PURPOSE: The main postnatal risk factors of retinopathy of prematurity (ROP) were described as prolonged oxygen therapy and lower gestational age. Recent data suggest poor early weight gain during the first weeks of life, which can be an additional predictor of severe ROP. We aimed to analyze the risk factors associated with requiring operation for ROP in preterm infants with very low birth weight (VLBW). METHODS: In a retrospective case control study, from January 2004 to June 2010, 140 VLBW infants diagnosed as ROP by the International classification of ROP were recruited. There were 14% of infants with stage 1 disease, 65.7% stage 2, and 20% stage 3 or more. A group requiring a laser surgery for ROP was 66 infants, and a group not requiring surgery was 74 infants. RESULTS: By a univariate analysis, antenatal steroid, chorioamnionitis, gestational age, birth weight, days on oxygen, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalasia and sepsis were significantly associated with ROP requiring surgery. Weight differences between birth and each from 4 to 12 weeks were significantly lower in the infants requiring surgery (P<0.05). However, after adjustment for gestational age in logistic regression, weight difference between birth and 8th week was a significant predictive factor for the requirement of surgery in infants with ROP (OR, 0.998; 95% CI, 0.996-0.999, P=0.013). CONCLUSION: We suggest that careful monitoring of weight change and aggresive nutritional support for poorly growing infants, during the first 8 weeks of life, may possibly prevent laser surgery of ROP in preterm VLBW infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Case-Control Studies ; Chorioamnionitis ; Diterpenes ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Laser Therapy ; Logistic Models ; Nutritional Support ; Oxygen ; Parturition ; Pregnancy ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors ; Sepsis ; Weight Gain

In addition to antibiotic therapy, the administration of supportive care is of utmost importance in sepsis deteriorating to septic shock. Close attention to cardiovascular, respiratory, fluid and electrolyte, hematological, renal and metabolic/nutritional support is essential to optimize the outcome. Firstly, fluid resuscitation is important to attain appropriate heart rate, blood pressure, and refill time. In case of nonresponse to fluid resuscitation, inotropes are used to increase cardiac output, and to improve perfusion of the tissues. Ideally, vasoactive agents, including epinephrine, should be administered by a secure central venous route, but in an emergency, it may be infused through a peripheral route. To improve the imbalance between the need for oxygen and consumption, early intubation and mechanical ventilation should be considered. In newborns with inadequate urine output, hepatomegaly, rale, and 10% weight gain, despite other supportive cares, dialysis or continuous renal replacement therapy should be performed, while on the extracorporeal membrane oxygenation circuit. Central venous access and arterial pressure monitoring are recommended in infants with fluid-refractory shock. Hemodynamic support directed to goals of mixed venous saturation, and cardiac index in newborns is associated with improved survival and neurologic function.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Dialysis ; Emergencies ; Epinephrine ; Extracorporeal Membrane Oxygenation ; Heart Rate ; Hemodynamics ; Hepatomegaly ; Humans ; Infant ; Infant, Newborn ; Intubation ; Oxygen ; Perfusion ; Renal Replacement Therapy ; Respiration, Artificial ; Respiratory Sounds ; Resuscitation ; Sepsis ; Shock ; Shock, Septic ; Weight Gain

Neonatal infections are frequent complications of neonates receiving intensive care unit. In particular, large cohort study has suggested that neonatal infections among extremely low birth weight infants are associated with poor neurodevelopmental and growth outcomes in early childhood. This review article will focus on the rational use of empirical antibiotics/antifungal therapy for early and late onset sepsis/fungemia, duration of antibiotic treatment, highlight clinically relevant aspects of the antibiotics commonly used in the treatment of sepsis, antibiotics requiring therapeutic dose monitoring, and management of antibiotic-resistant infection in the neonate.
Anti-Bacterial Agents ; Cohort Studies ; Drug Monitoring ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units ; Sepsis

I report a case of extremely low birth weight infant, who presented central diabetes insipidus associated with cytomegalovirus infection. His brain magnetic resonance imaging showed a flattened pituitary gland, and demonstrated a lack of posterior pituitary hyperintensity. It successfully managed with oral desmopressin (Minirin(R)) and persisted beyond the resolving of symptomatic cytomegalovirus infection.
Brain ; Cytomegalovirus ; Cytomegalovirus Infections ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Magnetic Resonance Imaging ; Pituitary Gland

Bronchial injury is a rare and serious complication of endotracheal intubation in neonates. Bronchial perforation following tracheal intubation causes a high-volume air leak mimicking pneumothorax and pneumomediastinum, and it may result in intraventricular hemorrhage, mediastinitis and sepsis. I report my experience of diagnosing a main bronchial perforation in an extremely low birth weight infant, who had a high-volume air leak following tracheal intubation, which persisted after chest tube insertion.
Chest Tubes ; Hemorrhage ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Mediastinal Emphysema ; Mediastinitis ; Pneumothorax ; Sepsis

Hallermann-Streiff syndrome is a very rare congenital disorder, which is primarily characterized by the head and face abnormalities. Approximately 180 cases have been reported worldwide, including 8 cases in Korea since it was first described by Hallermann in 1893. Patients exhibit a bird-like face, hypotrichosis, atrophy of skin, dental abnormalities, proportionate nanism, and various ophthalmic disorders, including congenital cataracts and bilateral micropthalmia. As a result of many life-threatening complications, such as respiratory and cardiac difficulties, many patients die during infancy. We report here two cases of HSS diagnosed immediately after birth with literature reviews. They showed two additional characteristics, including chubby cheeks and antenatal ultrasonographic findings, which have not been mentioned in previous reports.
Atrophy ; Cataract ; Cheek ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dwarfism ; Hallermann's Syndrome ; Head ; Humans ; Hypotrichosis ; Korea ; Microphthalmos ; Parturition ; Skin

PURPOSE: Premature and low birth weighted (LBW) infants as well as small for gestational age (SGA) infants have a high death rate and increasing the prevalence rate. We compared the proportion of these high-risk neonates and the relevant factor between the four regional settings. METHODS: We reviewed the data from 2005 to 2010, from the Korea National Statistics Office and compared the proportions of premature infants, LBW infants and SGA babies and the relevant factors between Seoul, metropolitan cities and small-to-medium-sized ones. RESULTS: Premature birth rate is as follows in each area: 4.00% in Seoul, 4.21% in metropolitan areas, 4.11% in small and medium size cities, and 4.27% in small towns. SGA birth rate is slightly lower in the medium-sized cities and higher in small towns. The birth rate of low birth weight infants is higher only in small towns (3.58%). It appears that low maternal age and low maternal education levels increase these high-risk newborns. Once calibrated variables, the result showed that the risk of premature infants is higher in the metropolitan areas (OR, 1.05), and the risk of SGA (OR, 1.06) and low birth weight (1.03) is higher in a small town. CONCLUSIONS: There were significant differences in the premature infants, low birth weight infants and SGA babies between the four different regional settings. Following the adjustment of the relevant variables, the proportion premature infant was higher in metropolitan cities and SGA babies and LBW infants were higher in small ones.
Birth Rate ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea ; Maternal Age ; Mothers ; Premature Birth ; Prevalence

PURPOSE: There has recently been improvement in treatment skills and outcomes of patients in neonatal intensive care units (NICUs) of Korea. According to several studies, such results of very to extremely low birth weight infants were markedly improved in comparison to that of Japan or USA. In speculation, the authors reviewed the survival outcomes by gestational age from 2002 to 2009. METHODS: We extracted the survival outcomes of NICU patients by gestational age from the data of previous studies. Data from Japanese Perinatal Care Center Research Network and NICHD Neonatal Research Network of US were used for comparison. RESULTS: The survival rates by gestational age are as follows (2002, 2007, and 2009 respectively): 22-23 weeks (3.4, 19.0, 28.6%), 24 weeks (21.3, 44.0, 59.3%), 26 weeks (59.4,77.8, 78.0%), 28 weeks (79.0, 88.0, 91.2%), 30 weeks (93.8, 95.3, 93.6%), 32 weeks (95.3, 97.1, 98.2%), 34 weeks (98.8, 99.0, 99.0%), 36 weeks (99.2, 99.1, 99.2%), 38 weeks (99.7, 99.5, 99.2%), 40 weeks (99.7, 99.4, 99.2%), longer than 42 weeks (100.0, 96.3, 94.7%). For infants with a gestational age lesser than 28 weeks, the survival rates of Korea (2009), Japan (2009), and US (2003-2007) were 77.5, 89.0 and 71.6% respectively. The statistics of Korea ranked between those of Japan, USA. CONCLUSION: The survival rate of neonates admitted to NICU in Korea markedly improved from 2002 to 2009. The present study is the first report of survival rate by gestational age in Korea and will become a fundamental basis for further improvement in neonatal care.
Asian Continental Ancestry Group ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Japan ; Korea ; National Institute of Child Health and Human Development (U.S.) ; Perinatal Care ; Survival Rate

PURPOSE: The number of teenage pregnancy is increasing on these days due to changes in sexual awareness, precocious puberty, lack of proper sex education and abortion restrictions. We evaluated the clinical features including the rate and perinatal complications of mother and neonates caused by teenage births. METHODS: Subjects were mothers whose ages were below 19 at time of admission in Wonkwang University Hospital from January 2000 to July 2011. We reviewed the medical records of teenage mothers and her neonates retrospectively, and investigated the differences between above and below the age of 16. RESULTS: The number of neonates of teenaged mothers was 73, which is 10.4 per 1,000 births and it showed an upward trend during the late decade of 2,000's. 14 (19.2%) of the mothers were multiparous, and 69 (94.5%) unmarried, 25 (34.2%) no prenatal examinations, 11 (15.1%) an abortion history, 47 (64.4%) middle or high school students, and 25 (34.2%) a single parent. Among the maternal complications, premature birth was the most prevalent with 34 cases (46.6%), followed by 11 (4.1%) of premature rupture of membrane. The most common neonatal complication was prematurity in 37 cases (50.7%), followed by 30 (41.1%) low birth weight, 19 (26%) ICU admission. There were no significant differences between above and below the age of 16 in neonatal and obstetrical complications. CONCLUSION: The number of teenage pregnancy is increasing recently, and they had a high prevalence rate of prematurity, low birth weight and respiratory distress syndrome. And, the grouping by age of above and below 16 was no affect the prognosis.
Abortion, Induced ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Medical Records ; Membranes ; Mothers ; Parturition ; Pregnancy ; Pregnancy in Adolescence ; Premature Birth ; Prevalence ; Prognosis ; Puberty, Precocious ; Retrospective Studies ; Rupture ; Sex Education ; Single Parent ; Single Person

PURPOSE: Young infants with suspected sepsis routinely undergo laboratory evaluation. In particular, when an infant is a newborn baby, evaluation of the cerebrospinal fluid (CSF) has been frequently included, because the prognosis is poor, irrespectively of the etiology of meningitis. We aimed to examine the clinical predictors of CSF pleocytosis among the newborns. METHODS: We retrospectively reviewed the records of all infants, aged 30 days or younger, requiring lumbar puncture. Electronic data sources provided the demographic data of the newborns, the clinical manifestations, and all laboratory values. After a univariate analysis, logistic regression analysis was performed to predict newborns at increased risk for CSF pleocytosis. RESULTS: One hundred thirteen newborns were studied; 20 of whom (17.7%) had CSF pleocytosis. Fever was significantly associated with CSF pleocytosis (P=0.008, OR=5.08, 95% CI, 1.39-18.54). The infants with lethargic appearance also had an increased risk for CSF pleocytosis. Blood urea nitrogen level was higher in patients with pleocytosis. Logistic regression analysis revealed that other clinical features and laboratory data were not significant, except for fever and lethargy. A total of 45% of the infants with CSF pleocytosis were diagnosed with serious bacterial infection, as opposed to 19.4% of those without CSF pleocytosis. CONCLUSION: In case of neonates, it would be better to perform lumbar puncture, when the infant has fever or lethargic appearance, although, the results of routine laboratory tests were nonspecific.
Aged ; Bacterial Infections ; Blood Urea Nitrogen ; Information Storage and Retrieval ; Electronics ; Electrons ; Fever ; Humans ; Infant ; Infant, Newborn ; Lethargy ; Leukocytosis ; Logistic Models ; Meningitis ; Prognosis ; Retrospective Studies ; Sepsis ; Spinal Puncture