A Case of D--/D-- Phenotype Associated with Moderate Hemolytic Disease of the Newborn / 대한수혈학회지

The very rare D--/D-- phenotype lacks C, c, E, e antigens with strong expression of the D antigen. A 31-year-old woman delivered her second baby, 3.6 kg girl at 38+4 weeks' gestation through repeat-Cesarean section. Her parents were not consanguineous. She had one artificial abortion, one Cesarean section with red blood cell transfusion and two spontaneous abortions. Her red cells were typed as O, D+C-c-E-e- and did not react with anti-Hr(o) (Rh 17). Her serum reacted with all of the screening cells and identification panel cells with strength of (++)~(+++). The baby was mildly jaundiced 12 hours after delivery. At 1 day after delivery, total bilirubin was 17.7 mg/dL, and direct and indirect antiglobulin tests were both positive. Phototherapy was immediately given for the baby but jaundice and anemia were worsened. Twenty six milliliter of the mother's whole blood was given twice to the baby after plasma depletion and leukocyte reduction. The baby showed improvement of jaundice and anemia, and discharged at hospital day 14. As far as we know, this is the third reported case of hemolytic disease of the newborn occurred in the D--/D-- mother with anti-Hr(o) in Korea, and the first case that was neither fatal nor treated with intensive medical care.

Mortality and Morbidity among Small for Gestational Age Infants in Extremely Low Birth Weight Infants

PURPOSE: This study is to evaluate the effect of intrauterine growth retardation on the mortality and morbidity in extremely low birth weight infants (ELBWI). METHODS: As retrospectively reviewing 266 ELBWI who were admitted to the neonatal intensive care unit of Samsung Medical Center, the effects of intrauterine growth on mortality and morbidity in ELBWI was assessed by comparing appropriate for gestational age (AGA) ELBWI to small for gestational age (SGA) ELBWI. RESULTS: The number of SGA and AGA infants was 65(24%), 201(76%) respectively. The mean gestational age of the SGA infants (28(+6)+/-2(+3) week) was significantly higher than in the AGA infants (26(+2)+/-1(+3) week) (P<0.001). The mean birth weight of the SGA infants (755+/-173 g) was significantly less than in the AGA infants (830+/-118 g) (P< 0.001). The mortality of the SGA infants (29%) was less than in the AGA infants (33%). However, when adjusted for gestational age, there was no statistically significant difference. The incidence of respiratory distress syndrome of the SGA infants (66%) was significantly lower than in the AGA infants (87%). The incidence of bronchopulmonary dysplasia of the SGA infants (20%) was lower than in the AGA infants (23%). However, when adjusted for gestational age, there were no statistically significant differences. There was no statistically significant association of SGA with intraventricular hemorrhage, retinopathy of prematurity and necrotizing enterocolitis. CONCLUSION: There was no statistically significant association of intrauterine growth retardation with mortality and morbidity in ELBWI.

Failure to Thrive of Very Low Birth Weight Infants up to Corrected 18 Months of Age

PURPOSE: The aim of this study was to investigate the incidence and contributing factors of failure to thrive (FTT) up to corrected 18 months of age in very low birth weight (VLBW) infants. METHODS: Medical records of 98 VLBW infants admitted to NICU of Samsung Medical Center from January 1996 to December 2000, were reviewed retrospectively whose follow-up's were possible up to corrected 18 months of age. We defined FTT as failure to achieve body weight below 10th percentile of standard Korean infant's growth curve for appropriate corrected age. We investigated maternal, neonatal risk factors for FTT and changing pattern of growth parameters. RESULTS: The risk factors of FTT in VLBW infants were birth weight, gestational age, RDS, BPD, durations of ventilator care, TPN and hospitalization. When corrected for birth weight and gestational age, only duration of hospitalization remained to be a significant risk factor. Unlike body weight, height attained 10th percentile at corrected 15 months for VLBW infants, 18 months for extremely low birth weight (ELBW) infants. Head circumference attained 10th percentile more earlier at corrected 5 months for VLBW infants, 12 months for ELBW infants, respectively. Catch up growth occurred in the order of head circumference followed by height. CONCLUSION: Risk factors for FTT in VLBW infants and ELBW infants is multifactorial. To enhance optimal growth and development of VLBW infants, further studies on nutritional management related to enteral feeding is needed.

The Changes of Incidence of Nosocomial Sepsis, and Risk Factors in Extremely Low Birth Weight Infants

PURPOSE: To know whether the changes in the risk factors of nosocomial sepsis had an impact on the occurrence of nosocomial sepsis (NS) in extremely low birth weight infants (ELBW I). METHODS: ELBW I who were admitted to the NICU at Samsung Medical Center from October 1994 to December 2000 were devided into three groups according to periods (period I:1994.10-1996.9, period II:1996.10-1998.12, period III:1999.1-2000.12), and charts were reviewed retrospectively for demographic profile, incidence of NS, and changing patterns of risk factors of NS. RESULTS: Gestational age and birth weight of ELBW I decreased and the incidence of NS increased significantly during third period. However, cumulative incidence of NS corrected by hospital days was not changed irrespective of periods. Among the risk factors of NS in 3rd period, use of antibiotics in the 1st day, postnatal dexamethasone and use and duration of indwelling umbilical catheters decreased significantly and the use of nasal continuous positive airway pressure increased significantly especially, in ELBW I under 800 g of birth weight. In the ELBW I under 800 g of birth weight, cumulative incidence of NS and mortality among the infants who suffered from NS decreased significantly in 3rd period. CONCLUSION: Efforts to decrease the risk factors of NS can prevent the increase in incidence of NS in ELBW I.