Objective: To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionalityeuroticism scale (odds ratio=1.152, p<0.001). Conclusion The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.

Pylorospasm is a cause of delayed gastric emptying in young infants. As in patients with hypertrophic pyloric stenosis, most pylorospasm patients present with projectile vomiting. However, unlike that in case of hypertrophic pyloric stenosis, no persistent pyloric stenotic lesions are present. As such, follow-up using serial gastrointestinal fluoroscopy or ultrasonography can be helpful in diagnosing patients with clinical signs of gastroparesis. Most cases can be treated conservatively, but some patients require pharmacologic treatment. Antispasmodics have been proposed as a treatment for pylorospasm, but their use in neonates and infants has rarely been reported. Herein, we present a case of pylorospasm diagnosed in the neonatal period and successfully treated with intravenous atropine.
Atropine ; Fluoroscopy ; Follow-Up Studies ; Gastric Emptying ; Gastroparesis ; Humans ; Infant ; Infant, Newborn ; Parasympatholytics ; Pyloric Stenosis, Hypertrophic ; Pylorus ; Spasm ; Ultrasonography ; Vomiting

PURPOSE: The goal of nutritional support for very-low-birth-weight (VLBW) infants from birth to term is to match the in utero growth rates; however, this is rarely achieved. METHODS: We evaluated postdischarge growth patterns and growth failure in 81 Korean VLBW infants through a retrospective study. Weight and height were measured and calculated based on age percentile distribution every 3 months until age 24 months. Growth failure was defined as weight and height below the 10th percentile at 24 months. For the subgroup analysis, small-for-gestational age (SGA) and extremely low birth weight (ELBW) infants were evaluated. The growth patterns based on the Korean, World Health Organization (WHO), or Centers for Disease Control and Prevention (CDC) standard were serially compared over time. RESULTS: At postconception age (PCA) 40 weeks, 47 (58%) and 45 infants (55%) showed growth failure in terms of weight and height, respectively. At PCA 24 months, 20 infants (24%) showed growth failure for weight and 14 (18%) for height. Growth failure rates were higher for the SGA infants than for the appropriate-weight-for-gestational age infants at PCA 24 months (P=0.045 for weight and P=0.038 for height). Growth failure rates were higher for the ELBW infants than for the non-ELBW infants at PCA 24 months (P<0.001 for weight and P=0.003 for height). Significant differences were found among the WHO, CDC, and Korean standards (P<0.001). CONCLUSION: Advancements in neonatal care have improved the catch-up growth of VLBW infants, but this is insufficient. Careful observation and aggressive interventions, especially in SGA and ELBW infants, are needed.
Centers for Disease Control and Prevention (U.S.) ; Gestational Age ; Humans ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Nutritional Support ; Parturition ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; World Health Organization

PURPOSE: The aims of this study were to evaluate the safety and pharmacokinetics of levetiracetam (LEV) in neonates with seizures and to establish a population pharmacokinetics (PPK) model by using the software NONMEM. METHODS: A retrospective analysis of 18 neonatal patients with seizures, who were treated with LEV, including 151 serum samples, was performed. The mean loading dose was 20 mg/kg, followed by a mean maintenance dose of 29 mg/kg/day. RESULTS: Seventeen neonates (94%) had seizure cessation within 1 week and 16 (84%) remained seizure-free at 30 days under the LEV therapy. The mean serum concentration of LEV was 8.7 µg/mL. Eight samples (5%) were found above the therapeutic range. No serious adverse effects were detected. In the PPK analysis for Korean neonates, the half-life was 9.6 hours; clearance, 0.357 L/hr; and volume of distribution, 4.947 L, showing differences from those in adults. CONCLUSION: LEV is a safe and effective option for the treatment of neonatal seizures with careful therapeutic drug monitoring.
Adult ; Drug Monitoring ; Half-Life ; Humans ; Infant, Newborn* ; Pharmacokinetics* ; Retrospective Studies ; Seizures*

The pulmonary interstitial emphysema (PIE) is a life-threatening illness in premature infants with mechanical ventilation. While most are managed conservatively, decompression would be necessary. Here, we report the first case of PIE treated by percutaneous catheter insertion in an extremely low birth weight (ELBW) infant in Korea. The patient, born with 660 g in 23+2 weeks of gestation, showed PIE in left lower lung on postnatal day 12. Percutaneous catheter insertion was performed on postnatal day 25. The size of PIE decreased, but didn't disappear completely. On postnatal day 42, we exchanged catheter and inserted additional catheter in pleural space. However, sudden desaturation and pneumothorax occurred on postnatal day 44. We changed catheter in pleural space, and pneumothorax and PIE improved. Finally, we successfully removed catheters, and weaned patient out. As in our case, percutaneous catheter insertion would be a useful option for ELBW infants with PIE.
Catheters* ; Catheters, Indwelling ; Decompression ; Emphysema* ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea ; Lung ; Pneumothorax ; Pregnancy ; Pulmonary Emphysema ; Respiration, Artificial

The pulmonary interstitial emphysema (PIE) is a life-threatening illness in premature infants with mechanical ventilation. While most are managed conservatively, decompression would be necessary. Here, we report the first case of PIE treated by percutaneous catheter insertion in an extremely low birth weight (ELBW) infant in Korea. The patient, born with 660 g in 23+2 weeks of gestation, showed PIE in left lower lung on postnatal day 12. Percutaneous catheter insertion was performed on postnatal day 25. The size of PIE decreased, but didn't disappear completely. On postnatal day 42, we exchanged catheter and inserted additional catheter in pleural space. However, sudden desaturation and pneumothorax occurred on postnatal day 44. We changed catheter in pleural space, and pneumothorax and PIE improved. Finally, we successfully removed catheters, and weaned patient out. As in our case, percutaneous catheter insertion would be a useful option for ELBW infants with PIE.
Catheters* ; Catheters, Indwelling ; Decompression ; Emphysema* ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea ; Lung ; Pneumothorax ; Pregnancy ; Pulmonary Emphysema ; Respiration, Artificial

Congenital intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. Their clinical manifestations tend to vary according to age, with pediatric populations being more likely to have symptoms like congestive cardiac failure and seizures because of arteriovenous shunting; hemorrhage is the major presentation in adult populations. Pediatric populations, especially newborn infants, seldom experience a hemorrhagic event. Here, we report two rare cases of neonates with congenital pial AVF presenting as intraventricular and subdural hemorrhage, respectively, which were treated with endovascular embolization.
Adult ; Arteriovenous Fistula* ; Brain* ; Embolization, Therapeutic ; Estrogens, Conjugated (USP) ; Heart Failure ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant ; Infant, Newborn* ; Intracranial Hemorrhages* ; Seizures

PURPOSE: Patent ductus arteriosus (PDA) is common in preterm infants, and about 30% of preterm infants undergo surgical ligation of the PDA. Cardiopulmonary instability, defined as hypotension and respiratory failure after PDA ligation, is reported to occur at a frequency of 40-50%. This study investigated the factors affecting cardiopulmonary instability after PDA ligation in preterm infants. METHODS: The medical records of 45 very low birth weight (VLBW) infants who underwent PDA ligation in the neonatal intensive care unit from January 2009 to December 2013 were analyzed retrospectively. PDA ligation was only performed when medical treatment for hemodynamically significant PDA failed or was contraindicated. The cases were categorized into the hemodynamic instability (n=20) and control (n=25) groups. RESULTS: Patients underwent ligation at the mean age of 14.3+/-13.3 days. There were no significant differences between groups in mortality or weaning from ventilation after PDA ligation. In the hemodynamic instability group, birth weight was significantly lower (P=0.046) and the pre-operation C-reactive protein (CRP) level was significantly higher (P=0.042) than in the control group. The use of high-frequency ventilation was higher in the hemodynamic instability group (P=0.033). There were no differences in use of inotropics, mean airway pressure at ligation, timing of ligation, or PDA size between groups. The birth weight and pre-operation CRP level at the time of ligation remained a significant risk factor for cardiopulmonary instability on multiple logistic regression analysis. CONCLUSION: In VLBW infants, lower birth weight and a higher pre-operation CRP level are related to unstable conditions after PDA ligation.
Birth Weight ; C-Reactive Protein ; Ductus Arteriosus, Patent* ; Hemodynamics ; High-Frequency Ventilation ; Humans ; Hypotension ; Infant* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Ligation* ; Logistic Models ; Medical Records ; Mortality ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors* ; Ventilation ; Weaning

PURPOSE: This study aimed to analyze the risk factors for the development of rickets of prematurity in extremely low birth weight (ELBW) infants. METHODS: We retrospectively reviewed the data of 57 ELBW infants. Nineteen infants were diagnosed with rickets and 38 infants without rickets were recruited. On radiologic evaluation, 47% of infants had grade I, 37% had grade II, and 16% had grade III rickets. RESULTS: In ELBW infants with rickets, the durations of oxygen administration, mechanical ventilation, parenteral nutrition, and hospitalization were significantly longer compared to those of the control group. The number of days for achieving an enteral caloric intake of 80 kcal/kg/d and the number of days for regaining birth weight were significantly longer compared to those of the control group. Serial weight changes from birth weight during 8 weeks after birth was significantly lower in the rickets group than in the control group. Retinopathy of prematurity was significantly higher in the rickets group than in the control group. After adjustment for birth weight, rickets of prematurity was correlated with days for regaining birth weight (odds ratio [OR], 1.316; P=0.010), and with weight changes from birth weight at 4 weeks of age (OR, 0.964; P=0.033). CONCLUSION: In ELBW infants, the risk factors for rickets of prematurity were days for regaining birth weight from birth and the weight changes at 4 weeks of age. Early aggressive nutrition for regaining birth weight earlier may reduce the development of rickets of prematurity.
Birth Weight ; Body Weight Changes ; Energy Intake ; Enteral Nutrition ; Hospitalization ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Oxygen ; Parenteral Nutrition ; Parturition ; Respiration, Artificial ; Retinopathy of Prematurity ; Retrospective Studies ; Rickets* ; Risk Factors*

PURPOSE: The vancomycin dosage regimen is regularly modified according to the patient's glomerular filtration rate (GFR). In the present study, we aimed to assess the usefulness of serum cystatin C (Cys-C) concentration, compared with serum creatinine (SCr) concentration, for predicting vancomycin clearance (CLvcm) in neonates. METHODS: We retrospectively analyzed the laboratory data of 50 term neonates who were admitted to the neonatal intensive care unit and received intravenous vancomycin, and assessed the pharmacokinetic profiles. Creatinine clearance (CLcr) and GFR based on Cys-C (GFRcys-c) were estimated using the Schwartz and Larsson formulas, respectively. RESULTS: The mean CLvcm (+/-standard deviation) was 74.52+/-31.17 L/hr, the volume of distribution of vancomycin was 0.67+/-0.14 L, and vancomycin half-life was 9.16+/-17.42 hours. The SCr was 0.46+/-0.25 mg/dL and serum Cys-C was 1.43+/-0.34 mg/L. The peak and trough concentrations of vancomycin were 24.65+/-14.84 and 8.10+/-5.35 mcg/mL, respectively. The calculated GFR based on serum creatinine concentration (GFR-Cr) and GFRcys-c were 70.2+/-9.45 and 63.6+/-30.18 mL/min, respectively. The correlation constant for CLvcm and the reciprocal of Cys-C (0.479, P=0.001) was significantly higher than that for CLvcm and the reciprocal of SCr (0.286, P=0.044). GFRcys-c was strongly correlated with CLvcm (P=0.001), and the correlation constant was significantly higher than that for CLvcm and CLcr (0.496, P=0.001). Linear regression analysis showed that only GFRcys-c was independently and positively correlated with CLvcm (F=41.9, P<0.001). CONCLUSION: The use of serum Cys-C as a marker of CLvcm could be beneficial for more reliable predictions of serum vancomycin concentrations, particularly in neonates.
Creatinine ; Cystatin C* ; Glomerular Filtration Rate ; Half-Life ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Linear Models ; Retrospective Studies ; Vancomycin*