PURPOSE: We investigated the vitamin D status of preterm infants to determine the incidence of vitamin D deficiency. METHODS: A total of 278 preterm infants delivered at Kyungpook National University Hospital between January 2013 and May 2015 were enrolled. The serum concentrations of calcium, phosphorous, alkaline phosphatase, and 25-hydroxyvitamin D (25-OHD) were measured at birth. We collected maternal and neonatal data such as maternal gestational diabetes, premature rupture of membranes, maternal preeclampsia, birth date, gestational age, and birth weight. RESULTS: Mean gestational age was 33(+5)+/-2(+2) weeks of gestation and mean 25-OHD concentrations were 10.7+/-6.4 ng/mL. The incidence of vitamin D deficiency was 91.7%, and 51.1% of preterm infants were classified as having severe vitamin D deficiency (25-OHD<10 ng/mL). The serum 25-OHD concentrations did not correlate with gestational age. There were no significant differences in serum 25-OHD concentrations or incidence of severe vitamin D deficiency among early, moderate, and late preterm infants. The risk of severe vitamin D deficiency in twin preterm infants was significantly higher than that in singletons (odds ratio, 1.993; 95% confidence interval [CI], 1.137-3.494, P=0.016). In the fall, the incidence of severe vitamin D deficiency decreased 0.46 times compared to that in winter (95% CI, 0.227-0.901; P=0.024). CONCLUSION: Most of preterm infants (98.9%) had vitamin D insufficiency and half of them were severely vitamin D deficient. Younger gestational age did not increase the risk of vitamin D deficiency, but gestational number was associated with severe vitamin D deficiency.
Alkaline Phosphatase ; Birth Weight ; Calcium ; Diabetes, Gestational ; Female ; Gestational Age ; Gyeongsangbuk-do ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Membranes ; Parturition ; Pre-Eclampsia ; Pregnancy ; Rupture ; Twins ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

PURPOSE: We investigated the iron status of very low birth weight infants receiving multiple erythrocyte transfusions during hospitalization in the neonatal intensive care unit (NICU). METHODS: We enrolled 46 very low birth weight infants who were admitted to the Kyungpook National University Hospital between January 2012 and December 2013. Serum ferritin was measured on their first day of life and weekly thereafter. We collected individual data of the frequency and volume of erythrocyte transfusion and the amount of iron intake. RESULTS: A total of 38 (82.6%) of very low birth weight infants received a mean volume of 99.3+/-93.5 mL of erythrocyte transfusions in NICU. The minimum and maximum serum ferritin levels during hospitalization were 146.2+/-114.9 ng/mL and 456.7+/-361.9 ng/mL, respectively. The total volume of erythrocyte transfusion was not correlated to maximum serum ferritin concentrations after controlling for the amount of iron intake (r=0.012, p=0.945). Non-transfused infants took significantly higher iron intake compared to infants receiving > or =100 mL/kg erythrocyte transfusion (p<0.001). Minimum and maximum serum ferritin levels of non-transfused infants were higher than those of infants receiving <100 mL/kg erythrocyte transfusions (p=0.026 and p=0.022, respectively). Infants with morbidity including bronchopulmonary dysplasia or retinopathy of prematurity received a significantly higher volume of erythrocyte transfusions compared to infants without morbidity (p<0.001). CONCLUSION: Very low birth weight infants undergoing multiply erythrocyte transfusions had excessive iron stores and non-transfused infants also might had a risk of iron overload during hospitalization in the NICU.
Bronchopulmonary Dysplasia ; Erythrocyte Transfusion* ; Ferritins ; Gyeongsangbuk-do ; Hospitalization* ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal* ; Iron Overload ; Iron* ; Retinopathy of Prematurity

PURPOSE: This study aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of full-term neonates in Daegu and Gyeongbuk province of Korea to determine the association between maternal and neonatal diseases, known to be affected by low 25(OH)D3 levels. METHODS: Serum 25(OH)D3 levels were evaluated in full-term neonates (n=122) who were born at Kyungpook National University Hospital. Normal full-term neonates (control group, n=38) were classified by sex, season of birth, and delivery mode (normal or caesarean section). Serum 25(OH)D3 levels in neonates (n=84) with maternal diseases (gestational diabetes mellitus, hypothyroidism, pregnancy induced hypertension, premature rupture of membrane and systemic lupus erythematosus) and neonatal diseases (small for gestational age, transient tachypnea of newborn and pneumonia) were compared with those in control group. RESULTS: The mean serum 25(OH)D3 level in the control group was 9.2+/-5.0 ng/mL. There were no statistically significant differences of serum 25(OH)D3 level between the control group and the disease group. In the control group, 63.2% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 34.2% referred to vitamin D insufficiency. In the maternal disease group and the neonatal disease group, 56.1% and 63.0% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 35.0% and 33.3% referred to vitamin D insufficiency. CONCLUSION: High percentages of neonates were found to be deficient or insufficient in vitamin D. Although low 25(OH)D3 levels have previously been associated with maternal and infant diseases, the association was not observed in this study.
Daegu* ; Diabetes Mellitus ; Female ; Gestational Age ; Gyeongsangbuk-do* ; Humans ; Hypertension, Pregnancy-Induced ; Hypothyroidism ; Infant ; Infant, Newborn* ; Korea* ; Membranes ; Parturition ; Pregnancy ; Rupture ; Seasons ; Transient Tachypnea of the Newborn ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

Eosinophilic gastroenteritis (EGE) is a disorder characterized by eosinophilic infiltration of the bowel wall and various gastrointestinal (GI) manifestations. This study aimed to evaluate the characteristics of EGE in infants and children. A total of 22 patients were diagnosed with histologic EGE (hEGE) or possible EGE (pEGE). Serum specific IgE levels, peripheral eosinophil counts, and endoscopic biopsies were carried out. In the hEGE group (n = 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. All patients in the infant group showed clinical improvement after switching from cow's milk feeding to special formula or breast feeding. The infant group showed a higher eosinophil count in the gastric mucosal biopsy than the child group. In the pEGE group (n = 9) initial symptoms included hematemesis, abdominal pain, and vomiting. Seven patients in this group showed a good response to treatment with restriction of the suspected foods and/or the administration of ketotifen. Both hEGE and pEGE groups showed clinical improvement after restriction of suspected foods in the majority of cases and also showed a similar clinical course. EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly.
Child ; Child, Preschool ; Diagnosis, Differential ; Disease Progression ; Endoscopy, Gastrointestinal/*methods ; Enteritis/*pathology/*therapy ; Eosinophilia/*pathology/*therapy ; Female ; Gastritis/*pathology/*therapy ; Humans ; Infant ; Infant, Newborn ; Intestinal Mucosa/*pathology ; Male ; Republic of Korea ; Treatment Outcome

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

A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.
Catheters ; Humans ; Hydrocephalus ; Infant, Newborn ; Infant, Premature ; Ventriculoperitoneal Shunt

PURPOSE: Bacterial meningitis in neonates and young infants is one of the most serious conditions that can lead to severe neurological sequelae despite the appropriate treatment. This study aimed at evaluating the clinical manifestations and treatment outcomes in patients under the age of three months, who had been diagnosed with bacterial meningitis. METHODS: A total of twelve patients with bacterial meningitis under the age of three months from January 1997 to June 2010 were retrospectively evaluated through a review of their medical records. Patients who showed positive culture results were included in the study. RESULTS: A total of 12 patients (6 males and 6 females, mean age 44.2+/-30.0 days) were enrolled in the study. All patients had fever upon admission. But most of them were unremarkable upon physical examination (75%). Streptococcus agalactiae was the most common organism cultured from CSF (7cases; 58.3%). Six cases showed positive results on CSF culture as well as on blood culture. Cefotaxime and ampicilin/sulbactam or cefotaxime and ampicilin were given as initial treatment with a mean treatment duration of 15.1+/-6.0 days. Neurological complications and sequelae included subdural effusion and hearing disturbance in two cases (16.7%). Nine cases (75%) showed excellent outcomes without neurological deficits, and none were left with a severe degree of sequelae. CONCLUSION: The study showed that neonates or young infants with bacterial meningitis almost always present with fever and that S. agalactiae was the most common causative organism. In addition, the final outcome for these patients may be improved with early and appropriate treatment.
Cefotaxime ; Female ; Fever ; Hearing ; Humans ; Infant ; Infant, Newborn ; Male ; Medical Records ; Meningitis, Bacterial ; Physical Examination ; Retrospective Studies ; Streptococcus agalactiae ; Subdural Effusion ; Treatment Outcome

PURPOSE: Neonatal strokes are common and may be associated with various complications. However, few studies have been conducted on the clinical spectrum in Korea. This study aimed at investigating the clinical presentation and neurological outcome of neonatal strokes. METHODS: Twenty-seven neonates with neonatal stroke were enrolled in the neonatal intensive care unit at Kyungpook National University Hospital from January 2000 to December 2009. Their medical records and neuroradiological findings were retrospectively reviewed. RESULTS: The mean age of the subjects was 4+/-5.6 days. Sixteen patients were full term, nine were prematurite and six had low birth weights. The onset of symptoms was mostly within first week (85.2%) of life, especially in the first day of life (51.9%). The most common symptom was seizure (40.7%), which were focal clonic (38.5%) or multifocal clonic (38.5%). Nine patients showed abnormal EEG findings. Thirteen patients had subdural hemorrhage, seven showed intraventricular hemorrhage, and three revealed cerebral infarction. Among 12 patients who followed-up for one year, four had mild neurologic dysfunction and two had severe impairment. CONCLUSION: We found that the onset of symptom in neonatal strokes was mostly within the first day of life, and the most common symptom was focal seizure. We, therefore recommend that neuroimaging be done when newborns have seizures within their first week of life. However, further studies are needed to elucidate this further.
Cerebral Infarction ; Electroencephalography ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infarction ; Intensive Care, Neonatal ; Korea ; Medical Records ; Neuroimaging ; Neurologic Manifestations ; Retrospective Studies ; Seizures ; Stroke

PURPOSE: Perinatal asphyxia is an important cause of neonatal mortality and subsequent lifelong neurodevelopmental handicaps. Although many treatment strategies have been tested, there is currently no clinically effective treatment to prevent or reduce the harmful effects of hypoxia and ischemia in humans. Erythropoietin (Epo) has been shown to exert neuroprotective effects in various brain injury models although the exact mechanisms through which Epo functions are not completely understood. This study investigates the effect of Epo on hypoxic-ischemic (HI) brain injury and the possibility that its neuroprotective actions may be associated with iron-mediated metabolism. METHODS: HI brain injury was produced in 7-day-old rats by unilateral carotid artery ligation followed by hypoxia with 8% oxygen for 2 h. At the end of HI brain injury, the rats received an intraperitoneal injection of 5,000 units/kg erythropoietin. Random premedication with iron, deferoxamine, iron-deferoxamine, or saline were performed 23 d before HI brain injury. The severity of the brain injury was assessed at 7 d after HI. RESULTS: Single Epo treatment post-HI brain injury reduced the gross and histopathological findings of brain injury. Iron premedication did not increase the incidence or severity of the injury as measured by the damage score. Deferoxamine administration before HI brain injury improved the brain injury as compared to no treatment or Epo treatment. CONCLUSION: These findings indicate that Epo provides neuroprotective benefits after HI in the developing brain. These findings suggest that Epos neuroprotective actions may involve reducing iron in tissues that mediate the formation of free radicals.
Animals ; Anoxia ; Asphyxia ; Brain ; Brain Injuries ; Carotid Arteries ; Deferoxamine ; Erythropoietin ; Free Radicals ; Humans ; Incidence ; Infant ; Infant Mortality ; Injections, Intraperitoneal ; Iron ; Ischemia ; Ligation ; Neuroprotective Agents ; Oxygen ; Premedication ; Rats

PURPOSE: The objective of this study was to establish the serum IGF-1 level in newborn infants, and investigate its association with growth and diseases. METHODS: In a retrospective study, serum IGF-1 levels were measured for newborn infants admitted to NICU at Kyungpook University Hospital from March 2007 to July 2007. Birth data, disease history, and hospital course were obtained from medical records. RESULTS: Of 52 blood samples obtained at birth, serum IGF-l levels in 30 preterm infants (31.6+/-27.3 ng/mL) were lower than in 22 full-term infants (53.4+/-40.0 ng/mL; P<0.05). In sick full-term infants, serum IGF-1 levels (46.0+/-40.2 ng/mL) were lower than in healthy full-term infants (64.1+/-39.5 ng/mL; P<0.05). In preterm infants, there were no differences in IGF-1 levels between healthy (33.2+/-23.3 ng/mL) and sick infants (30.6+/-30.4 ng/mL); however, IGF-1 levels in both sick and healthy preterm infants were lower than in healthy full-term infants. Among infants admitted after 8 days of life, serum IGF-1 levels were higher in infants who gained weight (70.8+/-36.2 ng/mL) than in infants who lost weight (13.3+/-19.9 ng/mL; P<0.01); however IGF-1 levels showed no difference between gender or method of delivery. CONCLUSION: The study showed lower IGF-l levels in preterm infants than in full-term infants. Additionally, the IGF-l level in infants with weight loss was lower than in infants with weight gain. These results indicate that serum IGF-1 is associated with gestational age and postnatal growth.
Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Insulin-Like Growth Factor I ; Medical Records ; Parturition ; Retrospective Studies ; Weight Gain ; Weight Loss