Early Onset Hyperkalemia in Very Low Birth Weight Infants

PURPOSE:This study was designed to know the clinical significance and risk factors of hyperkalemia in very low birth weight infants (VLBWI). METHODS:We compared the incidence of hyperkalemia and its associated ECG abnormalities and mortality rate according to birth weight (102 of less than 1,000 g vs. 328 of 1,000 to 1,500 g) in 430 VLBWI who were born from Jan. 2000 to July 2004, retrospectively, and also compared the several parameter according to serum potassium (35 of hyperkalemia vs. 11 of normokalemia) in 49 selected VLBWI who need mechanical ventilation for respiratory distress without oliguria within 72 hours of life to know the risk factors of hyperkalemia. RESULTS:Overall incidence of hyperkalemia in VLBWI was 21.1%, and was significantly higher in below 1,000 g than in 1,000 to 1,500 g (32.4% vs. 17.7%, P<0.05). Hyperkalemia associated ECG abnormalities, life-threatening cardiac arrhythmia, and death were also significantly higher in below 1,000 g. There were no significant differences in maternal or infant's characteristics, laboratory findings and clinical conditions between hyperkalemic vs. normokalemic group. The incidence of cardiac arrhythmia and mortality rate were also significantly higher in hyperkalemic group. CONCLUSION:Early onset nonoliguric hyperkalemia is often associated with life- threatening cardiac arrhythmia and death in VLBWI, especially less than 1,000 g. Although perinatal risk factors were not found in this study, prospective study is needed to establish the preventive strategy and to improve the outcome.

Management of Newborns of Mothers with the Premature Rupture of Membranes / 대한주산의학회잡지

OBJECTIVE: This clinical study was carried out to evaluate the effect of premature rupture of the membranes (PROM) on neonatal sepsis in infants who were delivered more than 35 weeks of gestational age (GA). METHODS: Clinical data were collected from 125 newborns of mothers with PROM who were delivered more than 35 weeks of GA at Chonnam National University Hospital during the five-year period from January 1998 to December 2002. RESULTS: The incidence of PROM was 15.4% with little yearly variations and PROM in which GA more than 35 weeks was 3.5%. The incidence of positive C-reactive protein (CRP), neonatal fever and neonatal sepsis were not increased but the neonatal use of antibiotics was increased in relation to the duration of the PROM. In the patients with neonatal sepsis, positive CRP rate and incidence of neonatal and maternal fever were significantly high, and use of maternal antibiotics was significantly low. CONCLUSION: When the newborns of mothers with PROM were delivered more than 35 weeks of GA, maternal history of fever or antibiotic treatment and neonatal history of fever, blood culture and CRP should be checked regardless of duration of PROM, and then begin to start antibiotics according to the baby's clinical signs and symptoms.

Two Cases of Severe Neonatal Anemia associated with Massive Feto-Maternal Hemorrhage / 대한주산의학회잡지

Feto-maternal hemorrhage, the presence of fetal red blood cells in the maternal circulation, occurs in up to 75% of pregnancies. But its volume is usually very small. Feto-maternal hemorrhage of more than 30 ml of whole blood is relatively rare. The key features that lead to early diagnosis are the maternal history, fetal monitoring, the clinical and laboratory findings of anemia and a negative Coombs' test. Diagnosis is confirmed by Kleihauer-Betke test. Perinatal problems include fetal distress, neonatal anemia, hypovolemic shock, and death. The fetal outcome depends on the amount and rate of bleeding. The initial hemoglobin level was a better predictor than the volume of bleeding. We present two cases of severe neonatal anemia associated with massive feto-maternal hemorrhage, which was confirmed by Kleihauer-Betke test.

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.

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.