Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

Incontinentia Pigmenti with Extensive Brain Infarction in a Newborn

Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystemic disorder with characteristic skin lesions. In addition to skin lesions, the teeth, nails, hair, eyes, and central nervous system are involved. Central nervous system involvement in the neonatal period may cause intellectual disabilities, severe neurologic impairment, or death. IP is associated with mutations in the NF-kappa B essential modulator gene located on chromosome Xq28 and is most commonly seen in female patients. We experienced one case of a newborn with multiple vesiculobullous skin lesions over the entire body after birth and partial seizures with secondary generalization. The brain magnetic resonance imaging showed extensive cerebral infarction, and retinal hemorrhage was observed in the fundus examination. The patient was clinically diagnosed with incontinentia pigmenti.

Clinical characteristics of febrile young infants with serious bacterial infection in the emergency departments in Korea and validation of Philadelphia criteria and modified Philadelphia criteria: retrospective multicenter study

OBJECTIVE: This study examined the characteristics of febrile young infants with a serious bacterial infection (SBI) who visited emergency centers in Korea and validated the Philadelphia criteria and modified Philadelphia criteria to predict the risk of SBI. METHODS: This was a retrospective study conducted on 450 infants aged 31 days to 56 days who visited three emergency centers with fever from September 2014 to August 2017. The characteristics of the SBI patients were analyzed, and the validation of the Philadelphia and modified Philadelphia criteria sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. RESULTS: Of 450 patients, 165 patients (36.7%) had SBI, such as urinary tract infection (33.3%), bacteremia (4.0%), acute osteomyelitis (0.2%), and bacterial meningitis (BM) in two patients (0.4%). The most common pathogen of invasive bacterial infection was Escherichia coli. In the Philadelphia criteria, the sensitivity, specificity, PPV, NPV, and accuracy were 73.9%, 47.0%, 44.7%, 75.7%, and 56.9%, respectively. In the modified Philadelphia criteria that excluded lumbar puncture as a predictor, the sensitivity, specificity, PPV, NPV, and accuracy were 93.3%, 31.9%, 44.3%, 89.2%, and 54.4%, respectively. The most common failed low risk criteria was appearance (43.3%). Two patients with bacterial meningitis were excluded from low risk group by the modified Philadelphia criteria. Although one out of 2 patients met the failed low risk criteria due to their poor condition, this factor is not objective, so BM can be missed. CONCLUSION: Bacterial meningitis was too rare in this study. New criteria are needed to predict SBI. The Philadelphia and modified Philadelphia criteria were not useful for predicting SBI in this study. Other prediction models will be needed to predict SBI in the vaccination era.

Perinatal Risk Factors for Postnatal Weight Loss in Late Preterm Infants

PURPOSE: Many studies have reported associations of early postnatal growth failure in preterm infants with several morbidities. However, the risk factors for postnatal weight loss (PWL) in late preterm infants have not been identified. We investigated the independentrisk factors for PWL in late preterm infants.METHODS: This was a retrospective cohort study. We enrolled 369 late preterm infants born at 34⁺⁰ to 36⁺⁶ weeks gestational age who were admitted to the Soonchunhyang University Cheonan Hospital between 2015 and 2017. PWL% was calculated as (birth weight–lowest weight)/birth weight×100. The infants were classified into lower (< 5%) and higher (≥10%) PWL% groups by propensity score matching for gestational age, sex, and birth weight. Perinatal risk factors were analyzed using multivariable logistic regression.RESULTS: The lower and higher PWL% groups included 62 and 31 infants, respectively. Antenatal steroids administered within 1 week before birth (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.015 to 10.465; P=0.047), lower total calorie intake during days 1 to 7 (OR, 0.98; 95% CI, 0.977 to 0.999; P=0.027), and phototherapy (OR, 5.28; 95% CI, 1.327 to 21.024; P=0.018) were independent risk factors for the higher PWL%.CONCLUSION: Further studies are needed to identify the risk factors that cause high PWL% according to gestational age and short- and long-term morbidities based on the degree of PWL.

A Case of a Patent Omphalomesenteric Duct Presenting with Meconium Discharge from the Umbilicus

The omphalomesenteric duct is a link between the primitive midgut and the yolk sac. Normally, the duct obliterates around 6 weeks of gestation, yet varying degrees of incomplete obliteration can take place in 1%–4% of infants. This study described the case of a newborn with a patent omphalomesenteric duct remnant fistula identified at birth with meconium in the umbilical cord. At birth, the infant presented meconium staining and meconium discharged within the umbilical cord. Physical examination and other examinations showed no other specific findings. The omphalomesenteric duct fistula was confirmed through the imaging study (abdominal ultrasonography, gastrografin enema). A surgery was carried out where the remnant was resected. The patient did well and was discharged soon after without complication.

Comparison of R-mix Virus Culture and Multiplex Reverse Transcriptase Polymerase Chain Reaction for Assessment of Neonatal Respiratory Viral Infection

OBJECTIVE: Respiratory viral infection of the neonatal period is highly contagious. Rapid and accurate diagnosis is important for proper treatment and prevention. However, the existing diagnostic method, respiratory virus cell culture, takes a long time to diagnose. Recent development of rapid diagnostic methods such as multiplex reverse transcriptase polymerase chain reaction (RT-PCR) enable early detection and effective treatment of respiratory viral infections. We compared the efficiency of multiplex RT-PCR and R-mix virus culture for rapid detection of respiratory viruses. METHODS: We retrospectively analyzed the clinical features and results of R-mix virus culture and multiplex RT-PCR with nasopharyngeal aspiration specimens in 117 newborns admitted to neonatal intensive care unit suspected of infectious diseases. RESULTS: R-mix virus culture was positive in 29 cases (24.8%) and RT-PCR in 86 cases (73.5%). R-mix virus culture and multiplex RTPCR were identical in 54 cases (positive 26 cases, negative 28 cases). Among 75 cases that showed different results, 60 showed negative result in R-mix virus culture and positive result in multiplex RT-PCR, and three showed positive result in R-mix virus culture and negative result in multiplex RT-PCR. Different viruses were detected in the remaining 12 cases by both methods. CONCLUSION: Multiplex RT-PCR is faster than R-mix virus culture and has the advantage of identifying new respiratory viruses. On the other hand, Multiplex RT-PCR is more susceptible to false positives and mixed infections than R-mix virus culture, so more attention is required when interpreting test results.

A Single-center, Prospective, Cross-over Study to Compare the Efficiency of Oxygen Supply between the OxyMask™ and Non-rebreather Mask in Healthy Adults

PURPOSE: In this single-center, prospective, randomized, cross-over study, we compared the efficiency of oxygen supply between OxyMask and non-rebreather mask (NRM), depending on the position of the mask. METHODS: Either OxyMask or NRM was applied to 33 healthy volunteers, in a random manner, on the upper (that 1 cm upper to it), lower (that 1 cm inferior to it) and lateral malposition (that 1 cm lateral to it). After a 3-minute oxygenation, at a flow rate of 15 L/min, we measured the fractional expired oxygen concentration (F(E)O₂), fractional expired carbon dioxide concentration (F(E)CO₂), and visual analogue scale (VAS) scores for the degree-of-wearing sensation. RESULTS: OxyMask showed a lower level of F(E)O₂ as compared with NRM in all positions. Moreover, OxyMask showed no significant difference between F(E)O₂ and the position of the mask. However, NRM showed a significantly lower F(E)O₂ in the upper and lateral malposition. F(E)CO₂ had no significant difference with the types and position of the mask. The mean VAS scores for the degree-of-wearing sensation were 2.2±1.5 in the OxyMask and 4.3±1.5 in the NRM (p<0.001). CONCLUSION: OxyMask may offer greater benefit in maintaining the concentration of supplied oxygen and provide greater comfort than NRM in patients with difficulty applying the mask on an adequate location and maintaining the seal.

Factors about Failure after High Flow Oxygen through Nasal Cannula Therapy in Hypoxic Respiratory Failure Patients at Emergency Department Presentation

PURPOSE: High-flow oxygen through a nasal cannula may offer an alternative therapy to patients with respiratory failure. However, a recent study has shown that the success rate of high-flow oxygen through a nasal cannula was only 62%, and the mortality rate for patients who require intubation after failure of high-flow oxygen through a nasal cannula was as high as 32.5%. The aim of this study is to determine the parameters, specifically for emergency department presentation, associated with high-flow oxygen through a nasal cannula failure. METHODS: A retrospective cohort study was performed in respiratory patients who were admitted between June 2015 and January 2016 at a single university hospital. All patients who were treated with high-flow oxygen through a nasal cannula were included. The exclusion criteria for high-flow oxygen via nasal cannulation were as follows: Hemodynamic instability, hypercapnic coma, inefficient clearance of secretions, and cardiac arrest. Univariable regression analysis was used and, if the p-value was less than 0.10, analyses were entered into a multivariable logistic regression analysis model. RESULTS: Sixty-two patients were enrolled in our study. High-flow oxygen through a nasal cannula was successful in 33 patients, and 29 required intubation. Older age (over 65 years), Glasgow Coma Scale Score of less than 15, and respiratory rate of more than 30/min were significantly associated with the failure of high-flow oxygen through a nasal cannula according to multivariable analysis (p-value<0.05). CONCLUSION: Older age, low Glasgow Coma Scale Score, and respiratory rate of more than 30/min are factors associated with the failure of high-flow oxygen through a nasal cannula.

Idiopathic Pneumoperitoneum in a Premature Infant

Pneumoperitoneum is generally a surgical emergency that needs immediate surgical intervention to improve survival in neonates. Its main etiologies include necrotizing enterocolitis, secondary meconium ileus, intestinal obstruction, or various other causes such as gastric perforation from the insertion of a nasogastric tube. However, pneumoperitoneum can rarely present without any gastrointestinal perforation. This condition has been called nonsurgical, asymptomatic, benign, misleading, spontaneous, or idiopathic pneumoperitoneum. In this report, a rare case of pneumoperitoneum in a premature infant is presented, the definite cause of which was not found even after an explorative laparotomy.

Adrenal Insufficiency in 6-Year-Old Boy with Pneumococcal Meningitis

A 6-year-old boy with acute onset fever, mental change, and vomiting was admitted to the intensive care unit. He had neck stiffness and positive Kernig/Brudzinski sign. He showed neither skin pigmentation nor hirsutism. Brain magnetic resonance image showed diffuse sulcal T2 fluid attenuated inversion recovery hyperintensity in bilateral cerebral hemisphere. We started intravenous vancomycin and ceftriaxone. There was streptococcus pneumoniae in cerebrospinal fluid (CSF) culture. He showed no improvement of mental change and hemodynamic instability. His adrenocorticotropic hormone and cortisol level was 5.47 pg/mL and 15.08 µg/dL. We suspected adrenal insufficiency and prescribed intravenous hydrocortisone (50 mg/m2/day). Mental change and hemodynamic instability were improved after that. The CSF culture was negative 24 days after admission and he was discharged with oral hydrocortisone (10 mg/m2/day). In synacthen test (250 µg), basal and 60 minutes 17-OH-progesterone level was 3.84 ng/mL and 5.04 ng/ mL. We suspected non classic congenital adrenal hyperpalsia and planed further work up.