Vitamin D in Full-term Neonates in Daegu and Gyeongbuk Province of Korea and the Association with Maternal and Neonatal Diseases / 대한주산의학회잡지

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.

The Iron Status of Very Low Birth Weight Infants Receiving Multiple Erythrocyte Transfusions during Hospitalization in the Neonatal Intensive Care Unit / 대한소아소화기영양학회지

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.

Differences in Features and Course of Mucosal Type Eosinophilic Gastroenteritis between Korean Infants and Children

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.

Severe vitamin D deficiency in preterm infants: maternal and neonatal clinical features / 소아과

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.

Pharmacological Approaches in Newborn Infants with Hypoxic Ischemic Encephalopathy

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.

Intraparenchymal Pericatheter Cyst as a Complication of a Ventriculo-Peritoneal Shunt in a Premature Infant

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.

Clinical Spectrum of Neonatal Strokes / 대한소아신경학회지

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.

Clinical Manifestations and Treatment Outcome of Bacterial Meningitis in Neonates and Infants Under the Age of Three Months / 대한소아신경학회지

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.

The effect of erythropoietin in neonatal rat model of hypoxic-ischemic brain injury / 소아과

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.

The association between serum IGF-1 and neonatal growth and disease in a NICU / 소아과

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.

The Effect of Hyperthermic Pretreatment in a Neonatal Rat Model of Hypoxic-ischemic Brain Injury

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. In the clinical setting, maternal hyperthermia induces adverse effects on the neonatal brain, but recent studies have shown that hyperthermic pretreatment (PT) plays some role in hypoxic-ischemic (HI) injuries of the developing brain. The present study investigated the effect of hyperthermic PT on HI brain injuries in newborn rats. METHODS: HI was produced in 7-day-old neonatal rats by unilateral common carotid artery ligation, followed by hypoxia with 8% oxygen at 38degrees C for 2 hours. Twenty-four hours before HI, one-half of the pups were exposed to a 40degrees C environment for 2 hours. The severity of the brain injury was assessed 7 days after the HI. RESULTS: Hyperthermic PT reduced the gross and histopathologic findings of brain injury from 64.7 to 31.2% (P<0.05). There were no differences in location and severity of injury between the pretreated and control brains. CONCLUSION: These findings indicate that hyperthermic PT provides neuroprotective benefits on HI in the developing brain. Also, these findings suggest maternal hyperthermia may have protective effect on perinatal HI brain injuries.

Correlation between Cephalhematomas and Intracranial Hematomas

PURPOSE: Cephalhematomas rarely lead to serious complications, such as skull fractures and intracranial hematomas, so CT and/or MRI scans are indicated only in cases in which depressed fractures are suspected or neurologic symptoms develop. Nevertheless, we have experienced several cases of cephalhematomas associated with intracranial hematomas in the absence of remarkable neurologic symptoms. The aim of this study was to evaluate the correlation between cephalhematomas and intracranial hematomas and determine the need for neuroimaging in infants with cephalhematomas. METHODS: Infants who were admitted to the NICU with cephalhematomas and underwent neuroimaging (CT and/or MRI) between January 2002 and July 2006 were evaluated. Neuroimaging was done when the symptoms suggested the development of an intracranial hematoma. RESULTS: Among 54 infants with cephalhematomas, 18 infants underwent neuroimaging. Six of 18 infants (33.3%) had intracranial hematomas, 4 infants had epidural hematomas, and 2 infants had subdural hematomas. Four of these 6 infants had neurologic symptoms or depressed skull fractures; 2 infants had no neurologic symptoms or depressed skull fractures. The neuroimaging was done to evaluate the cause of an excessive elevation of serum bilirubin and unexplained anemia. There were no remarkable differences between the infants with and without intracranial hematomas with respect to gestational age, birth weight, head circumference, diameter of the cephalhematoma, neurologic symptoms, and other clinical signs and symptoms. CONCLUSION: Based on this study, intracranial hematomas are common complications of cephalhematomas, thus more careful inspection and neuroimaging may be needed in cases of cephalhematomas in newborns.

Epidural hematoma treated by aspiration of accompanying cephalhematoma in a newborn infant / 소아과

Epidural hematoma is relatively rare in newborn infants and frequently associated with instrumental deliveries or other complications during labor and delivery. Although surgical evacuation has been the most common therapy, many other procedures have been described. Although many epidural hematomas require surgical evacuation rather than nonsurgical management, conservative or aspiration of hematoma have been attempted. In the case of EDH associated with cephalhematoma, aspiration of cephalhematoma could be attempted because frequent features of these combination were communication between these hematoma. We report a case of successful nonsurgical management of epidural hematoma through the aspiration of accompanying cephalhematoma in a 5-day-old newborn infant.

Diagnostic limitation and usefulness of (99m)Tc-DISIDA hepatobiliary scanning on neonatal cholestasis / 소아과

PURPOSE: To assess the usefulness of (99m)Tc-DISIDA scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia. METHODS: DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. 5 mg/dL vs. 9.7 percent for 5 mg/dL), especially if it delays early diagnosis and surgical intervention.

Auditory brainstem response (ABR) results in NICU graduates / 소아과

PURPOSE: Hearing loss is one of the most common birth defects, and early detection and intervention positively impact language/speech and cognitive development. It has been reported that NICU graduates have a high incidence of hearing loss. So we investigated the incidence, risk factors and clinical outcome of hearing loss in NICU graduates. METHODS: This study involved neonatal auditory brainstem response (ABR) testing of newborn infants who graduated from the NICU of Kyungpook National University Hospital during a 3-year period (between July 2002 and June 2005) and subsequent follow-up of these infants. RESULTS: ABR evaluations were performed on 474 infants. Of these infants, 64 showed abnormal ABR (13.5 percent). Of 128 ears from these 64 infants, two ears (1.6 percent) and 10 ears (7.8 percent) were classified as severe and profound hearing loss, respectively. The infants with abnormal ABR had higher incidence of prematurity, low birth weight, very low birth weight, neonatal asphyxia, cranio-facial malformation and amikacin treatment over 15 days (P<0.05). In infants with hyperbilirubinemia, the peak level of serum bilirubin, duration of phototherapy and exchange transfusion were not associated with the higher incidence of hearing loss. Follow-up ABR evaluation was performed on 15 infants with abnormal ABR at 8.8 +/- 4.4 months. In follow-up ABR, 80.0% showed improvement or normalization of threshold sensitivity. CONCLUSION: NICU graduates exhibit high risk for hearing loss. Systemic and effective hearing assessment program is needed for these high risk infants.

Thyroid Dysfunction in Premature Infants

PURPOSE: Severe neonatal hypothyroxinemia is associated with leukomalacia, intraventicular hemorrhage and long-term neurodevelopmental disability. We designed this study to evaluate the incidence of thyroid dysfunctions and the effects of low T4 level on neonatal morbidity to establish the basis for the thyroid hormone supplementation. METHODS: Thyroid function tests, measured by radioimmunoassay and filter paper screening, were obtained from the preterm infants with birth weights less than 2000 g. The first measurement was done during 2nd week of life followed by the measurement at 2 weeks later and repeated until normalized. RESULTS: 17/32 (53.1%) infants had thyroid dysfunction: Four infants had hypothyroidism, twelve infants had hypothyroxinemia and one infant had hyperthyrotropinemia. The frequency of thyroid dysfunction showed inverse relationship to the birth weight. All infants with birth weights less than 1, 000 g, 11 infants (70.6%) with birth weights between 1, 000 and 1, 499 g and two infants (18.2%) with birth weights more than 1500 g had thyroid dysfunction. Nine infants with thyroid dysfunction were not detected by filter paper screening test. Infants with hypothyroxinemia had more RDS, longer mechanical ventilation days and hospital stay compared to the infants with normal T4 level. CONCLUSION: Thyroid dysfunction is frequently observed in premature infants and it can be associated with increased neonatal morbidity. Serial follow up of thyroid function test is recommened among premature infants.

Patterns of Intrahepatic Gene Expression in Neonatal Cholestasis / 대한소아소화기영양학회지

PURPOSE: To identify genes specifically expressed in biliary atresia, we compared the patterns of gene expression between biliary atresia and neonatal hepatitis syndrome using cDNA microarray analysis. METHODS: Liver tissues were taken from livers of 11 patients (7 patients with biliary atresia and four with neonatal hepatitis) with neonatal cholestasis by needle biopsy. Normal control could be obtained from donor liver tissue during living-related liver transplantation. Total RNA was extracted from each samples and reversely transcribed to make cDNA. Then fluorescent cDNA were pooled and hybridized to the clones on the microarray. Fluorescence intensities at the immobilized targets were measured. Utilizing cDNA arrays of 4.7 K human genes, gene expression profiles were analyzed. RESULTS: Among 4,700 microarray clones, 17 cDNA clones were significantly over-expressed in all 11 patients with neonatal cholestasis, while 20 clones were significantly decreased. Genome-wide expression analysis was carried out in livers obtained at the time of diagnosis. We could identify 49 genes, in which there showed differential expression between biliary atresia and neonatal hepatitis syndrome. CONCLUSION: This study shows the pattern of differentially expressed genes in biliary atresia and neonatal hepatitis syndrome. We believe that this study can contribute to the understanding of pathogenesis of neonatal cholestasis.

The Relationship between Developmental Quotient in Children with Delayed Language Development and Later Intellectual Quotient / 소아과

PURPOSE: The objective of this study was to test the predictive validity of developmental test for later intellectual development in young children with delayed language development. METHODS: The study subjects were 66 children who had presented delayed language development and had an initial developmental test and a follow-up intelligence test. The mean age at initial test was 34.2 months(17-48 months), and the mean age at the follow-up test was 55.0 months(40-79.5 months). RESULTS: According to CAT DQ(Cognitive Adaptive Test Developmental Quotient), 66 children were divided into 4 groups: group I(CAT DQ = or85). There was a moderate correlation between CAT DQ and later total IQ in group I(r=0.58) and II(r= 0.50), but a low correlation in group III(r=0.19) and IV(r=-0.16). IQs in follow-up tests of all children in group I and II were lower than 70, except two children whose IQs were 75 and 78. IQs of children in group III were lower than 85 except for three children whose IQs were 89, 89, and 90, respectively. CONCLUSION: The findings of this study suggest that if DQ is lower than 70, the child is highly probable to be mentally subnormal in later years. Although the correlation between CAT DQ and later total IQ is low in children with DQs over 70, if a DQ is between 70 and 84, the child is very likely to have learning disability in later years.

A Comparison of Rectal, Axillary, and Skin-to-Mattress Temperatures in Neonates

PURPOSE: This study was conducted to evaluate the comparability and accuracy of body temperatures measured at three different sites: rectum, axilla and between skin and mattress in the newborn infants. METHODS: 168 term and preterm infants admitted to NICU at Kyungpook University Hospital were enrolled in the study. Glass and digital thermometers were used for the simultaneous measurement of rectal, axilla and skin-to-mattress temperatures. RESULTS: Among three different body temperatures measured by glass thermometer, the rectal temperatures recorded the highest in the bassinet, while no differences were found in the incubator. Rectal temperature by glass thermometer agreed most closely with axillary temperature by digital thermometer. The digital thermometers took significantly less time to measure temperatures from rectum and axilla than glass thermometer. Phototherapy did not influence body temperature measured in the incubator. CONCLUSION: In the bassinet, axilla temperature measured by a digital thermometer was as reliable as rectal temperature measured by a glass thermometer. Skin-to-mattress temperature provides an accurate, safe and easily accessible alternative site while infants are in the incubator.

Total Parenteral Nutrition-associated Cholestasis in Premature Infants

PURPOSE: Cholestasis is a major complication in prolonged use of TPN, especially in the neonatal period, but there are few long-term reviews examining the clinical course in premature infants. Thus, in this study, we reviewed premature infants with TPN-associated cholestasis(TPNAC) to determine the incidence, clinical courses and possible risk factors. METHODS: Retrospective review of 66 premature infants less than 2,000 gm of birth weight and on TPN for more than two weeks was performed. Cholestasis was defined as a serum direct bilirubin level greater than 2.0 mg/dL. The clinical course of cholestasis was described, and perinatal risk factors were evaluated. RESULTS: TPNAC developed in 21 out of 66 infants(31.8%). The onset was 41.7+/-17.4 days after receiving TPN, and the mean duration was 33.6 +/- 23.4 days. The incidence of TPNAC was significantly correlated with birth weight, and gestational age, and duration of TPN. But, possible etiologic factors, such as incidence of perinatal asphyxia or infection, showed no remarkable differences between infants with TPNAC and those without TPNAC(control). The enteral intake in the third postnatal week was significantly smaller in infants with TPNAC than in the control infants(P=0.033). CONCLUSION: The enteral intake in the third postnatal week was smaller in the infants with TPNAC than in the control infants. Thus, the incidence of TPNAC may be reduced by increasing the amount of oral intake during TPN in high risk infants.