PURPOSE: Brain magnetic resonance imaging (MRI) scans have become increasingly popular as a predictive tool for neurodevelopmental outcome in preterm infants, while serial brain ultrasonograms remain as a standard evaluation modality for neonatal brain. The aim of this study was to determine whether brain MRI taken at term-equivalent age could give us further information over serial brain ultrasonograms taken during admission. METHODS: We analyzed 225 preterm infant (<32 weeks gestational age) who were admitted to NICU at Seoul National University Bundang Hospital from January 2006 to June 2011. The 28 infants with chromosomal abnormalities or major congenital anomalies were excluded. We compared abnormal findings between brain MRI scan taken at term-equivalent age and serial brain ultrasonograms taken during admission in 197 preterm infants. RESULTS: The brain MRI scans taken at term-equivalent age showed normal findings in 142 out of 197 (72%) infants and abnormal findings in 55 out of 197 (28%) infants. The brain ultrasonograms during admission revealed 82 intraventricular hemorrhages, 90 periventricular leukomalacias, 7 brain parenchymal lesions, 3 ischemic lesions. Brain MRI scans discovered 30 intraventricular hemorrhages, 10 periventricular leukomalacias, 12 brain parenchymal lesions, 3 ischemic lesions. Ventriculomegaly was discovered only by the brain ultrasonography. Five brain parenchymal lesions and 9 cerebellar lesions were appeared only on the brain MRI scans. Brain MRI scans taken at term-equivalent age detected grade 1 or 2 intraventricular hemorrhages which were not discovered by last brain ultrasonograms. CONCLUSION: In compare to the serial brain ultrasonograms, the brain MRI scan taken at term-equivalent age is advantageous in discovering brain parenchymal lesions and cerebellar lesions and precise grading of intraventricular hemorrhage in preterm infants.
Brain ; Chromosome Aberrations ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Neuroimaging

PURPOSE: This study was aimed to evaluate the neonatal mortality and morbidity of infants affected by twin-twin transfusion syndrome (TTTS) compared to the control twins matched for gestational age. Also the perinatal outcomes of donor parts of TTTS twins with their counterpart recipients were compared. METHODS: A retrospective case-control study was conducted from infants born at Seoul National University Children's Hospital and Seoul National University Bundang Hospital between April 2005 and July 2011. Eighteen pairs of TTTS infants were allocated to the TTTS group. The control group consisted of 36 pairs of twin infants unaffected by TTTS who were matched for gestational age. Neonatal deaths and morbidities were recorded. RESULTS: The mortality in TTTS group was significantly higher than control group (27.8% vs. 4.2%, P=0.001). The incidence of acute renal failure (41.2% vs. 9.7%, P<0.001), cardiac ventricular hypertrophy (31.3% vs. 2.9%, P<0.001), congestive heart failure (45.7% vs. 5.6%, P<0.001), grade > or =2 intraventricular hemorrhage (33.3% vs. 11.1%, P=0.012) and grade > or =2 periventricular leukomalacia (24.2% vs. 2.8%, P=0.001) were significantly higher in TTTS group than control group. There was no significant difference in mortality and morbidities between donors and recipients except significantly higher incidence of acute renal failure in donors (70.6% vs. 11.8%, P=0.001). CONCLUSION: Twin infants affected by TTTS have higher risk of neonatal death and several severe morbidities. These results indicate that alert monitoring and checking about possible morbidities are very important in newborns with TTTS and early intervention is critical for improving the overall outcome of the affected infants.
Acute Kidney Injury ; Case-Control Studies ; Early Intervention (Education) ; Gestational Age ; Heart Failure ; Hemorrhage ; Humans ; Hypertrophy ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Retrospective Studies ; Tissue Donors

PURPOSE: With conventional methods it has been difficult to maintain a normal body temperature in the case of premature infants born between 23 and 24 weeks of gestation (23/24W). The aim of the present study involves the evaluation of the efficacy of novel clinical strategies to prevent the initial symptoms of hypothermia in 23/24W. METHODS: We retrospectively analyzed the medical records of all 23/24W who were born and admitted to Samsung Medical Center from January 2007 to July 2010 (Period 1) and from August 2010 to May 2011 (Period 2). Data collected from medical charts included body temperature, admission delay time intervals, blood gas analysis, and estimated insensible water loss(IWL). The measurements from three days after birth were compared to those obtained during period 1 (P1), in which conventional support was applied to infants and period 2 (P2), in which new clinical strategies including 1. Elevation of the environmental temperature of the delivery room 2. NICU baby-wrapping, 3. Decreased delays in time intervals from delivery to admission, and 4. Initiation of procedures following the stabilization of body temperature. RESULTS: The body temperature upon admission was significantly higher in P2 than P1 (P1 34.7+/-0.9 vs. P2 35.3+/-0.6degrees C, P=0.011). After the initial procedure, following NICU admission, the body temperature was also significantly higher in P2 than in P1 (P1. 34.9+/-0.8 vs. P2 35.5+/-0.4, P<0.001). The IWL of the first and second day was significantly decreased in infants in the P2 group. Subjects in the P2 group demonstrated significantly improved initial blood gas results of base deficits and bicarbonate concentration, as compared to the P1 group. CONCLUSION: New strategies for the prevention of hypothermia were beneficial for decreasing the recorded incidence of hypothermia and improving the IWL, and base deficits of the initial blood gas analysis in 23/24W.
Blood Gas Analysis ; Body Temperature ; Body Temperature Regulation ; Delivery Rooms ; Hot Temperature ; Humans ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Medical Records ; Parturition ; Pregnancy ; Retrospective Studies

PURPOSE: To report the follow-up status and neurodevelopmental outcomes of extremely low birth weight (ELBW) survivors at 18 months' corrected age (CA). METHOD: We performed a retrospective study of 130 ELBW infants admitted to neonatal intensive care unit of Seoul National University Children's Hospital between January 2005 and May 2009. The follow-up status and neurodevelopmental outcomes were evaluated until the CA of 18 months. The assessment of outcomes included cerebral palsy, cognitive developmental delay, blindness, deafness and catch-up growth. Clinical data were collected to identify the factors influencing neurodevelopmental disability. RESULTS: Of the 130 survivors at discharge, 122 (93.8%) participated in the follow-up at 18 months' CA. Study characteristics included a mean birth weight of 783 g and a mean gestation of 27 weeks. One hundred and eleven infants (85.4%) were evaluated for cerebral palsy (CP) and 11 (9.9%) were identified with CP. Eighty five infants (74.6%) were assessed with the Bayley Scales of Infant Development-III (BSID-III) at 8 months' CA and 2 (2.4%) had a cognitive scale <70. Fifty four infants (41.9%) were assessed with BSID-III at 18 months' CA and 2 (3.7%) had a cognitive scale <70. There were 2 (1.2%) cases of blindness and the case of deafness was not present in this study. The failure of catch-up growth was seen in 40 (32.8%) infants. Severe intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus and shunt insertion were the most important risk factors for neurologic abnormality. CONCLUSION: In our institution, neurodevelopmental outcomes of ELBW survivors were comparable to recent reports from the USA. ELBW infants need to be monitored on multidisciplinary follow-up programs and more efforts should be made to improve the follow-up.
Birth Weight ; Blindness ; Cerebral Palsy ; Deafness ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Outpatients ; Pregnancy ; Retrospective Studies ; Risk Factors ; Survivors ; Weights and Measures

Necrotizing enterocolitis (NEC) is the most common serious disease of the gastrointestinal tract in preterm infants. Although the pathogenesis of NEC is completely unknown, enteral bacterial growth plays in such disease. The immature development of the preterm gut and the exposure to the neonatal intensive care unit environment along with associated treatments promotes inappropriate intestinal colonization with a predominance of pathogenic organisms. Probiotics are the dietary supplements, containing potentially beneficial bacteria or yeast and may offer potential benefits for preterm infants by increasing mucosal barrier function, improving nutrition, up-regulation of the immune system, reducing mucosal colonization by potential pathogens, and altering the key components of intestinal inflammation. Large randomized controlled trials have shown its effectiveness in the probiotics of the prophylaxis for NEC and mortality. However, important questions remain in establishing the clinical applications for the probiotics, including the optimal duration of administration as well as preferred probiotics dose and species. Further, there is a need to understand the interaction of the probiotics and gut. More additional clinical studies are needed to determine the safety and efficacy of the probiotics in the prophylaxis of NEC.
Bacteria ; Colon ; Dietary Supplements ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Humans ; Immune System ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intensive Care, Neonatal ; Intestines ; Probiotics ; Up-Regulation ; Yeasts

With developing information technology, hospital information systems such as computerized provider order entry system (CPOE) and picture archiving and communication system (PACS) are being increasingly used by many hospitals. The hospital information systems improve the efficiency of hospital management and patient care. Currently, electronic medical records (EMR) are not used as much as CPOE and PACS. However, EMR will soon be the cornerstone of hospital patient care systems. Because EMR for the neonatal intensive care unit (NICU) is different from that for adult care unit, neonatologists should have a basic knowledge of EMR and should play an important role in implementing EMR system in NICU.
Adult ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Order Entry Systems ; Patient Care

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