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.

An Outbreak of Epidemic Keratoconjunctivitis by Adenovirus Type 8 in a Neonatal Intensive Care Unit

PURPOSE: Epidemic keratoconjunctivitis (EKC) caused by adenovirus is a highly contagious disease, which has been reported as outbreaks involving adults in the community. However, there has been no report on EKC outbreak by adenovirus in a neonatal intensive care unit (NICU) in Korea. Aims of this study were to investigate the EKC outbreak by adenovirus type 8 in NICU and to confirm an effectiveness of polymerase chain reaction (PCR) for diagnosis. METHODS: Conjunctival swab or nasopharyngeal aspirate specimens were taken from all patients and tested by viral culture and PCR. Adenovirus serotype was determined by sequencing of PCR product of selected region of hexon gene using the virus isolates or specimens. RESULTS: An outbreak of EKC occurred which was involving 12 preterm infants in the NICU of the Seoul National University Children's Hospital between July 12th and August 1st, 2005. Three hospital staffs and one family member of the neonate were also affected. Adenovirus was detected in 12/12 (100%), 6/11 (54.5%) by PCR and virus culture, respectively. Eleven PCR-positive neonates were identified as serotype 8 by sequencing. The first affected 4 babies have had routine ROP (retinopathy of prematurity) examinations one week ago. While previous outbreaks were sustained for a few months, the event in our unit was controlled without complications in 3 weeks. CONCLUSION: We analyzed the EKC outbreak by adenovirus type 8 in NICU. Adenovirus serotype was identified by PCR and sequencing with high sensitivity for the first time in Korea, so we suggest this method can be very useful for rapid diagnosis and infection control.

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.