A Case of Acute Poststreptococcal Glomerulonephritis Accompanied with Acute Pyelonephritis

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinuira. Serial urine cultures grew Escherichia coli. (99m)Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin O titer, and low serum complement levels. The patient improved completely with supportive treatment, including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be superimposed on each other.

A Case of Trisomy 9 Mosaicism

Trisomy 9 mosaic syndrome is a rarely reported chromosomal abnormality with high incidence of intrauterine growth retardation and perinatal death. Even a baby lives, he has severe mental retardation and significant malformations. The incidence and severity of malformations and mental retardation correlate with the percentage of trisomic cells in the different tissues. The characteristic craniofacial abnormalitis are narrow bifrontal diameter, up-slanted and short palpebral fissures, a prominent nasal bridge with a short root, a prominent lip covering a receding lower lip, low-set, posteriorly rotated, and misshapen ears. Ventricular septal defect is a main cardiac abnormality. Bony hypoplasia and dislocated hips have been frequently reported. Central nervous system, hepatobiliary, gastrointestinal and genitourinary abnormalities also had been reported. The authors report a baby who had characteristic abnormalities of trisomy 9 mosaicism with narrow temples, up-slanted palpebral fissures, a bulbous nose, thin and protruding upper lip, low set and malformed ears, hyperextended wrist and overlapping fingers. Cytogenetic analysis performed to confirm the chromosomal abnormality revealed trisomy 9, low level mosaic type.

Changes in Incidence, Survival Rate and Morbidity of Very Low Birth Weight Infants

PURPOSE: The survival rate of very low birth weight infants(VLBWI) has improved by virtue of specialized neonatal care. This study was performed to analyze the changes in incidence, survival rate and morbidity of VLBWI who admitted to Chonnam National University Hospital from 1996 to 2001. METHODS: We enrolled 565 VLBWI, and compared the incidence and the survival rate according to the birth weight or gestational weeks between period I(1996 to 1998) and period II(1999 to 2001). The mortality rate according to the postnatal age, cause of death, morbidity and days of hospital stay were also compared. Morbidity is categorized into 'short term' which is curable until discharge, and 'long term' causing any types of sequelae after discharge. RESULTS: Incidence of VLBWI significantly increased in period II over period I(6.0% vs. 11.0%, P<0.001). The survival rate also increased in period II(71.8% vs. 80.1%, P<0.05), especially in 1,000 to 1,249 gm of birth weight(P<0.001) and in 28 to 30 weeks of gestation(P<0.001). The most common cause of death was respiratory distress syndrome in period I; however it was sepsis in period II. Although overall and short term morbidity rate increased, long term morbidity and days of hospital stay didn't increase in period II. CONCLUSION: Although the incidence of VLBWI significantly increased and the survival improved in period II compared to period I, especially in 1,000 to 1,249 gm of birth weight and 28 to 30 weeks of gestation, 'long term' morbidity rate and hospital days didn't increase.

Complications and Perinatal Factors According to the Birth Weight Groups in the Infants of Diabetic Mothers

PURPOSE: This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). METHODS: Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. RESULTS: Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. CONCLUSION: In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.

Frequency of Platelet Transfusions and Outcome in Neonates with Thrombocytopenia

PURPOSE: We compared the underlying or associated diseases according to the frequency of platelet transfusions in neonates with thrombocytopenia to know the factors predicting which patients will require multiple platelet transfusions. We also compared mortality. METHODS: A retrospective study was performed in 72 neonates who received the platelet transfusions in neonatal intensive care unit(NICU) between August 1996 and July 2001. Group I received one platelet transfusion and group II received two or more. We compared the frequency of underlying or assodiated diseases such as sepsis/disseminated intravascular coagulopathy(DIC), respiratory distress syndrome(RDS), intraventricular hemorrhage(IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis(NEC), liver or renal disease, and mortality between two groups. RESULTS: Of the 72 patients, 29(40.2%) received one and 43(59.7%) received two or more transfusions; 16(22.2%) received four or more. There were no statistically significant differences in gestational age, birth weight, sex, and maternal history between two groups. C-section rate was higher in group II(20.7% vs. 55.8%, P<0.05) and the incidence of PDA was higher in group I (55.2% vs. 30.2%, P<0.05). Otherwise, there were no statistically significant differences in the incidence of sepsis/DIC, RDS, IVH, RDS, CLD, NEC, liver or renal disease, pulmonary hemorrhage and hypoxic ischemic encephalopathy, and mortality between group I and group II. CONCLUSION: There was no significant difference in clinical morbidity and mortality according to the frequency of platelet transfusion in neonates with thrombocytopenia. Further study is needed to know the predicting factor for multiple platelet transfusions in neonates with thrombocytopenia.

Effects of Single Fetal Death on Mother and Live Co-twin in Twin Pregnancy

PURPOSE: Twins have a higher mortality and morbidity than singletons. Co-twin with one fetal death is particularly at risk. We investigated the neonatal outcome of live co-twins when one fetus had died after the 20th gestational week, and associated risk factors. METHODS: A retrospective study was performed in fifteen cases of twin pregnancy with single intrauterine fetal deaths after the 20th gestational week during the period from January 1996 to December 2000 at Chonnam University Hospital. RESULTS: Gestational age was 33.7+/-3.2 weeks, birth weight was 1,992+/-592 g. Interval between one fetal death being detected and the delivery of a live co-twin was 32.4+/-29.5 days. There were 11 cases(73.3%) of premature babies less than 37 gestational weeks. Main causes of preterm delivery were preterm labor and premature rupture of membranes. Hematologic findings suggesting disseminated intravascular coagulopathy(DIC) were not found in all mothers before delivery, and was not associated with DIC and encephalomalacia of the live co-twin. Perinatal outcome of fifteen live co-twins was as follows : six were normal(40%), three were DIC(20.0%), three were encephalomalacia(20.0%), one suffered intrauterine growth retardation, there was one case of twin to twin transfusion syndrome, and one of congenital heart disease(atrial septal defect with pulmonary stenosis). The occurrence of DIC and encephalomalacia in live co-twins was not related to placental chorionicity, birth weight, gestational week, and the interval between the detection one fetal death and the delivery of a live co-twin. CONCLUSIONS: We could not find any maternal hematologic problems in twin pregnancies complicated by one fetal death. Twenty percent of live co-twins showed DIC and encephalomalacia. However, its associated risk factors were not found. We need to investigate more closely the cases of live co-twins with one intrauterine fetal death.

Nosocomial Infection in Neonatal Intensive Care Unit

PURPOSE: Neonates in neonatal intensive care units(NICU) have a high risk of acquiring nosocomial infection because of their impaired host defence mechanism and invasive procedures. Nosocomial infection result in considerable morbidity and mortality among neonates. This study was carried out to survey both the epidemiology of nosocomial infection in our NICU and the annual trends of pathogens. METHODS: We retrospectively reviewed culture proven nosocomial infection which occurred in our NICU from January 1995 to December 1999. The data included clinical characteristics, site of infection, pathogens, and mortality. RESULTS: Nosocomial infection rates was 9.0 per 100 NICU admissions during the five-year period. Major sites of infection were bloodstream(32.3%), skin(18.4%), endotracheal tube(17.2%), and catheter(10.6%). The most common pathogen was S. aureus(29.9%). and the others were coagulase-negative staphylococci(CONS)(14.8%), Enterobacter(12.4%), and Candida(9.0%). During the five-year period, nosocomial infection rates increased from 9.5 to 11.6 per 100 admissions with the increase of CONS, Candida, Klebsiella, and Acinetobacter baumannii. The infection rate of S. aureus decreased. Multiple episodes of nosocomial infection occurred in 26.1% of all nosocomial infections. Overall bloodstream infection rates were 3.6 per 100 NICU admissions during five years. CONS(29.1%) and S. aureus(27.1%) were the two most common pathogens. Increasing rates of bloodstream infection by CONS, Candida, Klebsiella, and Acinetobacter baumannii were observed. Bloodstream infection related mortality was 11.9%. CONCLUSION: The predominant pathogens of nosocomial infection in NICU were S. aureus and CONS. Bloodstream infection, the most frequent nosocomial infection, should be a major focus of surveillance and prevention efforts in NICU.

Hematologic Findings of Toxemia Mothers and Their Babies / 대한주산의학회잡지

OBJECTIVE: Hematologic abnormalities in toxemia mothers and their babies have been documented. The purpose of this study was to explore the hematologic findings in mothers with toxemia and postnatal hematologic findings in their babies. The relationship of hematologic findings between toxemia mothers before delivery and their babies immediately after birth was also examined. METHODS: Forty-six pairs of singleton toxemia mothers and their babies born by C-section with 28 to 35 weeks of gestation from Jan. 1995 to Dec. 1999 were enrolled. Fifty pairs of singleton normotensive mothers and their babies with the same gestational period and delivery method were matched for control group. Blood samples of mothers were performed before delivery, and those of their babies, were done immediately after birth, day 3 and 7 of life. Hemoglobin(Hb) concentration, total white blood cell(WBC) count, absolute neutrophil count(ANC), and platelet count were examined. RESULTS: Toxemia mothers have significantly lower platelet count compared with controls(191,000+/-83,200/mm3 vs. 252,000+/-92,700/mm3, p<0.05). There were no difference between both groups in Hb, WBC and ANC. On the first day of life, Hb was significantly higher(16.97+/-2.36g/dL vs 14.32+/-1.5g/dL, p<0.05), but WBC, ANC and platelet count were significantly lower in babies born to toxemia mothers than those of control group(p<0.05 for all). In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life(16.97g/dL, 15.48g/dL, 14.61g/dL, p<0.05), however, WBC and platelet count were significantly decreased until the third day of life and then incresed until the seventh day of life(11,832/mm3, 8,334/mm3, 10,104/mm3 for WBC, p<0.05, and 152,220/mm3, 144,720/mm3, 214,090/mm3 for platelet, p<0.05, respectively). CONCLUSION: Hemoglobin concentration was significantly higher, whereas WBC, ANC and platelet were significantly lower in babies of toxemia mothers than those of control group. In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life, however, WBC and platelet count were significantly decresed until the third day and then increased until the seventh day of life. There was no relationship between hematologic findings of toxemia mothers and their babies.

Prevalence and Risk Factors of Candida Sepsis in Neonatal Intensive Care Unit

PURPOSE: With the development of neonatal intensive care and the increased use of systemic antibiotics, candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The purpose of this study was to investigate the prevalence rate and its associated risk factors. METHODS: We retrospectively reviewed medical records of 28 cases with candida sepsis who were admitted in the neonatal intensive care unit(NICU) of Chonnam University Hospital from July 1995 to June 2001. Twenty-nine patients without candida sepsis were enrolled for the control group to verify the risk factors. RESULTS: The overall incidence of candida sepsis was 0.61% for all NICU admissions and 3.68% for all very low birth weight infants with the gradual increase of the annual prevalance rate over time. The endotracheal intubation, percutaneous central vein catheter(PCVC), umbilical vein catheter, total parenteral nutrition, intralipid and dopamine were more applied than the control group (P<0.01 for all). The durations of mechanical ventilator care, central catheter appliance, nothing per os, and admission were also significantly longer than the control group(P<0.01 for all). Ampicillin/sulbactam, ceftazidime, amikacin, netilmicin, teicoplanin and imipenem/cilastatin were significantly more used than the control group(P<0.05). The durations of ampicillin/sulbactam, ceftazidime, netilmicin and imipenem/cilastatin administration were also proved to be significant as the risk factors(P<0.01). CONCLUSION: The average annual prevalence rate of candida sepsis in NICU for six years was 0.61% with gradual increasing tendency over time. The elimination of the above risk factors is important in decreasing neonatal morbidity and mortality associated with candida sepsis.

Growth and Neurodevelopmental Outcome at 15 Months of Corrected Age in Very Low Birth Weight Infants with Chronic Lung Disease

PURPOSE: This study was performed to compare the growth and neurodevelopmental outcome at 15 months of corrected age in very-low-birth weight infants between chronic lung disease(CLD) group and the control group. METHODS: Very-low-birth-weight infants who were admitted and survived in the NICU(neonatal intensive care units) of Chonnam Univeristy Hospital from Jan. 1997 to Jan. 2000 were divided into two groups, CLD group(n=55) and the control group(n=130). Physical assessment for body weight, length and head circumference, and neurologic examination were done at postconceptional 40 weeks, and then one to two months of interval until the baby reached 15 months of corrected age. Frequency of readmission and presence or absence of cerebral palsy were also examined. Statistical analysis was done between the two groups by SPSS program. RESULTS: Infants in the CLD group were lighter birth weight with shorter gestational age, and had more neonatal respiratory morbidity and higher readmission rate than that of the control group. Incidence of head growth below third percentile was significantly higher in CLD group, however when the comparison was done below the tenth percentile, there showed no difference between the two groups. Incidences of motor and language delay, and cerebral palsy were not different between the two groups, but the personal-social delay was higher in the CLD group. CONCLUSION: Incidences of head circumference below third percentile and of personal-social delay at 15 months of corrected age were significantly higher in CLD group than in the control group. But the incidence of cerebral palsy was not different.

Factors Influencing the Time to Full Enteral Feeding in Very Low Birth Weight Infants

PURPOSE: We investigated the factors influencing the time to reach full enteral feeding in very low birth weight infants. We compared the days of life to start tube or oral feeding, to regain birth weight, and to establish full enteral feeding in very low birth weight infants and determined the risk factors delaying full enteral feeding. METHODS: We reviewed the medical records of 214 newborn infants less than 1,500 g at birth, who were delivered at Chonnam National University Hospital from January 1, 1997 to May 31, 2000. These infants were divided into three groups by birth weight (less than 1,000 g, 1,000-1,249 g, and 1,250-1,499 g). Gestational age, birth weight, the days of life to start first tube or oral feeding, to regain bith weight and to reach full enteral feeding, and the possible risk factors delaying the progress of enteral feeding were analyzed. RESULTS: The gestational age was 29.69+/-2.33 weeks and the birth weight was 1,212+/-194.3 g. The time to start tube or oral feeding, to regain birth weight, and to establish full enteral feeding were significantly later and longer in the lower birth weight group. The time to reach full enteral feeding was related to the duration of mechanical ventilation and oxygen therapy, and was significantly longer in the infants with severe respiratory distress syndrome (RDS), chronic lung disease (CLD), apnea, intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, sepsis/disseminated intravascular coagulopathy, ricketts, and total parenteral nutrition. CONCLUSION: The time to reach full enteral feeding was inversely related to the birth weight, and the risk factors for delayed full enteral feeding were the presence and/or the severity of diseases related to the prematurity such as the duration of mechanical ventilation and oxygen therapy, RDS, CLD, apnea, IVH, and sepsis.

Effects of Percutaneous Central Venous Catheterization in very Low Birth Weight Infants

PURPOSE: The present study was aimed to investigate the clinical effects of percutaneous central venous catheterization (PCVC) such as frequency of venipuncture, duration of fluid therapy and changes of weight gain in very low birth weight infants. METHODS: The subjects were 70 very low birth weight infants, weighing from 1,000 to 1,500 g, hospitalized in the neonatal intensive care unit at Chonnam University Hospital during the period from January 1998 to December 1999. The control group of 35 infants was subjected to a conventional peripheral venipuncture during the first one year, and the study group of 35 infants used PCVC during the later one year. Data were analyzed using repeated measures of GLM and Student' t-test in SAS program. RESULTS: The frequency of venipuncture was significantly lower in PCVC group than in the control (P=0.0001). Duration of total parenteral nutrition was significantly longer in PCVC group than in the control (P=0.03). The weight gain after the initial weight loss was significantly greater in PCVC group than in the control (P=0.009). CONCLUSION: It is suggested that PCVC may reduce the stress of repeated venipucture. In addition, PCVC may keep the parenteral nutrition longer and may enhance the weight gain in very low birth weight infants.

Effects of Dexamethasone Treatment on Blood Pressure in Preterm Infants with Chronic Lung Disease (CLD)

PURPOSE: This study was designed to see the BP changes according to the time course and the duration of dexamethasone (DXM) therapy in premature infants with chronic lung disease (CLD). METHODS: We studied 27 chronic lung disease patients treated with DXM in NICU, Chonnam University Hospital from January 1994 to May 1998. Systolic, diastolic, and mean arterial pressure were recorded at three times (8 AM, 4 PM, midnight) daily. Data were analyzed by time peroid : Pre DXM means 14 days before DXM therapy, DXM during the therapy and Post DXM 14 days after the completion of therapy. Of 27 patients, 16 received short-course (7 days), and 11 long-course therapy (42 days). RESULTS: Mean gestational age of the patients was 29.3 (+/-1.5) weeks and the mean birth weight was 1,169 (+/-262) gm. Systolic, diastolic and mean BP were significantly increased during the DXM therapy compared to pre DXM (76+/-7 mmHg vs 67+/-9 mmHg, P<0.001, 44+/-6 mmHg vs 38+/-6 mmHg, P<0.001, 55+/-6 mmHg vs 49+/-7 mmHg, P<0.001, respectively). Even 14 days after the completion of therapy, systolic, diastolic and mean BP were not decreased to the level of pre DXM therapy. The maximal increase of BP was noted on the second day of treatment. When the BP changes were compared according to the duration of therapy, post DXM BP was decreased to the level of pre DXM in short course, but not in long course group with the higher post DXM systolic BP than that of short course group (78+/-11 mmHg vs 69+/-7 mmHg, P<0.05). CONCLUSION: BP significantly increased during DXM therapy, particularily on the second day of treatment. Also our result suggests that we have to watch the BP carefully more than two weeks after the completion of therapy.

A Study on the Prediction of Neurodevelopmental Outcome by Cranial Ultrasound in Preterm and Low Birth Weight Infants

PURPOSE: Recent progress in neonatal medicine increased the survival of preterm low birth weight infants. However, neurodevelopmental sequelae are ever increasing. We carried out this study to determine whether serial cranial ultrasonographic findings could predict neurodevelopmental outcome. METHODS: Four hundred and forty-one preterm low birth weight infants, who were admitted to the Neonatal Intensive Care Unit of Chonnam University Hospital from Jan. 1996 to Dec. 1998, were enrolled in this study. Infants were allocated to one of four groups, according to their ultrasonographic findings. Cases were included in group I when they showed normal ultrasound scans or their periventricular echogenicity was equal to choroid plexus(n=232); in group II, subependymal hemorrhage, intraventricular hemorrhage without ventricular dilatation(n=146); in Group III, intraventricular hemorrhage with ventricular dilatation or perivemtricular echogenicity-3 (n=48); in Group IV, bilateral cystic Periventricular leukomalacia(PVL)(n=15). In these four groups, correlation among the incidence of cerebral palsy and neurodevelopmental abnormalities, cranial ultrasonographic findings, and other perinatal parameters were evaluated by ANOVA test, chi- square test, and logistic regression analysis. RESULTS: The incidence of cerebral palsy was remarkably high in group IV(86.6%) and half of them showed a combination of other developmental abnormalities. The significant predictors of cerebral palsy were cystic PVL and duration of oxygen therapy. CONCLUSION: Cranial ultrasonographic findings could predict the development of cerebral palsy and other neurodevelopmental outcome in preterm low birth weight infants.

A Case of Kabuki Make-Up Syndrome

Kabuki make-up syndrome (KMS) was firstly reported in 1981 by Niikawa, et al. and Kuroki et al. in a total of ten unrelated Japanese children with characteristic array of multiple congenital anomalies and mental retardation. The name reflects the resemblance between the facial features of patients and the actors of Kabuki, one of the most famous traditional performing arts in Japan. The syndrome is characterized by mental and developmental retardations and peculiar facial features including long palpebral fissures with eversion of the lateral portion of lower eyelid and arching of eyebrows. In addition, dermatoglyphic and skeletal abnormalities are commonly associated. In Japan, the syndrome appears to have an incidence of about 1 : 32,000 newborns. Outside of Japan, a growing number of patients have been recognized. However, this syndrome has been reported only a few cases in Korea. We report a boy diagnosed by clinical features with a brief review of the literature.

Risk Factors and Prognosis of Bronchopulmonary Dysplasia

PURPOSE: The incidence of bronchopulmonary dysplasia(BPD) may further increase in the coming decade as advances in neonatal intensive care enable clinicians to save even smaller, younger and more critically ill infants. The purpose of this study was to evaluate risk factors and prognosis associated with BPD in premature infants. METHODS: The retrospective review on RDS infants admitted to the neonatal intensive care units at the Chonnam University Hospital was done from Jan. 1995 to July. 1997. These infants were divided into two groups, BPD group(n=25) and non-BPD group(n= 112). The incidence, risk factors and therapeutic results of BPD were analyzed. RESULTS: Infants in the BPD group had lower birth weight, gestational age, and lower 1 min Apgar score compared to that of infants in the control group. The incidence of BPD was 18.2Yo and was higher in male infants. Longer duration of oxygen, ventilatory support and higher PIP were noted in the BPD group. There were no significant differences between the two groups concerning duration of postnatal requirement of oxygen supplementation, ventilatory support, and ventilatory parameters such as FiO2 and PEEP. The incidences of PDA and pneumothorax mean fluid volume and weight loss were similar in two groups. Frequent episodes of respiratory infection occurred(31.6%) in BPD group and one patient expired during 6 to 12 month follow up. 22 infants(88%) received dexamethasone in BPD group. Side effects of dexamethasone including hypertension and hyperglycemia occurred in 59.1% and 31.8%, respectively. CONCLUSION: The overall incidence of BPD was 18.2% and the risk factors for BPD included lower birth weight and gestational age, lower Apgar score at 1 minute, longer duration of oxygen and ventilatory support with higher PIP.

Retinopathy of Prematurity and Perinatal Risk Factors

PURPOSE: The incidence of retinopathy of prematurity(ROP) which is one of the most common cause of childhood blindness has not decreased despite the restricted use of oxygen. There may be other factors responsible for ROP which could not be explained solely by improved survival of very low birth weight infants. We tried to clarify perinatal risk factors that are nrelated to the occurrence of ROP. METHODS: We enrolled 239 infants with gestational ages less than 33 wks or with birth weight less than 1,800 gm who had received ophthalrnologic examination between Jan. 1995 and Dec. 1997. The patients were categorized into two groups,' "No ROP" group as control(n=185) and ROP group as study population(n=54), and we compared the perinatal risk factors between the two. RESULTS: 54(22.6%) out of 239 infants were diagnosed as having ROP. The annual incidence of ROP decreased but the incidence of treated ROP increased. The incidence of ROP decreased with longer gestation and higher birth weight. Mean gestational age was 30.3 weeks in the study group vs 31.0 weeks in the control group, and mean birth weight was 1,390 gm and 1,586 gm, respectively. Significant factors contributing to increased incidence of ROP included: duration of oxygen therapy, ventilator therapy, total parenteral nutrition and hospitalization, frequency of hyperoxia, hypercarbia, and transfusion and respiratory distress syndrome, umbilical artery catheterization, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, use of dexamethasone and aminophylline, pneumonia, air leak syndrome, and hyperglycemia. The incidence of ROP and treated ROP was not influenced by the mode of surfactant treatment(prophylactic vs rescue) in RDS patients and the mode of dexamethasone treatment(short vs long) in BPD patients. CONCLUSION: The risk factors for retinopathy of prematurity included gestational age, birth weight and duration of oxygen, as well as other aforementioned perinatal factors. The occurrence of ROP can be decreased by preventing preterm birth, minimizing the use of oxygen, and further morbidity can be prevented by performing proper ophthalmologic examination and doing an appropriate follow-up.

Changes of neonatal mortality rate between 'pre' and 'post' surfactant period

The objective of this study was to determine how the neonatal mortality rate has changed since surfactant (S) therapy was introduced in our Neonatal Intensive Care Unit (NICU), and to evaluate the efficacy of surfactant therapy in respiratory distress syndrome (RDS) patients. Incidences of risk babies such as outborns, prematurity, low birth weight infants and RDS, and neonatal mortality rates were compared between 'pre' (control, 1988 to 1991, n=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients of 'post' S period, neonatal mortality rate was compared between S-treated and non-treated patients, and chest X-ray and ventilatory parameters were compared between pre- and post-72 hr of surfactant treatment. Surfactant therapy showed short term effects, judging by the decrease of early neonatal deaths and improvement of chest X-ray and ventilatory parameters in RDS patients. The overall neonatal mortality rate had a tendency to decrease in spite of increased incidences of risk babies in 'post' S period but it was less than expected. The reasons were thought to be that we had a high proportion of risk babies, and there was some bias in patient selection for surfactant therapy and its use. In conclusion, with the active prevention of risk baby delivery and appropriate use of surfactant, better results could be expected.

Prognostic Implication of MDR1 (Multidrug Resistance) Gene Expression in Childhood Acute Leukemia / 대한혈액학회지

BACKGROUND: The most important mechanism of drug resistance is related to the overexpression of P-glycoprotein which is encoded by the MDR1 gene. The expression of MDR1 and its clinical implication in childhood leukemias has not been extensively assessed. METHODS: To evaluate the expression of MDR1 gene and its prognostic implication on the remission induction rate, relapse rate and survival, we assayed MDR1 mRNA by reverse-transcriptase polymerase chain reaction (RT-PCR) from bone marrow samples of 23 childhood ALL and 17 AML patients. The prognostic factors were analyzed by logistic regression and Cox proportional hazards model. RESULTS: mdr1 mRNA was expressed in 51.5% of patients at diagnosis. MDR1 status did not influence the remission induction rate both in ALL and AML. The relapse rate was significantly higher in MDR1 positive patients than in negative patients (29.4% vs. 0.0%, P= 0.04). The cumulative relapse probability at 2 year was 60% vs 0% according to MDR1 status (P=0.006), suggesting the importance of MDR1 in the mechanism of relapse for childhood leukemias. The Kaplan-Meier 3-yr event-free survival (EFS) was 42.7% for MDR1 positive group, and 93.8% for negative patients (P=0.046). Analyses of prognostic factors showed that mdr1 mRNA expression was the sole prognostic factor predicting the poor EFS (X2, 6.217; P=0.013). CONCLUSION: These results suggest that RT-PCR for mdr1 mRNA expression is a readily feasible and useful method of assessing multidrug resistance. The expression of MDR1 was found to be the most important prognostic factor predicting the possibility of relapse and EFS in patients with childhood leukemia.

Prognostic Implication of MDR1 (Multidrug Resistance) Gene Expression in Childhood Acute Leukemia / 대한혈액학회지

BACKGROUND: The most important mechanism of drug resistance is related to the over-expression of P-glycoprotein which is encoded by the MDR1 gene. The expression of MDR1 and its clinical implication in childhood leukemias has not been extensively assessed. METHODS: To evaluate the expression of MDR1 gene and its prognostic implication on the remission induction rate, relapse rate and survival, we assayed mdr1 mRNA by reverse-transcriptase polymerase chain reaction (RT-PCR) from bone marrow samples of 23 childhood ALL and 17 AML patients. The prognostic factors were analyzed by logistic regression and Cox proportional hazards model. RESULTS: mdr1 mRNA was expressed in 51.5% of patients at diagnosis. MDR1 status did not influence the remission induction rate both in ALL and AML. The relapse rate was significantly higher in MDR1 positive patients than in negative patients (29.4% vs. 0.0%, p=0.04). The cumulative relapse probability at 2 year was 60% vs 0% according to MDR1 status (p=0.006), suggesting the importance of MDR1 in the mechanism of relapse for childhood leukemias. The Kaplan-Meier 3-yr event-free survival (EFS) was 42.7% for MDR1 positive group, and 93.8% for negative patients (p=0.046). Analyses of prognostic factors showed that mdr1 mRNA expression was the sole prognostic factor predicting the poor EFS(X 2, 6.217; p=0.013). CONCLUSION: These results suggest that RT-PCR for mdr1 mRNA expression is a readily feasible and useful method of assessing multidrug resistance. The expression of MDR1 was found to be the most important prognostic factor predicting the possibility of relapse and EFS in patients with childhood leukemia.