Methicillin-resistant Staphylococcus aureus (MRSA) Infection in Neonates

Methicillin-resistant Staphylococcus aureus is composed of 80% of isolated Staphylococcus aureus in intensive care units and has become a threat to critically ill population including neonates not only in Korea. A key to success in eradicating MRSA infection within neonatal intensive care unit involves formulating an infection control guideline that is sustainable under the support of senior leader and day to day leader. When decolonization is done with mupirocin, judicious use of mupirocin should be done due to prevalance of mupirocin resistant MRSA strains found in Korea especially in the community hospitals. Implementing an effective infection control strategies to eradicate MRSA among neonatal population in Korea must include medical facilities in the community.

Predictable risk factors and clinical courses for prolonged transient tachypnea of the newborn / 소아과

PURPOSE: Transient tachypnea of the newborn (TTN) is usually benign and improves within 72 hours. However, it can also progress to prolonged tachypnea over 72 hours, profound hypoxemia, respiratory failure, and even death. The aim of this study is to find predictable risk factors and describe the clinical courses and outcomes of prolonged TTN (PTTN). METHODS: The medical records of 107 newborns, >35(+0) weeks of gestational age with TTN, who were admitted to the NICU at Seoul Asan Medical Center from January 2001 to September 2007 were reviewed. They were divided into 2 groups based on duration of tachypnea. PTTN was defined as tachypnea > or =72 hours of age, and simple TTN (STTN) as tachypnea 90/min, FiO2 >0.4, and required ventilator care more frequently than STTN infants. PTTN had lower level of serum total protein and albumin than STTN. The independent predictable risk factors for PTTN were grunting, maximal respiration rate >90/min, and FiO2 >0.4 within 6 hours of life. CONCLUSION: When a newborn has grunting, respiration rate >90/min, and oxygen requirement >0.4 of FiO2 within 6 hours of life, the infant is at high risk of having persistent tachypnea > or =72 hours. We need further study to find the way to reduce PTTN.

A Case of Hydrops Fetalis due to Placental Chorangiomatosis / 대한주산의학회잡지

Apart from the common etiologies of neonatal hydrops fetalis, a miscellaneous group of rare causes of them include abnormalities of the placenta, namely, chorangioma (chorioangioma). Chorangiomatosis is multiple small chorangiomas, a rare tumor occurring in 1% of pregnancies, of varying sizes in the placenta. When chorangioma is large enough it can cause high output cardiac failure of the fetus and results in non-immune hydrops. We report a case of neonatal hydrops fetalis caused by placental chorangiomatosis in which the placenta could have been easily overlooked. We suggest evaluating every placenta for biopsy in cases of neonatal hydrops fetalis especially when the other causes of hydrops fetalis have been ruled out.

Four Cases of Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) with severe pulmonary hypoplasia is associated with significant mortality. Recently, several new therapeutic methods have been suggested, such as high- frequency oscillatory ventilation and inhaled nitric oxide. For hypoxemic respiratory failure unresponsive to these advanced medical treatment options, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment. An understanding of the pathophysiology of pulmonary hypertension associated with CDH led to a strategy involving preoperative stabilization and delayed surgical intervention with ECMO. We describe four cases of ECMO, including the first report of ECMO for neonatal CDH in Korea.

Neonatal Hearing Screening in Neonatal Intensive Care Unit Graduate

PURPOSE: Hearing loss is one of the common birth defects in humans, with a reported prevalence of 1-3 per 1000 newborns. We investigated the incidence of hearing loss and evaluated the use of neonatal hearing screening test in neonatal intensive care unit (NICU) graduates who are at greater risk for hearing loss than normal newborns. METHODS: The neonates admitted to the NICU of Asan Medical Center from 1 March, 2003 to 30 March, 2008 who were available for follow-up were included. Those who failed the first auditory brainstem response prior to discharge were retested with the stapedial reflex test, auditory brainstem response and tympanometry in the Otolaryngology department. RESULTS: Of 2,137 neonates, 2,000 (93.5%) neonates were tested prior to discharge. Sixty-seven neonates (3.4%) failed the first newborn hearing screening test. Of 67 infants, 52 infants were retested for a second hearing test. Excluding 10 infants (19.2%) who were lost during follow-up, 16 infants were confirmed to have hearing impairment of which 12 and 4 infants had unilateral and bilateral hearing loss, respectively. Of 16 infants, 5 did not meet the criteria set by the Korean National Health Insurance Corporation. CONCLUSION: The prevalence of hearing impairment in NICU graduates is about 0.8%, excluding those who were lost for follow up, necessitating a systemic and effective hearing assessment program among these high risk infants and more generous national insurance coverage.

Outcomes of Extremely Low Birth Weight Infants at the Asan Medical Center between 2003 and 2006

PURPOSE: The purpose of this study was to determine the outcomes of extremely low birth weight infants (ELBWI) who were born at the Asan Medical Center and evaluate the recent status of neonatal intensive care and associated problems. METHODS: We retrospectively evaluated 120 inborn ELBWI who were admitted to the NICU of the Asan Medical Center between 2003 and 2006. The survival rate, neurodevelopmental outcomes, maternal and infant factors, and infant mordibities were evaluated and the relationships with survival and catch-up growth were investigated. RESULTS: The survival rate of the ELBWI was 82% at a mean gestational age of 27+2 weeks, and with a mean birth weight of 801.3+/-129.0 g. The duration of hospitalization was 85.7+/-27.2 days, the duration of O2 use was 43.9+/-35.4 days, and the duration of ventilatory support was 20.9+/-20.9 days among the survivors. The incidence of respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, and periventricular leukomalacia were 41.8%, 61.2%, 3%, and 4%, respectively. The mean mental developmental index and psychomotor development index of Bailey Scales of Infant Development (II) at follow-up were 83.4+/-18.2 and 83.3+/-20.3, respectively. Among the infants who had >18 months of follow-up, 50.8% had catch-up growth at 12 months. CONCLUSION: The survival rate of ELBWI has improved; however, the morbidities remain high, thus indicating further efforts must be implemented to reduce morbidity and improve neurodevelopmental outcomes.

A Case of Scalp AV Malformation Cured by Embolization

Congenital arteriovenous malformation of the scalp is a relatively rare disease, and its treatment remains challenging because of the unpredictable behavior and high recurrence rate. We report herein a case of an 8 days old male referred for a pulsating scalp mass in the right parietal area with congestive heart failure which was found to be due to AV malformation of the scalp. Embolization of two feeding arteries arising from the right superficial temporal artery on day of life 11 resulted in a complete cure without recurrences.

A Case of 18P-Syndrome with Frequent Intection

No abstract available.