The Changes of Incidence of Nosocomial Sepsis, and Risk Factors in Extremely Low Birth Weight Infants

PURPOSE: To know whether the changes in the risk factors of nosocomial sepsis had an impact on the occurrence of nosocomial sepsis (NS) in extremely low birth weight infants (ELBW I). METHODS: ELBW I who were admitted to the NICU at Samsung Medical Center from October 1994 to December 2000 were devided into three groups according to periods (period I:1994.10-1996.9, period II:1996.10-1998.12, period III:1999.1-2000.12), and charts were reviewed retrospectively for demographic profile, incidence of NS, and changing patterns of risk factors of NS. RESULTS: Gestational age and birth weight of ELBW I decreased and the incidence of NS increased significantly during third period. However, cumulative incidence of NS corrected by hospital days was not changed irrespective of periods. Among the risk factors of NS in 3rd period, use of antibiotics in the 1st day, postnatal dexamethasone and use and duration of indwelling umbilical catheters decreased significantly and the use of nasal continuous positive airway pressure increased significantly especially, in ELBW I under 800 g of birth weight. In the ELBW I under 800 g of birth weight, cumulative incidence of NS and mortality among the infants who suffered from NS decreased significantly in 3rd period. CONCLUSION: Efforts to decrease the risk factors of NS can prevent the increase in incidence of NS in ELBW I.

Changes in the Outcomes of Very Low Birth Weight Infants

PURPOSE: The outcomes of infants weighing less than 1,500 gm(very low birth weight infant : VLBWI) reflect recent progress in neonatal intensive care. In this study, we analyzed changes over time in survival rate and morbidity of VLBWIs during the past seven years. METHODS: A retrospective review of medical records was analyzed for VLBWIs admitted to the neonatal intensive care unit of Samsung Medical Center within three days from birth. We compared the outcomes of previous corresponding data(period I : Oct. 1994 to Sept. 1996), with the outcomes of period II(Oct. 1996 to Dec. 1998) and period III(Jan. 1999 to Dec. 2000). RESULTS: As shown in Tables 1 and 3, the distribution of birth weight, gestational age(GA), gender, and inborn admissions did not change during the 7-year study. The overall survival rate of VLBWI increased significantly over time(period I : 72% vs period III : 88.3%, P<0.05). Between period I and period II, the birth weight-specific survival rate increased by 23.6%(75% vs 92.7%, P<0.05) for infants 1,000 to 1,249 gm. Between period II and period III, the birth weight-specific survival rate increased three times(20% vs 66.7%, P<0.05) for infants <750 gm. The survivors of lowest birth weight included infants at 624 gm(GA : 26(+5) weeks), 667 gm(GA : 25(+6) weeks) and 480 gm(GA : 26(+2) weeks) in each period. The gestational age-specific survival rate in period III increased significantly in GA 25-26 weeks and 29-30 weeks(vs period I and period II, P<0.05). The survivors of lowest gestational age included infants at GA 26 weeks(970 gm), GA 23(+5) weeks(791 gm) and GA 24(+1) weeks(740 gm) in each period. The incidence of severe IVH(grade III, IV) and the early death rate(

A Case of Transient Neonatal Hypothyroidism Due to Maternal TSH-Binding Inhibitor Immunoglobulins / 대한소아내분비학회지

Recognition of transient forms of neonatal hypothyroidism is very important to prevent the complications of congenital hypothyroidism. Transplacental passage of TSH-binding inhibitory immunoglobulins(TBII) may result in transient congenital hypothyroidism. Transient neonatal hypothyroidism was found in a daughter of 25-yr-old mother who was receiving levothyroxine for primary hypothyroidism due to Hashimoto's thyroiditis. The neonate was treated with thyroxine which was discontinued at 24 months of age. Thyroid scanning during the neonatal period failed to identify functional thyroid tissue, suggesting thyroid agenesis, whereas thyroid scan performed on subsequent follow-up revealed a normal gland. Sequential measurements of serum autoantibodies directed towards the TSH receptor were made in the patient and her mother. High titers of blocking antibodies were present in the mother(TBII, 82.1%) and newborn(TBII, 85.5%) at 19 days after birth. The levels remained persistently high in the mother, whereas they declined and undetectable in the patient at 23 months of age. The above laboratory and clinical data were compatible with blocking nature of TBII, resulting in transient neonatal hypothyroidism and an athyreotic appearance on scan. The TBII measurement can be a useful predictor of neonatal hypothyroidism as well as confirming the nature of the disease in newborn.

Ifosfamide and Etoposide in Relapsed Refractory Childhood Acute Lymphoblastic Leukemia / 대한소아혈액종양학회지

BACKGROUND: The prognosis for children with relapsed acute lymphoblastic leukemia remains dismal. Ifosfamide has previously been shown to be active as a single agent and in combination with doxorubicin, etoposide, and teniposide in pediatric solid tumors, recurrent acute lymphoblastic leukemia and adult acute leukemia. We assessed the efficacy and the toxicity of the drug combination with ifosfamide and etoposide in patients with relapsed refractory acute lymphoblastic leukemia. METHODS: Between April 1995 and May 1996, twenty children aged 1 to 14 years with ALL in Catholic Medical Center, all heavily pretreated and in bone marrow relapse, were enrolled in this study. Drugs were given intravenously each day for 5 days at the following doses ; ifosfamide 1.8 g/m2/day, etoposide 100 mg/m2/day and mesna 1440 mg/ m2/day(as a uroprotectant) ; Cycles were repeated every 28 days for two cycles. RESULTS: 1) Twenty heavily pretreated patients were entered on study. At study entry, seventeen patients were in first relapse, two were in second relapse and one was in third relapse. 2) Six patients(30%) achieved complete remission, and eight patients(40%) achieved partial remission. Overall response rate was 70%. 3) Duration of remission ranged from 30 days to 230 days. 4) The toxicity of the regimen was tolerated. Moderate or severe toxicity evaluated on a per cycle basis included : neutropenia 52.5%, thrombocytopenia 45%, hemorrhagic cystitis 12.5% and mucositis 2.5%. 5) Two patients went on to bone marrow transplantation with histocompatibility matched sibling donors while in remission. CONCLUSION: The combination of ifosfamide and etoposide with mesna uroprotection has significant activity in relapsed refractory childhood lymphoblastic leukemia with tolerable toxicity. We recommended bone marrow transplantation after successful reinduction because of short remission duration of this regimen.