Infants, born with a birth weight above 4.0 kg, are categorized as high birth weight infant (HBWI). The term HBWI is often used in similar context with macrosomia. Macrosomia is associated with many complications, and is considered to be a high risk group that requires an intensive care in most cases. This report is presenting an extreme macrosomia born at a gestational age of 38+5 weeks, with a body weight of 6.14 kg. The infant was born by a cesarean section from a mother with diabetes, and was admitted into an intensive care unit with tachypnea, which had occurred soon after birth. There were other complications, such as hypoglycemia, hypocalcemia, secondary atrial septal defect, patent ductus arteriosus, pulmonary hypertestion, and etc. With conservative management, the symptoms improved over a 10 day course and the patient was discharged from the hospital. To this day, the child has not presented with further health problems during the 6 months of follow up period. We reviewed the frequency and trend of the births of HBWI, through the raw data from the Statistics Korea on births between 2000 and 2010. With additional analysis of the cases of macrosomia, through the years of 1964 to 2011, we were able to find 7 reports, including this current case of infants born with a body weight above 6.0 kg. This case was the fifth heaviest infant among these 7 cases. We are reporting this case with the hope that it may contribute to the future care of high risk infants in a neonatal intensive care unit.
Benzeneacetamides ; Birth Weight ; Body Weight ; Cesarean Section ; Child ; Ductus Arteriosus, Patent ; Female ; Follow-Up Studies ; Gestational Age ; Heart Septal Defects, Atrial ; Humans ; Hypocalcemia ; Hypoglycemia ; Infant ; Infant, Newborn ; Critical Care ; Intensive Care Units ; Intensive Care, Neonatal ; Korea ; Mothers ; Parturition ; Piperidones ; Pregnancy ; Tachypnea

Neonatal upper gastrointestinal bleeding is rare in healthy full term infants and is known to be caused by stress ulcer, intracranial hemorrhage, increased intracranial pressure, congenital heart disease, perinatal asphyxia, respiratory distress, hypoglycemia and use of drugs such as steroids. Mallory-Weiss syndrome and hemorrhagic gastritis can cause life threatening upper gastrointestinal bleeding and are rarely reported in neonates and young infants. The authors experienced a case of Mallory-Weiss syndrome in a full term infant without particular perinatal history and a case of acute hemorrhagic gastritis in a preterm infant born at 33 weeks of gestation and 2,260 g of birth weight, both showed life threatening upper gastrointestinal bleeding. We report these two cases with a review of current literature.
Asphyxia ; Birth Weight ; Gastritis ; Gastrointestinal Hemorrhage ; Heart Diseases ; Hemorrhage ; Humans ; Hypoglycemia ; Infant ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; Intracranial Pressure ; Mallory-Weiss Syndrome ; Pregnancy ; Steroids ; Ulcer

Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital vascular disorder, and its pathophysiology is still unclear and most cases occur sporadically. Cutaneous lesions are observed at birth with a marbled bluish and deep-purple appearance. The associated anomaly is manifest as body asymmetry, macrocephaly, hydrocephalus, mental retardation, syndactyly and congenital glaucoma. We report our experience of CMTC1 in a female infant with the gestational age of 34 weeks and 6 days and birth weight of 2,300 g who was born by cesarean section with abnormal skin lesions. The cutaneous lesions covered most of the lower body and they faded as she continues to grow. She also had onychodysplasia in her left 2nd phalanges. In this case, close follow up by not only pediatricians but also ophthalmologist and neurologists to treat various forms of lesions involved, though the prognosis of CMTC is generally good.
Birth Weight ; Cesarean Section ; Female ; Follow-Up Studies ; Gestational Age ; Glaucoma ; Humans ; Hydrocephalus ; Infant ; Intellectual Disability ; Macrocephaly ; Parturition ; Pregnancy ; Prognosis ; Skin ; Skin Diseases, Vascular ; Syndactyly ; Telangiectasis ; Vascular Malformations

PURPOSE: The aim of this study is to characterize and to investigate the factors related to the recurrence of febrile urinary tract infection (UTI) in infants less than 2 months of age. METHODS: We performed a retrospective study in 60 infants, who were treated for the first febrile UTI. Among them, 27 infants were followed for 12 months, and were reviewed concerning the factors related to the recurrence. The factors compared for the recurrence included sex, age at diagnosis, laboratory and radiologic findings like degree of the reflux and renal cortical defect. RESULTS: Among the 60 infants studied, 52 were male (86.7%). Age at diagnosis was 39+/-13 days. The most common pathogen was E.coli (71.7%). The infants underwent an ultrasonography (n=59), DMSA scan (n=55), and voiding cystourethrography (VCUG). Further hydronephrosis, renal cortical defect, vesicoureteral reflux (VUR) were found in 28 (47.4%), 12 (21.8%) and 11 (20.4%) infants, respectively. The hydronephrosis was found frequently in the recurrent UTI group (P=0.012). The VUR was found frequently, but not significantly, in therecurrent UTI group (44.4%) than that of the non-recurrent UTI group (16.7%). CONCLUSION: During the 12 months after the first febrile UTI, hydronephrosis increased the risk of recurrent UTI. The ultrasonography is needed during the follow up of UTI in infants less than two months of age.
Clinical Laboratory Techniques ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant ; Male ; Recurrence ; Retrospective Studies ; Succimer ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: To compare the oral feeding tolerance that reflects a general maturity of organization of behavior and response among preterm twins less than 34 weeks of gestation conceived after in vitro fertilization with/without embryo transfer (IVF-ET) with that of natural conception. METHODS: Medical records of 135 preterm twins less than 34 weeks of gestation (74 twins conceived after IVF-ET and 61 spontaneously conceived twins) admitted to the Neonatal Intensive Care Unit (NICU) of Dong-A Medical Center during the period from January 2003 to December 2010 were used for a retrospective study. The primary study outcomes were perinatal mortality and overall short term morbidity. The secondary study outcome was oral feeding tolerance. RESULTS: There was no difference among the two groups in the gestational age and birth weight. Perinatal mortality rate and morbidity rate was not different between the two groups. In terms of feeding practice, there was no significant difference in terms of the starting date of first enteral feeding (4.1+/-4.5 days vs. 3.5+/-3.6 days, IVF-ET twin group vs. spontaneous twin group), the time it took to reach full enteral feeding (26.7+/-20.5 days vs. 27.6+/-24.3 days), the time it took to reach full oral feeding (34.4+/-21.7 days vs. 34.3+/-24.1 days) and PMA upon full oral feeding (36.0+/-2.2 weeks vs. 36.0+/-1.8 weeks), the duration of total parenteral nutrition (23.1+/-21.0 days vs. 24.9+/-24.3 days), displaying similar oral feeding tolerance. CONCLUSION: There was no difference in oral feeding tolerance between two groups.
Birth Weight ; Embryo Transfer ; Enteral Nutrition ; Fertilization in Vitro ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parenteral Nutrition, Total ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies

PURPOSE: In preterm infants, neonatologists often encounter abnormally high level of 17-alpha-hydroxy progesterone (17-OHP), however as there is no normative reference level for Korean preterm neonates, repeated tests for 17-OHP are conducted until the level reaches the normal value of term infants. The aim for the study is to investigate the longitudinal follow up of 17 OHP levels according to gestational age. METHODS: The samples for 17-OHP were obtained as tandem mass spectrometry (TMS) by heel prick between the 3rd and 7th day of life from 1,040 preterm infants who were born at Asan Medical Center from June 2008 to June 2010. If initial 17-OHP level was abnormal (>12 ng/mL), the serum levels were followed every 2-4 weeks until normalization. RESULTS: The mean levels of 17-OHP obtained from initial TMS according to gestational age were as follows: 24-26 weeks (26.4+/-20.7 ng/mL, n=20); 27-28 weeks (14.8+/-14.6 ng/mL, n=39); 29-30 weeks (7.6+/-7.3 ng/mL, n=54); 31-32 weeks (5.1+/-5.8 ng/mL, n=86); 33-34 weeks (4.6+/-3.9 ng/mL, n=186); 35 weeks (5.0+/-5.5 ng/mL, n=251); and 36 week (3.6+/-2.3 ng/mL, n=403). The mean and 99.5 percentile 17-OHP levels correlated inversely with gestational age. Those 63 infants (mean gestational age 28.6+/-4.1 weeks) whose initial 17-OHP levels were abnormally high, all became normalized at mean of 67.2+/-49.0 days. The mean number of follow-up was 2.9+/-1.9 times (range: 1-7 times) until normalization. CONCLUSION: The 17-OHP levels correlated inversely with gestational age and the number of false-positive results in the absence of congenital adrenal hyperplasia is high among preterm population. The percentile values presented here for 17-OHP in relation to gestational age could serve as a useful guideline for 17-OHP level follow up.
Adrenal Hyperplasia, Congenital ; Follow-Up Studies ; Gestational Age ; Heel ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Neonatal Screening ; Progesterone ; Reference Values ; Tandem Mass Spectrometry

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