, and supplementation with lactoferrin and or probiotics, may reduce the fungal infection. In conclusion, prophylactic systemic antifungal therapy along with comprehensive infection control measures, restrictive use of drugs and proper feeding practice reduce the incidence of invasive fungal infection in high risk very low birth weight infants in NICU. However, further study is needed for the routine use of prophylactic antifungal therapy because the effect on mortality rate was not significant and the data on the long-term neurodevelopmental consequences were limited. In addition, further data on the emergence of resistant organisms and Malassezia colonization are needed.
Birth Weight ; Candidiasis ; Central Venous Catheters ; Cephalosporins ; Colon ; Critical Illness ; Female ; Fluconazole ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight ; Infection Control ; Intensive Care, Neonatal ; Lactoferrin ; Malassezia ; Milk, Human ; Obstetric Labor, Premature ; Pregnancy ; Probiotics ; Proton Pump Inhibitors ; Survival Rate ; Survivors

4

Cite

Share

Methicillin-resistant Staphylococcus aureus (MRSA) Infection in Neonates.

Ellen A KIM

Neonatal Medicine.2013;20(3):354-360. doi:10.5385/nm.2013.20.3.354

Methicillin-resistant Staphylococcus aureus is composed of 80% of isolated Staphylococcus aureus in intensive care units and has become a threat to critically ill population including neonates not only in Korea. A key to success in eradicating MRSA infection within neonatal intensive care unit involves formulating an infection control guideline that is sustainable under the support of senior leader and day to day leader. When decolonization is done with mupirocin, judicious use of mupirocin should be done due to prevalance of mupirocin resistant MRSA strains found in Korea especially in the community hospitals. Implementing an effective infection control strategies to eradicate MRSA among neonatal population in Korea must include medical facilities in the community.
Critical Illness ; Hospitals, Community ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care, Neonatal ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Staphylococcus aureus

5

Cite

Share

Therapeutic Application of Neural Stem Cells for Neonatal Hypoxic-ischemic Brain Injury.

Kook In PARK ; Kyoyeon GOO ; Kwangsoo JUNG ; Miri KIM ; Il Sun KIM ; Seokhwan YUN ; Il Shin LEE ; Jeong Eun SHIN ; Ha Yang YU ; Ho Seon EUN ; Jung Eun KIM ; Ran NAMGUNG ; Chul LEE

Neonatal Medicine.2013;20(3):343-353. doi:10.5385/nm.2013.20.3.343

Neural stem cells (NSCs) are characterized by a capacity for self-renewal, differentiation into multiple neural cell lineages, and migration toward damaged sites in the central nervous system (CNS). NSCs expanded in culture could be implanted into the brain where they integrate into host neural circuitry and stably express foreign genes. It hence appears that transplantation of NSCs has been proposed as a promising therapeutic strategy in neurological disorders. During hypoxic-ischemic (HI) brain injury, factors are transiently elaborated to which NSCs respond by migrating to degenerating regions and differentiating towards replacement of dying neural cells. In addition, NSCs serve as vehicles for gene delivery and appear capable of simultaneous neural cell replacement and gene therapy (e.g. with factors that might enhance neuronal differentiation, neurites outgrowth, proper connectivity, neuroprotection, and/or immunomodulatory substances). When combined with certain synthetic biomaterials, NSCs may be even more effective in 'engineering' the damaged CNS towards reconstitution. Human NSCs were isolated from the forebrain of an aborted fetus at 13 weeks of gestation and were grown as neurospheres in cultures. After the characterization of human NSCs in preclinical testing and the approval of the IRB, a clinical trial of the transplantation of human NSCs into patients with severe perinatal HI brain injury has been performed. The existing data from these clinical trials have shown to be safe, well tolerated, and of neurologically-some benefits. Therefore, long-term and large scale multicenter clinical study is required to determine its precise therapeutic effect and safety.
Aborted Fetus ; Biocompatible Materials ; Brain ; Brain Injuries ; Cell Lineage ; Central Nervous System ; Ethics Committees, Research ; Genetic Therapy ; Humans ; Nervous System Diseases ; Neural Stem Cells ; Neurites ; Neurons ; Pregnancy ; Prosencephalon ; Tissue Therapy ; Transplants

6

Cite

Share

Pharmacological Approaches in Newborn Infants with Hypoxic Ischemic Encephalopathy.

Heng Mi KIM

Neonatal Medicine.2013;20(3):335-342. doi:10.5385/nm.2013.20.3.335

Despite marked improvements in perinatal practice, neonatal hypoxic-ischemic encephalopathy (HIE) remains one of the major causes of acute mortality and chronic neurologic disability in infants and children. Several new therapeutic approaches aiming at this condition have been used in the last decade, including therapeutic hypothermia and many pharmacological agents. Therapeutic hypothermia remarkably reduces death and neurological impairment, and has therefore rapidly become the standard therapy for full-term newborn infants with moderate-to-severe HIE. However, despite these promising outcomes of therapeutic hypothermia, approximately 50% of the infants treated with hypothermia have an adverse outcome. Therefore, there exists an urgent need for other treatment options. A mechanistically driven approach to HIE has resulted in the development of many drugs that are potent antagonists of specific steps in cascades of molecular reactions in HI injury. This review provides an overview of promising pharmacological approaches of neuroprotection that may be used in clinical practice. Although several drugs have been found to be effective in preclinical evaluations, such antagonists have been ineffective in human trials. Failure has been attributed to many factors such as the complex pathology of HIE in neonates, the inevitable delays in initiation of therapy in clinical practice, and the side effects of the drugs. Moreover, many of these drugs interfere with only one step of the cascades, while multiple biochemical cascades are put in motion simultaneously. Therefore, neuroprotective strategies such as hypothermia have to deal with multiple cascades. Research is now being focused on drugs that may act synergistically or additively with hypothermia, with the hope that combination therapy might augment neuroprotection.
Anoxia ; Child ; Humans ; Hypothermia ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Ischemia

7

Cite

Share

Clinical Applications of Plasma B-type Natriuretic Peptide Assays in Preterm Infants with Patent Ductus Arteriosus.

Eun Hee LEE ; Byung Min CHOI

Neonatal Medicine.2013;20(3):323-334. doi:10.5385/nm.2013.20.3.323

Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is a common and important problem associated with significant morbidity and mortality including: intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. The rapid and accurate determination of the indications for therapeutic closure of hsPDA in preterm infants is important but often difficult. Currently used tools, such as the clinical findings, including heart failure and the typical echocardiographic features of hsPDA, have unsatisfactory sensitivity and/or specificity. Over the last decade, measurement of plasma B-type natriuretic peptide (BNP) levels using a commercially available bedside testing kit has been proposed to aid in the diagnosis and treatment of hsPDA in preterm infants. The present review analyzes the clinical usefulness of a rapid plasma BNP assay for the management of hsPDA in preterm infants and speculates on potential future therapeutic directions, including predicting subsequent hsPDA for early targeted treatment and predicting of treatment response for decision-making regarding surgical intervention before and after medical treatments.
Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Heart Failure ; Hemorrhage ; Humans ; Infant, Newborn ; Infant, Premature ; Natriuretic Peptide, Brain ; Plasma ; Point-of-Care Testing ; Sensitivity and Specificity

8

Cite

Share

Surfactant Therapy in Severe Meconium Aspiration Syndrome.

Sang Lak LEE ; Chun Soo KIM

Neonatal Medicine.2013;20(3):318-322. doi:10.5385/nm.2013.20.3.318

Meconium is a strong inactivator of pulmonary surfactant. The deficiency of surfactant or surfactant dysfunction may contribute to respiratory failure in a wide group of disorders, including meconium aspiration syndrome (MAS). We reviewed the effect of pulmonary surfactant therapy for severe MAS in ours as well as other countries. In general, surfactant therapy improves pulmonary oxygenation (oxygenation index or arterial/alveolar oxygen tension) and reduces the requirement for ventilation, and oxygen supplementation or hospitalization time. However, its effects on mortality and pulmonary or extrapulmonary complications are variable. In Korean studies, outborn infants are five times more common than inborn infants; therefore, the initial hospital care at delivery including adequate tracheal suctioning is important to improve the outcome of patients with severe MAS. To confirm the effect of surfactant therapy in MAS, additional well-designed, multicenter, randomized, controlled trials are needed. In addition, determining the optimal type of surfactant therapy (bolus, lavage, or combined) and the appropriate dose and duration of therapy is important.
Hospitalization ; Humans ; Infant ; Infant, Newborn ; Meconium ; Meconium Aspiration Syndrome ; Oxygen ; Pulmonary Surfactants ; Respiratory Insufficiency ; Suction ; Therapeutic Irrigation ; Ventilation

9

Cite

Share

Association between Respiratory Disorders and Candidate Genes in Korean Newborn Infants.

Heui Seung JO

Neonatal Medicine.2013;20(3):311-317. doi:10.5385/nm.2013.20.3.311

Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain major acute and chronic postnatal lung diseases in the Neonatal Intensive Care Unit. RDS and BPD are multifactorial diseases influenced by genetic factors. Specific genetic variants contributing to the regulation of pulmonary development, structure and function or inflammatory response, and host defense mechanism can be risk factors for the development of RDS and/or BPD. This review summarizes recent association studies of genetic polymorphisms with RDS and BPD. In addition, we analyze the genetic differences among various study populations to identify potential candidate genes for susceptibility to RDS and BPD in Korean preterm infants.
Bronchopulmonary Dysplasia ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Lung Diseases ; Polymorphism, Genetic ; Risk Factors

10

Cite

Share

Fetal Alveolar Type II Cell Injury Induced by Short-term Exposure to Hyperoxia.

Hyeon Soo LEE

Neonatal Medicine.2013;20(3):300-310. doi:10.5385/nm.2013.20.3.300

A High concentration of oxygen (>40%) is used as a life-saving therapy in preterm newborns since birth. By generating excess reactive oxygen species, however, hyperoxia can cause lung injury leading to bronchopulmonary dysplasia (BPD). Although hyperoxia-induced lung injury contributes to the evolution of BPD, the mechanisms by which hyperoxia contributes to the genesis of lung injury in preterm lungs are not yet fully defined, and there are no specific measures for the protection of preterm lungs against injury secondary to hyperoxia. Alveolar type II cells are key components of the alveolar structure, and they are responsible for the restoration of normal alveolar epithelium after acute lung injury. However, hyperoxia is primarily delivered to the alveolar epithelium and alveolar type II cells can be the main target for the injury secondary to hyperoxia. To date, my researches have been focused on injury of fetal alveolar type II cells exposed to hyperoxia and the role of anti-inflammatory cytokine, IL-10 minimizing fetal type II cell injury induced by hyperoxia. Based on my previous studies, this article summarizes the cellular and molecular mechanisms of fetal type II cell injury induced in the early stage of hyperoxia and the protective potency of IL-10 in fetal alveolar type II cells and neonatal lungs injured by hyperoxia.
Acute Lung Injury ; Bronchopulmonary Dysplasia ; Epithelium ; Humans ; Hyperoxia ; Infant, Newborn ; Interleukin-10 ; Lung ; Lung Injury ; Oxygen ; Parturition ; Reactive Oxygen Species

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share