Uric Acid as a Predictor of Severe Intraventricular Hemorrhage in Very Low Birth Weight Infants

PURPOSE: To determine whether serum uric acid levels in the first 7 days of life can predict development of severe intraventricular hemorrhage (IVH) among very low birth weight (VLBW) infants. METHODS: VLBW infants admitted to the neonatal intensive care unit of Asan Medical Center between January 2009 and December 2012 were selected for chart review. Infants were divided into groups with and without severe IVH (grade> or =3). To determine whether uric acid is a predictor of severe IVH, uric acid levels on the first day (within 24 hours of birth), peak uric acid levels (during the first 7 days for infants without severe IVH, prior to IVH documentation by cranial sonogram for infants with severe IVH, and trend in uric acid levels were analyzed for both groups. Various antenatal and postnatal factors were compared between the groups, and risk factors associated with severe IVH were identified. RESULTS: A total of 397 VLBW infants were included, with mean birth weight of 1,075+/-292 g and a mean gestational age of 29.6+/-3.3 weeks. Higher levels of uric acid on day 1, higher peak levels, and rising uric acid levels were all found to be associated with the development of severe IVH on univariate analysis. Multivariate analysis confirmed that rising uric acid levels predicted subsequent development of severe IVH. Other factors associated with development of severe IVH included higher sodium, higher potassium, higher PaCO2, higher lactic acid, and lower PaO2. CONCLUSION: Careful attention to uric acid levels, which are easily measured, may be useful in predicting subsequent development of severe IVH among VLBW infants.

Sensory Guillain-Barre syndrome presenting as 'Burning Feet Syndrome': A case report

The existence of purely sensory Guillain-Barre syndrome (GBS) is controversial, although diagnostic criteria have been established and several cases have been reported. Motor nerve conduction studies (NCS) have found that most GBS cases present with some motor weakness or abnormality, and seem to be predominantly sensory rather than purely sensory types. A 12-year-old girl presented at our hospital with acute onset, severe stabbing pains in both feet. Clinical and electrophysiological studies revealed normal motor nerve functions but decreased or absent sensory nerve action potentials. Cerebro-Spinal Fuild (CSF) examinations demonstrated albuminocytologic dissociation. Following intravenous gammaglobulins and high dose methylprednisolone, she experienced gradual pain reduction and recovery to near normal status. We here describe this rare case of purely sensory GBS presenting with burning feet syndrome.