Clinical Characteristics of Hospitalized Pediatric Patients with 2009 Novel Influenza A Infection / 소아알레르기및호흡기학회지

PURPOSE: Novel influenza H1N1 A virus developed pandemic infection, and patients requiring hospitalization have rapidly increased because of severe clinical symptoms and signs. We describe the clinical features of hospitalized pediatric patients with novel influenza virus infection. METHODS: We reviewed the medical charts of 128 pediatric patients under the age of 16 who were hospitalized in Dongguk University Ilsan Hospital between September 2009 and February 2010. We compared the clinical features of the pneumonia and non-pneumonia groups of patients, and analyzed clinical difference according to M. pneumoniae coinfection and severity of pneumonia. RESULTS: The male to female sex ratio of the subjects was 2.2:1, and the average age was 6.2 years. Sixty-five patients (50.8%) had pneumonia and their average age was 6.7 years. Variables including duration of admission, total WBC counts, neutrophil percentage and CRP were significantly different between the 2 groups, however, the other variables were not. The number of patients diagnosed with severe pneumonia was 20 (30.8%). M. pneumoniae coinfection occurred in 24.6% of patients in the pneumonia group, however, it did not influence the severity of pneumonia. Underlying asthma was more significantly associated with severe pneumonia than with mild pneumonia. There was no death case. CONCLUSION: In this study, 2009 novel influenza infection was more prevalent in school-age boys. M. pneumoniae coinfection occurred frequently, however, it did not seem to influence disease severity. Patients with underlying asthma tend to develop severe pneumonia more frequently.

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.

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.

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.