PURPOSE: The aim of this study was to investigate the relationship between diffuse excessive high signal intensity (DEHSI) in the white matter of the brain MRI and neurodevelopmental abnormalities in VLBW infants. METHODS: The T1- and T2-weighted MR images of the brain around a near term-equivalent age in 167 VLBW infants were evaluated for the white matter lesions. The presence of DEHSI was determined and classified into four grades on the extent of DEHSI. The relationship between the grade of DEHSI and neurodevelopmental abnormalities was investigated in 94 infants who were assessed for neurodevelopmental outcomes by using a neurologic examination and neurodevelopmental assessment (BSID-II) at 18-24 months of corrected age. RESULTS: DEHSI was the most commonly observed white matter lesion (68.3%) in the MR imaging of the brain around a near term-equivalent age. Gestational age and birth weight tended to increase with increasing grade of DEHSI (P=0.060, P=0.001, respectively). There was no significant relationship between the grade of DEHSI and neurodevelopmental outcomes at 18??4 months of corrected age (P>0.05). Periventricular cysts and ventriculomegaly in the brain MRI were significant risk factors for neurodevelopmental abnormalities (P<0.05). CONCLUSION: DEHSI, most commonly seen in the white matter of the brain MRI around a near term-equivalent age in VLBW infants, did not seem to be related to the neurodevelopmental abnormalities at 18-24 months of corrected age.
Birth Weight ; Brain ; Cerebral Palsy ; Gestational Age ; Humans ; Infant ; Infant, Very Low Birth Weight ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neurologic Examination ; Risk Factors

PURPOSE: To investigate the effects of umbilical cord milking on the level of the hemoglobin, frequency of transfusion, initial adaptation after birth and morbidities in the extremely low birth weight infants (ELBWI). METHODS: Medical records of ELBWI admitted to the Samsung Medical Center Neonatal Intensive Care Unit from November 2007 to October 2010 were reviewed retrospectively. Before June 2009, infants' umbilical cords were clamped immediately (control group, n=39). After that time, umbilical cords were clamped after repeated (two or three times) milking of the cord toward the neonate under the radiant warmer (milking group, n=37). RESULTS: ELBWI with a gestational age of > or =26 weeks presented higher level of hemoglobin at the age of 3 days (16.9+/-2.6 vs. 14.3+/-2.3 g/dL, P=0.008) and 7 days (14.6+/-1.7 vs. 12.6+/-1.8 g/dL, P=0.005), lower frequency of transfusion during the hospital days (2.5+/-0.7 vs. 4.0+/-3.0) and smaller number of neonate undergoing transfusion within the first three weeks of life in the milking group than the control group (30% vs. 70%). There was no significant difference between the two groups in blood pressure and the urine output changes. There was no significant difference in mortality and morbidity, including respiratory distress syndrome, patent ductus arteriosus, bronchopulmonary dysplasia and intraventricular hemorrhage. CONCLUSION: Umbilical cord milking in ELBWI may be a useful method to reduce transfusion in neonates, especially in those of longer than 26 weeks gestation.
Blood Pressure ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Gestational Age ; Hemoglobins ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Milk ; Parturition ; Pregnancy ; Retrospective Studies ; Umbilical Cord

PURPOSE: Palivizumab prophylaxis has been used in the high risk groups of respiratory syncytial virus (RSV) infections, especially with the prematures, infants with chronic lung diseases or hemodynamically significant congenital heart disease. Substantial variations in timing of RSV outbreaks presents a challenge for the optimized use of palivizumab prophylaxis. This study investigates the epidemiologic characteristics of RSV associated lower respiratory tract infections (LRTI) in children, to help guide in the application of palivizumab prophylaxis in the Republic of Korea. METHODS: This was a retrospective observational study. We performed RSV culture or multiplex RT-PCR from children under 60 months of age admitted for LRTI at three hospitals in the capital area of Korea from May 2008 to April 2011. The study identified RSV infection and analyzed the RSV detection rates. RESULTS: RSV detection rate was 18.8% (1,721/9,178). The RSV season of 2008-2009 is from the second week of August to the fourth week of March and, that of 2009-2010 is from the first week of October to the third week of Apirl and that of 2010-2011 is from the third week of September to the third week of March. The RSV detection rate in preterms and low birth weight infants were significantly higher during the RSV season and non-RSV season. CONCLUSION: The RSV seasons were shown to have variations in onset, offset, and durations in each year. Physicains should determine the timing of the first and final doses of palivizumab on the basis of information about the RSV season in their own area. The real-time surveillance systems to analyze the variations of RSV seasons are necessary for the effective and economical preventions of RSV infections in high risk groups.
Antibodies, Monoclonal, Humanized ; Child ; Disease Outbreaks ; Heart Diseases ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Lung Diseases ; Republic of Korea ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Seasons ; Palivizumab

The benefits of exogenous synthetic or animal-derived natural surfactants for treatment of respiratory distress syndrome (RDS) are well established. Although synthetic surfactants have potential safety advantages over animal-derived products, they seem to be clinically inferior to animal-derived natural surfactant, based on the results of numerous comparative trials. In recent years, however, synthetic surfactant has experienced a surge in breakthroughs to the point of rivaling natural surfactant, mainly due to the development of protein-containing synthetic surfactant. This article will review the historical background on the development of artificial pulmonary surfactant, compositional and physicochemical aspects on pulmonary surfactant lipids and proteins, results of comparative trials among natural, protein-free and protein-containing surfactants, and current status of development of protein-containing surfactants for treatment of RDS.
Humans ; Hyaline Membrane Disease ; Infant, Newborn ; Infant, Premature ; Proteins ; Pulmonary Surfactants ; Surface Tension ; Surface-Active Agents

Many premature infants require mechanical ventilatory support and oxygen supply. Because they have immature lungs, these ventilator supports contribute to the development of ventilator induced lung injury, which causes the development of bronchopulmonary dysplasia (BPD) in large portion. Recent meta-analysis reported that the volume-targeted ventilation reduced the development of BPD and death. Non-invasive ventilator support also can reduce the adverse effects associated with intubation and mechanical ventilatory support. The technological advancements, including microprocessors, enhance the development of new devices with new modes of ventilatory support. A lot of limits and demerits of conventional ventilatory support obviously inspired the thoughts of new modes of ventilatory support. In this article, new modes of ventilatory support for neonates, as well as conventional modes, are introduced in the hope of adopting strategies with evidences efficiently.
Bronchopulmonary Dysplasia ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Intubation ; Lung ; Microcomputers ; Oxygen ; Tidal Volume ; Ventilation ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical

Umbilical venous catheter (UVC) insertion is a life-saving procedure in neonates who require neonatal intensive care unit (NICU). It is a relatively easy procedure and it is routinely performed on the NICU. This life-saving yet relatively easy procedure, however, can yield some undesirable complications if it is not administered correctly. One of them is a liver abscess. This is a case report of a preterm infant who developed a liver abscess after UVC insertion. We inserted UAC and UVC to a preterm of 35 weeks of gestational age and birth weight of 2,720 g for treatment of respiratory distress syndrome, patent ductus arteriosus, and sepsis. A liver abscess associated with UVC was suspected on screening abdominal sonogram performed for evaluation of infection at 8 days of life. UAC was removed at 5 days of life, however, UVC was still being used. The patient recovered after 4 weeks of antibiotic treatment with prompt elimination of UVC. This case along with a brief review of literature illustrates an importance of proper maintenance and casuistic use of UVC for preterm infants.
Birth Weight ; Catheterization ; Catheters ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Liver ; Liver Abscess ; Mass Screening ; Sepsis

The congenital complete atrioventricular block(CCAVB) is a rare disease, which is the most serious complication of neonatal lupus erythematosus. Newborn with CCAVB are at risk of diminished cardiac output and the subsequent development of congestive heart failure. Transplacental steroid and beta-adrenergic agonist therapies are useful for the first and second degree atrioventricular block. But those therapies are usually not effective for complete atrioventricular block. If the fetus has a complete atrioventricular block, delivery should be considered unless other delivery contraindications. In this situation, early pacemaker implantation surgery can improve the survival rate of patients. We report one case of premature newborn with congenital complete atrioventricular block who is successfully recovered by pacemaker implantation.
Adrenergic beta-Agonists ; Atrioventricular Block ; Cardiac Output ; Fetus ; Heart Failure ; Humans ; Infant, Newborn ; Lupus Erythematosus, Systemic ; Rare Diseases ; Survival Rate

Induced hypothermia for newborns with hypoxic-ischemic encephalopathy results in a significant decrease in mortality and neurodevelopmental disability. For optimal neuroprotection following perinatal hypoxia-ischemia (HI), therapy should begin within 6 hrs of the insult and continue for > or =72 hrs. We report on a baby with HI who underwent therapeutic hypothermia that was initiated with a cooling fan, as the whole-body cooling machine was in use for another patient. Although overcooling occurred, the method was successful. For effective and safe brain hypothermic therapy (BHT), a purpose-built cooling machine is recommended. The adherence to standard protocol is required for every BHT, as clearly defined by protocols similar to those used in published trials.
Brain ; Butylated Hydroxytoluene ; Combined Modality Therapy ; Electroencephalography ; Guideline Adherence ; Heart Rate ; Humans ; Hypothermia ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Infant, Newborn

PURPOSE: Neonatal morbidity is strongly related to birth weight, and low birth weight (LBW) is known to be associated with childhood and even adult outcomes. This study aimed to investigate the associations of parental socio-economic status (SES) on the risks of low birth weight in the Republic of Korea. METHODS: Data on 450,574 singleton births were obtained from the National Birth Registration (NBR) database of 2008 and analyzed. Parental educational level and parental employment status were considered for the analysis. The place of birth, sex, marital status, parental age, and parity were included in the analysis of the unconditional multiple logistic regressions. LBW was defined as birth weight less than 2,500 g. RESULTS: 15,782 (3.5% of total subjects) of LBW infants were identified. The group with the lowest educational level (below high school) had the highest odds ratio of LBW, in both the father and mother, in the multivariable analysis [odds ratio (OR) 1.38 and 1.35, respectively]. Regarding paternal employment status, unemployed group had statistically significantly higher OR compared to the non-manual group (OR 1.14). Maternal employment status was analyzed not to have significant effect on the risk of LBW. CONCLUSION: The study confirmed that low parental SES in educational level or employment status increased the likelihood of LBW.
Adult ; Birth Weight ; Employment ; Fathers ; Female ; Humans ; Hypogonadism ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Logistic Models ; Marital Status ; Mitochondrial Diseases ; Mothers ; Odds Ratio ; Ophthalmoplegia ; Parents ; Parity ; Parturition ; Residence Characteristics ; Social Class

PURPOSE: This study was performed to investigate the effectiveness and safety of the prophylactic administration method of surfactant, followed by rapid extubation to nasal CPAP (nCPAP) in very preterm infants. METHODS: Thirty-three preterm infants with 24-29 weeks gestational age (GA) were treated with the method of prophylactic administration of surfactant by a brief intubation within 15 minutes after birth and rapid extubation to nCPAP for the treatment of respiratory distress. The variables and complications related to oxygen therapy and mechanical ventilation (MV) were compared with those of 24 historical control infants with comparable GA, treated with the rescue surfactant administration with prolonged MV for the respiratory distress syndrome (RDS). RESULTS: Prophylactic surfactant with nCPAP did not reduce the total durations of oxygen therapy and MV, compared with the rescue surfactant with MV (P=0.622 P=122, respectively). The incidence of death and BPD at 36 weeks postmenstrual age (PMA) and other complications related to oxygen therapy and MV were not increased in the infants treated with prophylactic surfactant with nCPAP despite the lower GA and birth weight. In the subgroup analysis for infants with 27-29 weeks of GA, the total duration of MV tended to decrease in infants treated with prophylactic surfactant with nCPAP (Odd ratio, 0.93, 95% Confidence interval, 0.87, 1.00, P=0.051). CONCLUSION: Prophylactic surfactant administration followed by rapid extubation to nCPAP tended to reduce the duration of MV in infants with GA of 27-29 weeks, compared with the rescue surfactant administration with prolonged MV for RDS.
Birth Weight ; Continuous Positive Airway Pressure ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intubation ; Oxygen ; Parturition ; Respiration, Artificial