Serum Enzymes in Predicting the Severity of Meconium Aspiration Syndrome in Newborn / 대한주산의학회잡지

PURPOSE: Meconium aspiration syndrome (MAS), often progresses to respiratory failure and its' serious complication, persistent pulmonary hypertension of the newborn (PPHN) is a major cause of neonatal mortality. Early recognition of infants at the risk for respiratory failure in MAS patients is necessary for treatment. So we aimed to identify serum enzymes such as lactate dehydrogenase (LDH), aspartate transaminase (AST), and alanine transaminase (ALT) as serum biologic marker for early detection of respiratory failure in MAS patients. METHODS: Infants admitted within 24 hours after birth to Neonatal Intensive Care Unit of Dongguk University Ilsan Hospital and diagnosed with MAS from August 2005 to March 2014 were analyzed retrospectively. Serum enzymes were measured on admission. RESULTS: Of the total 60 patients diagnosed with MAS, 28 were in the positive pressure ventilation (PPV) group and 32 were in the non-PPV group. Six patients progressed to PPHN. Only serum LDH was significantly higher in the PPV group than the non-PPV group (median 1,123 vs. 831, P =0.01). Using the ROC curves, the cut-off value of 964 U/L for LDH offered the best predictive value for PPV requirement (sensitivity 61% and specificity 81%). Serum LDH was significantly higher in MAS with PPHN group than MAS without PPHN group (median 1,791 vs. 904, P =0.013). But serum AST, ALT were not predicting factor for the requirement of respiratory support and development of PPHN among MAS patients. CONCLUSION: LDH might be a good predicting factor for the requirement of respiratory support and development of PPHN among MAS patients.

Development of Immune Reaction Concept for Perinatology / 대한주산의학회잡지

Most of perinatological phenomenona and diseases are closely related with immune reaction. Most of initial immune responses occur through innate immunity and most causes, such as mechanical damage, hypoxia, and hyperoxia, are self and microorganisms are non-self, all of which are related with immune reaction concept. However, researches on perinatology are mainly focused on specific one or two causes of perinatal diseases, so often there is limitation to understand the basic concepts and phenomenona of the perinatal diseases. Through understanding of immune reaction concept, we can apply immune reaction theory to researches in perinatology and we can understand phenomenona in perinatology through knowledge of immune reaction. Therefore it is essential to understand historical development of immunology and concept of immune reaction for researches and treatment of perinatology.

Serum Enzymes in Predicting Transient Tachypnea of Newborn and Respiratory Distress Syndrome / 대한주산의학회잡지

PURPOSE: Perinatal asphyxia is a major factor correlated with diseases that cause respiratory distress in a neonate. So we aimed to investigate the relationship between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) with plasma biological markers of perinatal asphyxia in full-term neonates. METHODS: Full-term neonates with transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) who were admitted within 24 hours after birth were enrolled in a study group. And control group are infants with premature rupture of amniotic membrane without significant findings. Serum lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK) and myoglobin were measured at admission. RESULTS: Of the total 80 infants, 54 were of the study group and 26 were of the control group. The numbers of RDS and TTN groups were 27 and 27, and the numbers of RDS with hypoxic-ischemic encephalopathy (HIE) and RDS without HIE were 6 and 21 retrospectively. Serum AST, ALT, LDH and CK were significantly higher in the study group than the control group (P<0.05). When RDS group and TTN group were compared AST and LDH were significantly higher in RDS group than TTN group (P<0.05). Serum AST, ALT and LDH were significantly higher in RDS with HIE group than RDS without HIE group (P<0.05). A prediction of RDS by LDH analysis showed good correlation by receiver operating characteristic curve (P<0.05). A cut off level of 720 IU/L for LDH was the best predictor of RDS (sensitivity 63% and specificity 86%). CONCLUSION: LDH is an excellent predictor to differentiate RDS from TTN soon after birth in full-term neonates with respiratory distress.

Association with Ductus Arteriosus Closure by Ibuprofen and Intrauterine Inflammation in Very Low Birth Weight Infants / 대한주산의학회잡지

PURPOSE: Ibuprofen is an inhibitor of prostaglandin synthesis and used to close a patent ductus arteriosus (PDA) of preterm infants. This study investigated the association between the response to ibuprofen treatment for PDA and maternal intrauterine inflammation in preterm infants. METHODS: We retrospectively reviewed the medical records of very low birth weight (VLBW) infants diagnosed with PDA, who are admitted immediately after birth in the neonatal intensive care unit at Dongguk University Ilsan Hospital between March 2010 and May 2013. After the first cycle of ibuprofen therapy, infants whose ductus arteriosus was closed and not closed were classified as Responders and Non-responders I, respectively. After the second cycle of ibuprofen therapy, infants with persistent PDA were classified as Non-responders II. We performed multiple logistic regression analysis to determine the most important factor associated with persistent PDA. RESULTS: After the first cycle of ibuprofen therapy, the numbers of Responders and Non-responders I were 40 and 14, respectively. Rate of cesarean section was significantly lower in Non-responders I than that of Responders (P=0.023). In addition, Rate of maternal amnionitis in Non-responder I was significantly higher than that of Responders (P=0.016). By multiple logistic regression analysis, maternal amnionitis was found to be a significant risk factor of the failure of ductus arteriosus closure after the first cycle of ibuprofen treatment (P=0.039). CONCLUSION: The present study shows that maternal amnionitis is an independent risk factor for the treatment failure after the first cycle of ibuprofen therapy in VLBW infants with PDA.

Risk Factors and Prognosis of Early Onset Thrombocytopenia in Extremely Low Birth Weight Infants / 대한주산의학회잡지

PURPOSE: Thrombocytopenia, which is common in neonatal intensive care unit (NICU), is most common among extremely low birth weight (ELBW) neonates despite recent improvement in survival of ELBW neonates. However, study of thrombocytopenia in ELBW neonates is rare and has not been studied in Korea. So we sought to determine the incidence, timing, causes, and outcome of thrombocytopenia among ELBW neonates. METHODS: We retrospectively reviewed the medical records of preterm infants with gestational age <32 weeks and birth weight <1,000 g who were admitted immediately after birth to the NICU at Dongguk University Ilsan Hospital between January 2006 and December 2010. Thrombocytopenia was defined as platelet count < or =150x109/L. The infants who had early onset thrombocytopenia comprised the study group, while remainder of infants made up the control group. The relationships between early onset thrombocytopenia and the outcomes were studied. RESULTS: Of the 88, 82 (93.2%) had one or more platelet count < or =150x10(9)/L. Most were detected during the early days of life. Early onset thrombocytopenia is more common among the smallest patients and associated with respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH), which occurs few days after birth. The mortality rate was higher in study group than control group. Almost half of patients, the cause of the thrombocytopenia went undiagnosed. CONCLUSION: We observed high incidence of thrombocytopenia among ELBW neonates. Early onset thrombocytopenia was associated with RDS, IVH and high mortality. New efforts to improve the outcome of ELBW neonates should focus on this common problem of thrombocytopenia.

PHACE association with intracranial, oropharyngeal hemangiomas, and an atypical patent ductus arteriosus arising from the tortuous left subclavian artery in a premature infant / 소아과

PHACE association is a rare neurocutaneous condition in which facial hemangiomas associate with a spectrum of posterior fossa malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, and eye anomalies. We reported a case of PHACE association in a premature infant showing facial, intracranial, and oropharyngeal hemangiomas with evidence of the Dandy-Walker variant and complicated cardiovascular anomalies, including a right-sided aortic arch and an atypical patent ductus arteriosus arising from a tortuous left subclavian artery. To our knowledge, intracranial hemangiomas are rare in PHACE association, and a concomitant oropharyngeal hemangioma has not been previously reported in the PHACE association literature. In infants presenting with large, plaque-like facial hemangiomas, it is important to conduct active cardiovascular and neurological evaluations. Special attention should be given to the laryngoscopic examination to search for additional hemangiomas in the airway.

Analysis of Palivizumab Prophylaxis in Patients with Acute Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus / 소아감염

PURPOSE: The aim of this study was to identify the clinical characteristics of lower respiratory tract infection due to respiratory syncytial virus (RSV) in young children and to provide information for an effective guideline for palivizumab administration in Korea. METHODS: We reviewed medical charts of 167 patients under 3 years of age who were hospitalized in Dongguk University Ilsan Hospital for lower respiratory tract infection between January 2007 and February 2011. Diagnosis of the virus was made based on the multiplex real time polymerase chain reaction. RESULTS: There were 113 patients who were infected by respiratory syncytial virus. 90 patients were term infants and 23 patients were preterm infants. No difference was shown between term and preterm infants except the days of admission which was 9.0+/-6.0 days and 12.6+/-21.0 days respectively. In the preterm group their mean age at the time of admission was 5.21+/-4.9 months and the mean gestational age was 33.1+/-4.3 weeks, and the mean birth weight was 2,152+/-950 g. Only 4 patients were born under 28 weeks gestational age and were candidates for palivizumab administration. CONCLUSION: Most of the patients with severe RSV lower respiratory tract infection were term or near term infants who were not candidates for palivizumab prophylaxis. A nationwide study is needed to make a new risk stratified guideline for RSV prophylaxis for our country.

Coinfection of hepatitis A virus genotype IA and IIIA complicated with autoimmune hemolytic anemia, prolonged cholestasis, and false-positive immunoglobulin M anti-hepatitis E virus: a case report / 대한간학회지

A 37-year-old male presented with fever and jaundice was diagnosed as hepatitis A complicated with progressive cholestasis and severe autoimmune hemolytic anemia. He was treated with high-dose prednisolone (1.5 mg/kg), and eventually recovered. His initial serum contained genotype IA hepatitis A virus (HAV), which was subsequently replaced by genotype IIIA HAV. Moreover, at the time of development of hemolytic anemia, he became positive for immunoglobulin M (IgM) anti-hepatitis E virus (HEV). We detected HAV antigens in the liver biopsy specimen, while we detected neither HEV antigen in the liver nor HEV RNA in his serum. This is the first report of hepatitis A coinfected with two different genotypes manifesting with autoimmune hemolytic anemia, prolonged cholestasis, and false-positive IgM anti-HEV.

Comparison between Conventional 4 L Polyethylene Glycol and Combination of 2 L Polyethylene Glycol and Sodium Phosphate Solution as Colonoscopy Preparation / 대한소화기학회지

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.

Influence of histologic chorioamnionitis and funisitis on the level of peripheral blood C-reactive protein at birth in preterm infants / 소아과

PURPOSE: The objective of this study is to determine the change of C-reactive protein (CRP) levels in the peripheral blood of preterm infants at birth according to the stage of intrauterine inflammation. METHODS: A total of 187 infants (<32 weeks of gestation) were divided into a "no histologic chorioamnionitis" [HCAM (-), n=85] group and a "histologic chorioamnionitis" [HCAM (+), n=102] group according to placental pathologic findings. Furthermore, the HCAM (+) group was subdivided into a "funisitis" [F (+), n=49] group and a "no funisitis" [F (-), n=53] group and also into a "funisitis/amnionitis" [FA (+), n=58] group and an "isolated chorio-deciduitis" [FA (-), n=44] group. High-sensitivity CRP levels in the peripheral blood at birth were measured. RESULTS: Peripheral blood CRP levels were significantly higher in the HCAM (+), F (+), F (-), and FA (+) groups than in the HCAM (-) group, but were not significantly different between the FA (-) and HCAM (-) groups. In addition, peripheral blood CRP levels were significantly higher in the F (+) and FA (+) groups than in the F (-) and FA (-) groups, respectively. For identification of amnionitis or funisitis, a cut-off value of 0.02 mg/dL was chosen. Clinical chorioamnionitis, proven early onset sepsis, histologic chorioamnionitis, and funisitis had higher incidences in infants with peripheral blood CRP levels higher than 0.02 mg/dL. CONCLUSION: The present study shows that peripheral blood CRP levels at birth in preterm infants born before 32 weeks' gestation is significantly increased in amnionitis or funisitis and might reflect the progress of histologic chorioamnionitis.

Comparison of the Clinical Performance between Two Pulse Oximeters in NICU: Nellcor N-595(R) versus Masimo SET(R)

PURPOSE: Numerous false alarms by pulse oximetry, which is widely used in neonatal intensive care unit, can delay response to true alarms. Masimo SET(R) was introduced lately, to overcome false alarms by motion. We compared the clinical performance of two devices (Nellcor N-595(R) and Masimo SET(R)) for the evaluation of the false alarm frequency during usual motion artifacts and stable state. METHODS: A total of 20 preterm infants weighing 1,000-2,500 g were enrolled in the study. The sensors of two devices were placed on the different feet on the same infants, and both devices were programmed to emit an alarm for episode of hypoxemia (SpO2< or =85%). The false alarms were defined as episodes of poor correlation with ECG heart rate, poor waveforms, and the absence of obvious signs of hypoxia. We compared the frequency of false alarms between the two devices. RESULTS: The mean chronological age was 20.8 days and the mean body weight was 1,668 g on the study day. The frequency of total false alarm was significantly fewer for Masimo SET(R) pulse oximetry (48 in Nellcor N-595(R), 27 in Masimo SET(R)) although the false alarm during usual motion artifacts was not significantly between two devices (32 in Nellcor N-595(R), 19 in Masimo SET(R)). CONCLUSION: The Masimo SET(R) pulse oximetry has fewer false alarm rates and identified more true hypoxic events than Nellcor N-595(R) pulse oximetry. Therefore, it is useful for adequate oxygen therapy and helps to decrease unnecessary handling by clinicians and nurses.

Comparison of the Clinical Performance between Two Pulse Oximeters in NICU: Nellcor N-595(R) versus Masimo SET(R)

PURPOSE: Numerous false alarms by pulse oximetry, which is widely used in neonatal intensive care unit, can delay response to true alarms. Masimo SET(R) was introduced lately, to overcome false alarms by motion. We compared the clinical performance of two devices (Nellcor N-595(R) and Masimo SET(R)) for the evaluation of the false alarm frequency during usual motion artifacts and stable state. METHODS: A total of 20 preterm infants weighing 1,000-2,500 g were enrolled in the study. The sensors of two devices were placed on the different feet on the same infants, and both devices were programmed to emit an alarm for episode of hypoxemia (SpO2< or =85%). The false alarms were defined as episodes of poor correlation with ECG heart rate, poor waveforms, and the absence of obvious signs of hypoxia. We compared the frequency of false alarms between the two devices. RESULTS: The mean chronological age was 20.8 days and the mean body weight was 1,668 g on the study day. The frequency of total false alarm was significantly fewer for Masimo SET(R) pulse oximetry (48 in Nellcor N-595(R), 27 in Masimo SET(R)) although the false alarm during usual motion artifacts was not significantly between two devices (32 in Nellcor N-595(R), 19 in Masimo SET(R)). CONCLUSION: The Masimo SET(R) pulse oximetry has fewer false alarm rates and identified more true hypoxic events than Nellcor N-595(R) pulse oximetry. Therefore, it is useful for adequate oxygen therapy and helps to decrease unnecessary handling by clinicians and nurses.

Sorafenib-Induced Interstitial Pneumonitis in a Patient with Hepatocellular Carcinoma: A Case Report

Sorafenib is an oral multikinase inhibitor that has shown a survival benefit in patients with advanced hepatocellular carcinoma, and is considered to be generally safe. We treated a patient with interstitial lung disease that was associated with sorafenib therapy for the treatment of advanced hepatocellular carcinoma. A 74-year-old man with hepatitis-C-virus-related hepatocellular carcinoma was treated with sorafenib. After 8 days of sorafenib administration, he received radiation therapy for an intrahepatic tumor located in segment eight. On the 24th day of sorafenib treatment, the patient developed acute interstitial pneumonitis that rapidly improved after the discontinuation of sorafenib and treatment with high-dose steroids. This case alerts physicians to the possibility of sorafenib-induced interstitial lung disease.

Efficacy and predictors of the virologic response to entecavir therapy in nucleoside-naive patients with chronic hepatitis B / 대한간학회지

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy and the predictors of entecavir treatment in nucleoside-naive chronic hepatitis B patients. METHODS: A total of 160 patients treated with entecavir (0.5 mg daily) for at least 24 weeks were consecutively enrolled. The virologic response (HBV DNA1 log10 copies/mL increase in HBV DNA level above nadir on two consecutive occasions) were retrospectively analyzed. RESULTS: The mean follow-up duration was 58.8 weeks, and 85 patients (53.1%) showed HBeAg positivity. The median pretreatment levels of serum ALT and HBV DNA were 99 IU/L and 7.6 log10 copies/mL, respectively. The cumulative rates at 12, 24, 48, and 72 weeks were 37.5%, 68.1%, 87.4%, and 95.8%, respectively, for the virologic response; 40.0%, 66.2%, 84.5%, and 92.7% for the biochemical response; 10.6%, 18.8%, 27.0%, and 34.5% for HBeAg loss; and 3.5%, 7.1%, 9.0%, and 13.2% for HBeAg seroconversion. There was no case of virologic breakthrough. An absence of HBeAg and a low serum HBV DNA level (<8 log10 copies/mL) at baseline were significant predictors of the virologic response in a multivariate analysis (P<0.01). CONCLUSIONS: Entecavir therapy showed excellent efficacy in nucleoside-naive chronic hepatitis B patients. The predictors of a virologic response were an absence of HBeAg and a low baseline HBV DNA level.

AIDS presenting with severe thrombocytopenia: A case report / 대한내과학회지

The hematologic manifestations of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are common and may cause symptoms that are life threatening and impair the quality of life in these patients1). The most important of these manifestations is cytopenia. Among cytopenias, thrombocytopenia is caused by immune-mediated destruction of platelets, in addition to inadequate platelet production2). Thrombocytopenia has been reported in 5~15% of HIV-seropositive patients3). Profound thrombocytopenia (< 20,000/mm3) is rare (occurs in only 1.5% of cases) and presents only during advanced AIDS. With the exception of thrombocytopenia associated with advanced AIDS, severe thrombocytopenia in AIDS patients is extremely rare3). There are only a few reports of AIDS patients who first presented with severe thrombocytopenia. Here we report the case study of an AIDS patient who first presented with severe thrombocytopenia, mild abdominal distension, and edema in both lower legs. A brief review of the relevant literature is also presented.

AIDS presenting with severe thrombocytopenia: A case report / 대한내과학회지

The hematologic manifestations of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are common and may cause symptoms that are life threatening and impair the quality of life in these patients1). The most important of these manifestations is cytopenia. Among cytopenias, thrombocytopenia is caused by immune-mediated destruction of platelets, in addition to inadequate platelet production2). Thrombocytopenia has been reported in 5~15% of HIV-seropositive patients3). Profound thrombocytopenia (< 20,000/mm3) is rare (occurs in only 1.5% of cases) and presents only during advanced AIDS. With the exception of thrombocytopenia associated with advanced AIDS, severe thrombocytopenia in AIDS patients is extremely rare3). There are only a few reports of AIDS patients who first presented with severe thrombocytopenia. Here we report the case study of an AIDS patient who first presented with severe thrombocytopenia, mild abdominal distension, and edema in both lower legs. A brief review of the relevant literature is also presented.

Comparison of Outcomes According to the Hospitals of Antenatal Care in Very Low Birth Weight Infants

PURPOSE: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. RESULTS: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score (< or =3) was lower in the immediate group than the delayed group. CONCLUSION: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.

Genetic Variation in the Immunoregulatory Gene of Adenovirus Type 3 / 소아감염

PURPOSE: Various proteins encoded in the early region 3 (E3) of adenoviruses protect cells from being killed by cytotoxic T cells and death-inducing cytokines. We sought to find out whether the genetic heterogeneity of the E3 gene might contribute to the molecular diversity of adenoviruses. METHODS: Sequences in the E3 region were analyzed for 14 adenovirus type 3 (Ad3) strains that were isolated from children with lower respiratory tract infections in the Seoul National University Children's Hospital during the period 1991-2000. Full-length adenoviral DNA was purified from the infected A549 cell lysates using a modified Hirt procedure. RESULTS: There was 98% homology between 14 Korean Ad3 strains with a reference strain (M15952). Homology within the Korean Ad3 strains was 98.7%. Variation was found in the region of transcripts 20.1 kDa, 20.6 kDa, truncated 7.7 kDa, 10.3 kDa, 14.9 kDa, and 15.3 kDa. In particular, all 14 Korean strains showed a missense single point mutation at the start codon of the truncated 7.7 kDa. In addition, a deletion was found in the truncated 7.7 kDa region by 58 base pairs in 10 strains and 94 base pairs in 4 strains. Variations in amino acids were observed in the receptor internalization and degradation complex (10.3 kDa/14.9 kDa) which stimulates the clearance from the cell surface and subsequent degradation of the receptors for the Fas ligand and TRAIL, while no variations were observed in another immunoregulatory transcript, 19 kDa. CONCLUSION: Sequence analysis of the immunoregulatory region of adenovirus E3 shows that genetic heterogeneities are related to genome type patterns.

Analysis of Prenatal and Postnatal Factors Associated with Complications and Prognosis in Premature Infants with Leukemoid Reaction

PURPOSE: This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages 30,000/mm3. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. RESULTS: Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. CONCLUSION: Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.

An Outbreak of Scabies in Neurosurgery-Intensive Care Unit of a General Hospital / 병원감염관리

BACKGROUND: Scabies outbreaks have been reported in long-term care facilities, but less commonly in acute care facilities. We experienced an outbreak of scabies that occurred in neurosurgery-intensive care unit of a general hospital, Seoul, Korea. METHODS: An outbreak of scabies was noticed on September 2006 when hospital staffs of NICU were diagnosed with scabies. The infection control nurse reviewed medical records and interviewed all of patient in NICU and health care workers. The epidemic spread of scabies from a patient to other patient, hospital employees and their families and associates was identified from historical, clinical, and microbiologic skin preparation data. RESULTS: Forty-three NICU patients and 22 health care workers were investigated. Five scabies cases were identified in total of 42 cases who are exposed to index case with attack rate of 11.9%. The attack rate of scabies in health care workers and NICU patients were 10% and 13.6%, respectively. Tertiary cases also occurred among the family members of workers, with a tertiary attack rate of 44%. CONCLUSION: The patient of acute care facilities also have chances of being exposed to scabies outbreak, since sensorimotor deficits or cognitive disorders make it difficult for individuals to communicate and understand the implication of risky contacts.