Short-term clinical outcomes of late preterm infants / 소아과

PURPOSE: To identify the short-term clinical outcomes of late preterm infants and to test the hypothesis that late preterm infants have more clinical problems during the early postnatal period than term infants. METHODS: One hundred late preterm infants [gestational age (GA) 34(+0)-36(+6) weeks] and the same number of term infants (GA 37(+0)-41(+6) weeks) were randomly selected from 289 late preterm infants and 825 term infants born in the Seoul National University Bundang Hospital between January 2007 and December 2007, and their electronic medical records were reviewed and analyzed. RESULTS: Compared to term infants, late preterm infants had significantly more medical problems such as temperature instability (odds ratio [OR] 8.7), hypoglycemia (OR 17.5), intravenous fluid infusion (OR 10.2), evaluation for sepsis (OR 9.4), respiratory problems (OR 7.5), apnea and bradycardia (OR 8.6), phototherapy for jaundice (OR 3.6), and feeding intolerance (OR 10.0). Hospital stay was also significantly longer in late preterm infants. CONCLUSION: Late preterm infants had significantly more medical problems and increased length of hospital stay compared to term infants. More attention should be given to caring for these late preterm infants in newborn nursery during the early postnatal period.

A Case of Congenital Intrahepatic Portosystemic Shunt Associated with VSD Detected by Antenatal Sonography and Treated with Four Coil Embolizations and Open Heart Surgery after Birth

A congenital portosystemic shunt is a very rare portosystemic vascular anomaly which leads to jaundice, hypoglycemia, hyperammonemia, liver cirrhosis, hepatic coma, and pulmonary hypertension. Anatomically, portosystemic shunts are divided into intra- and extra- hepatic shunts. Congenital intrahepatic portosystemic shunts are rare anomalies, and the early diagnosis is important to prevent hepatic encephalopathy and hypoglycemia. We report a case of an infant with symptoms of heart failure due to a congenital intrahepatic portosystemic shunt and a ventricular septal defect (VSD), which were treated successfully with four coil embolizations and open heart surgery for the VSD.

A Comparison of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation in Preterm infant

PURPOSE: Besides necrotizing enterocolitis (NEC), the most common cause of intestinal perforation in preterm infants, there is another condition called spontaneous intestinal perforation (SIP) which, though it does not have the clinical or histological nature of NEC has been reported with increasing tendency. Aims of this study are to analyze gastrointestinal perforation in preterm infants and to speculate any difference in clinical manifestations, perinatal histories, and laboratory results between NEC and SIP. METHODS: A retrospective review of medical records of preterm infants with gastrointestinal perforations in the neonatal intensive care unit of Seoul National University Children's Hospital between January 2000 and August 2007 was performed. Preterm infants who underwent surgical intervention, and who had available histologic specimens, were enrolled. RESULTS: A total of 29 preterm infants were enrolled. They were classified into three groups: Group NEC (n=18), Group SIP (n=6), and Group Others (n=5). Group Others consisted of two patients with ileal atresia, one with meconeum ileus, one with omphalocele and one with anal atresia. Onset of perforation was delayed in Group NEC compared with that of Group SIP (18.1+/-13.0 versus 6.7+/-4.2; P<0.05) and enteral feeding before perforation was more frequent in Group NEC (94.4% versus 50%; P<0.05). CONCLUSION: During seven years and eight months, there were six cases of SIP and 18 cases of NEC in preterm infants. As well as NEC, SIP should be considered when gastrointestinal perforation is suspected, especially when patients with early onset time and no enteral feeding.