Prediction of HLA-DQ in Deceased Donors and its Clinical Significance in Kidney Transplantation

Background@#HLA-DQ typing in deceased donors is not mandatory in Korea. Therefore, when patients develop DQ antibodies after kidney transplantation (KT) from deceased donor, it is impossible to determine whether they are donor-specific antibodies (DSA). We developed DQ prediction programs for the HLA gene and evaluated their clinical utility. @*Methods@#Two HLA-DQ prediction programs were developed: one based on Lewontin’s linkage disequilibrium (LD) and haplotype frequency and the other on an artificial neural network (ANN). Low-resolution HLA-A, -B, -DR, and -DQ typing data of 5,603 Korean patients were analyzed in terms of haplotype frequency and used to develop an ANN DQ prediction program. Predicted DQ (pDQ) genotype accuracy was analyzed using the typed DQ data of 403 patients. pDQ DSA agreement, sensitivity, specificity, and false-negative rate was evaluated using 1,970 single-antigen bead assays performed on 885 KT recipients. The clinical significance of DQ and pDQ DSA was evaluated in 411 KT recipients. @*Results@#pDQ genotype accuracies were 75.4% (LD algorithm) and 75.7% (ANN). When the second most likely pDQ (LD algorithm) was also considered, the genotype accuracy increased to 92.6%. pDQ DSA (LD algorithm) agreement, sensitivity, specificity, and falsenegative rate were 97.5%, 97.3%, 98.6%, and 2.4%, respectively. The antibody-mediated rejection treatment frequency was significantly higher in DQ or pDQ DSA-positive patients than in DQ or pDQ DSA-negative patients (P < 0.001). @*Conclusions@#Our DQ prediction programs showed good accuracy and could aid DQ DSA detection in patients who had undergone deceased donor KT without donor HLA-DQ typing.

Outcome of Neonates with Agenesis of Septum Pellucidum: A Retrospective Single Center Study

PURPOSE: Agenesis of the septum pellucidum (ASP) is a very rare disease that can be isolated or associated with other brain abnormalities. The neurological prognosis of isolated ASP remains controversial. The aim of this study was to evaluate the clinical outcome of neonates with ASP. METHODS: We retrospectively analyzed the medical records of 12 neonates with isolated ASP or ASP combined with other brain abnormalities who were born at Cheil General Hospital & Women's Healthcare Center between January 2007 and December 2017. RESULTS: Of the 12 neonates, six were identified prenatally and six were identified postnatally. Isolated ASP was found in eight neonates; of these, four were detected antenatally. ASP associated with other brain abnormalities was found in four neonates. ASP was complete in nine neonates, including six with isolated ASP, and partial in three, including two with isolated ASP. Six of the eight neonates with isolated ASP had normal neurological development, except two who were lost to follow-up. Among the four neonates with other associated brain abnormalities, two had delayed motor development and a seizure, one had normal development, and one was lost to follow-up. In all neonates, ophthalmological examination revealed no optic nerve abnormalities. CONCLUSION: Isolated ASP seems to have a good neurological prognosis without ocular problems. This result needs to be confirmed by larger prospective studies over a longer developmental timeline.

Diagnostic Clues for Congenital Cytomegalovirus Infection: Association with Newborn Hearing Screening Tests

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.

Early Detection and Successful Treatment of Vertically Transmitted Fulminant Enteroviral Infection Associated with Various Forms of Arrhythmia and Severe Hepatitis with Coagulopathy

Enteroviral infections are common in neonates. One important infection pathway is vertical transmission from an infected mother to her neonate. Here, we report the early detection and successful treatment of a vertically transmitted fulminant enteroviral infection associated with myocarditis and hepatitis. The patient had a sudden onset of high fever on the fourth day of life and developed severe, rapidly progressing symptoms of disseminated intravascular coagulopathy (DIC), hepatitis, and myocarditis accompanied by tachyarrhythmia. As it was the peak season for enteroviral infections and both the mother and the patient's 36-month-old sibling had a high fever around the time of delivery, we suspected an enteroviral infection. Thus, we initiated prompt evaluation of enteroviral infection, as well as close observation and intensive care of the neonate. We strongly recommend evaluation for the possibility of vertical enterovirus infection in neonates when the mother is suspected of having a viral infection (e.g., high fever and negative results from bacterial infectious studies) around the time of delivery and when the neonate shows some early symptoms of infectious diseases such as thrombocytopenia, DIC, hepatitis, and myocarditis. Early detection of enteroviral infections and prompt implementation of proper treatment are key to reduce the risk of complications and mortality associated with enteroviral infections in neonates.

RASA1-Related Parkes Weber Syndrome in a Neonate

Parkes Weber syndrome is a rare congenital vascular anomaly, related to the RAS p21 protein activator 1 (RASA1) gene. It is characterized by capillary cutaneous malformations, bony and soft tissue hyperplasia, and multiple arteriovenous fistulas throughout the affected upper or lower extremity. These arteriovenous fistulas can be associated with life-threatening complications such as bleeding, thrombosis, and high output heart failure. In this report, we present a neonate who had a disproportionately hypertrophied left upper limb with port-wine stain, dystrophy of the left humerus, and hypertrophy of the left clavicle on X-ray, and arteriovenous malformation and massive dilatation of the left subclavian artery on magnetic resonance angiography. Exome sequencing analysis revealed a novel heterozygous splicing mutation (c.1776+2T>A) in the RASA1 gene. To the best of our knowledge, this report is the first case of RASA1-related Parkes Weber syndrome in Korea.

Use of child safety seats during transportation of newborns / 소아과

PURPOSE: Child safety seats (CSS) are critical for the protection of children, in case of motor vehicle accidents. Although the national legislation mandates that all newborns must be placed in an appropriately installed CSS during transportation, people often do not perceive the importance of CSS and do not use it as recommended. The purpose of this survey was to understand the use of CSS for the safe transport of newborns from hospital to home. METHODS: We interviewed parents of newborn infants, using a structured questionnaire, at the time of their discharge from Cheil General Hospital & Women’s Health Care Center, between May 2014 and July 2014. RESULTS: A total of 403 participants were interviewed. The rate of CSS use was only 14.9%. Overall, 76.4% of the families interviewed were not aware about the recommendations on CSS use for newborns when travelling in a car. The provision of education on using CSS significantly influenced their rate of use. Parents who were educated about mounting the CSS in a car used it more as compared with others (25.7% vs. 12.2%) (P=0.002). Furthermore, if parents had heard about the importance or necessity of CSS, they used it more than others did (19.5% vs. 10.6%, P=0.032). CONCLUSION: Despite the legal regulation, most parents transport their newborn infants without a CSS while traveling from hospital to their home. The rate of CSS use was influenced by parental education and their knowledge about its necessity. Education programs for parents must be reinforced to increase the CSS use.

An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

BACKGROUND: Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. METHODS: The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. RESULTS: We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. CONCLUSIONS: Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.

The First Newborn Screening Study of T-Cell Receptor Excision Circle and κ- Deleting Recombination Excision Circle for Severe Combined Immunodeficiency in Korea: A Pilot Study

PURPOSE: Severe combined immunodeficiency (SCID) is the most serious form of primary immunodeficiency. Infants with SCID are susceptible to life-threatening infections. To establish newborn screening for SCID in Korea, we performed a screening test for T-cell receptor excision circle (TREC) and κ-deleting recombination excision circle (KREC) in neonates and investigated the awareness of SCID among their parents. METHODS: Collections of dried blood spots from neonates and parent surveys were performed at the Samsung Medical Center and Cheil General Hospital & Women's Healthcare Center in Korea. The amplification crossing point (Cp) value 39.0 was defined as negative. RESULTS: For TREC/KREC screening, 141 neonates were enrolled; 63 (44.7%) were male. One hundred forty neonates (99.3%) had positive TREC/KREC results at the time of the initial test; 82.3% and 75.9% were positive and 17.0% and 23.4% were weakly positive for TREC and KREC, respectively. In one neonate (0.7%), the initial TREC/KREC test result was negative. However, repeated tests obtained and confirmed a positive result. For an awareness survey, 168 parents were engaged. Only 2% of parents (3/168) knew that the newborn screening test for SCID had been introduced and performed in other countries. Eighty-four percent of parents (141/168) replied that nationwide newborn SCID screening should be performed in Korean newborns. CONCLUSIONS: In this study, newborn SCID screening was performed along with assessment of public awareness of the SCID test in Korea. The study results showed that newborn SCID screening can be readily applied for clinical use at a relatively low cost in Korea.

Maternal food restrictions during breastfeeding / 소아과

PURPOSE: This study investigated self-food restriction during breastfeeding, reviewed the literature showing the effect of maternal diet on the health of breast-fed infants, and explored the validity of dietary restrictions. METHODS: Questionnaire data were collected from breastfeeding Korean mothers who visited the pediatric clinic of Cheil General Hospital & Women's Healthcare Center from July 2015 through August 2015. The survey included items assessing maternal age, number of children, maternal educational attainment, household income, degree of difficulty with self-food restriction, types of self-restricted foods, dietary customs during breastfeeding, and sources of information about breastfeeding. RESULTS: The questionnaire was completed by 145 mothers. More than a third (n=56, 39%) had discomfort from and usually avoided 4–5 types of food (mean, 4.92). Mothers younger than 40 years had more discomfort (odds ratio [OR], 12.762; P=0.017). Primiparas felt less discomfort than multiparas (OR, 0.436; P=0.036). Dietary practices were not influenced by maternal educational attainment or household income. The most common self-restricted foods were caffeine (n=131, 90.3%), spicy foods (n=124, 85.5%), raw foods (n=109, 75.2%), cold foods (n=100, 69%), and sikhye (traditional sweet Korean rice beverage) (n=100, 69%). Most mothers (n=122, 84.1%) avoided foods for vague reasons. CONCLUSION: Most mothers restricted certain foods unnecessarily. Literature review identified no foods that mothers should absolutely avoid during breastfeeding unless the infant reacts negatively to the food.

Clinical Significance of Neonatal Lenticulostriate Vasculopathy: Association with Congenital Cytomegalovirus Infection

PURPOSE: To investigate clinical characteristics of neonates with lenticulostriate vasculopathy (LSV) and determine the correlation between LSV and clinical characteristics, especially congenital cytomegalovirus (CMV) infection. METHODS: We retrospectively reviewed the medical records of neonates with LSV, born at Cheil General Hospital between January 2005 and December 2015. LSV was graded into three groups based on the number of the LSV lesions and classified into an isolated and combined group showing LSV with coexistent abnormalities noted on brain sonography. We compared clinical data based on the LSV classification. RESULTS: Our study included 102 neonates with LSV, which showed an unilateral pattern in 10 and bilateral pattern in 92 neonates. The numbers of neonates studied based on LSV grading were 33, 53, and 16 in grade 1, 2, and 3, respectively. We observed the isolated LSV in 62 and the combined type in 40 neonates. We observed that 93 (91.2%) of the neonates with LSV did not show specific underlying cause for this condition. Congenital CMV infection was detected in 7 neonates, including 0, 5, and 2 neonates belonging to grade 1, 2, and 3, respectively. Among these, 2 neonates showed the isolated, and 5 showed the combined type of LSV. Statistically, congenital CMV infection was more significantly associated with LSV in grade 2 and 3 than in grade 1 (P < 0.05). Additionally, congenital CMV infection was more commonly observed in the combined than in the isolated LSV type showing a marginal association (P=0.07). CONCLUSION: We observed that LSV was not clinically significant except when associated with CMV infection. We suggest that neonates presenting with a grade 2 or higher of LSV or a combined type of LSV detected via neonatal brain ultrasonography should be evaluated for CMV infection.

The Prenatal and Postnatal Incidence of Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT) Detected by Ultrasound

PURPOSE: Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common anomalies identified in newborns. This study aims to demonstrate the prevalence of CAKUT including hydronephrosis diagnosed by antenatal and postnatal ultrasound over a five-year period. METHODS: The records of births between May 1st, 2009 and April 30th, 2014 at our hospital were collected. The number of infants who underwent renal ultrasound after birth for the detection of CAKUT was counted. The incidence of each type of CAKUT such as hydronephrosis, size abnormality, horseshoe kidney, and Multicystic dysplastic kidney (MCDK) was retrospectively evaluated for antenatal screening and postnatal follow-up examination. RESULTS: During the study period, 33,276 infants were born and 521 neonates underwent postnatal renal ultrasound. 183 cases of CAKUT were detected prenatally and 140 postnatally using ultrasonographic examinations at the following time: (i) 3-7 days postnatally in 123 newborns (87.9%), (ii) during 1-3 months in 11 newborns (7.9%), and (iii) later than 3 months in 6 newborns (4.3%). Among diagnosed CAKUT, hydronephrosis was the most common anomaly with 113 newborns diagnosed prenatally and 46 postnatally. Duplex kidney was the second most common anomaly followed by horseshoe kidney, simple cysts in the kidney and so on. CONCLUSION: The detection of CAKUT is an important part of the prenatal ultrasound. This study analyzed the prevalence of CAKUT detected on prenatal screening and compared the results to those detected postnatally. Prenatal ultrasound screening fulfills the needs of postnatal examinations and therefore, both antenatal and postnatal sonographic investigations are of vital importance for diagnosis of renal and urinary tract anomalies.

A Case of Spontaneous Twin Anemia-Polycythemia Sequence

Twin anemia-polycythemia sequence (TAPS) is characterized by the transfer of blood via intertwin vascular anastomoses in a single placenta. It differs from twin-twin transfusion syndrome (TTTS) in that amniotic fluid levels remain normal during pregnancy. Since the concept of TAPS was first introduced in 2007, some cases have been reported abroad, but no such a case has been reported in Korea. Here, we report the first case of spontaneous TAPS in Korea.

Clinical Significance of Epidural Hematoma Related to Birth in Newborn / 대한주산의학회잡지

PURPOSE: Epidural hematoma (EDH) in newborn is very rare, but when it occurs it is usually due to birth injury. We have evaluated the incidence and clinical features of EDH related to birth in newborn. METHODS: We analyzed medical records of 12 newborns diagnosed with EDH at Cheil General Hospital and Women's Health Care Center from January 2000 to December 2015 retrospectively. RESULTS: The incidence of EDH related to birth was 0.01%, occurring in 1 of 10,000 live births. Of the total 12 cases, 10 occurred in male and 8 in vaginal delivery. Among them, 11 infants had evidences of birth injury. Clinical presentation was nonspecific: only 1 infant had neurologic symptoms. The temporooccipital area was the most frequent location of EDH. The median size of EDH was 3.2±0.8 cm in length and 1.2±0.7 cm in depth. Mass effect accompanied with midline shift on radiologic imaging was shown in one case. Surgical drainage was needed only in one infant with neurologic symptom and mass effect on radiologic imaging, while the others were treated conservatively. CONCLUSION: Neonatal EDH related to birth was treated conservatively in most cases. The radiologic mass effect and neurologic symptom should be considered as indication for surgical intervention.

A 12-Year Retrospective Study of Survival Rates and Outcomes of Very Low Birth Weight Infants in a Single Center

PURPOSE: To investigate the outcomes and survival rates of very low birth weight infants (VLBWI) born over a 12-year period in a single center. METHODS: A retrospective review of 613 VLBWI born from January 2000 to December 2011 was performed. We compared the incidence, survival rate, and morbidity of infants classified according to their birth weight or gestational age for the following periods: Period I (2000-2002), Period II (2003-2005), Period III (2006-2008), and Period IV (2009-2011). RESULTS: The incidence of VLBWI was 0.7%, while the overall survival rate was 94.9%. The survival rates were 92.8%, 92.9%, 95.9%, and 97.5% for periods I, II, III and IV, respectively; the rates improved significantly over time (P or =grade III), 8.5%; sepsis, 6.5%; cystic periventricular leukomalacia, 3.8%; necrotizing enterocolitis (> or =grade II), 3.4%; and intraventricular hemorrhage (> or =grade III), 2.3%. A significant decrease was seen in some clinical parameters: the time to start feeding, duration of parenteral nutrition, and duration required to reach full enteral feeding in every successive three-year period (P<0.01). CONCLUSION: The overall survival rate of VLBWI born between January 2000 and December 2011 was 94.9%. This survival rate was found to increase significantly in each successive three-year period starting January 2000.

Effect of Prophylactic Palivizumab on Admission Due to Respiratory Syncytial Virus Infection in Former Very Low Birth Weight Infants with Bronchopulmonary Dysplasia

The aim of this study was to observe the effects of prophylactic palivizumab on hospitalization secondary to respiratory syncytial virus (RSV) infection (RSVhospitalization) in former very low birth weight infants (VLBWI) with bronchopulmonary dysplasia (BPD). This study also sought to identify the risk factors of RSVhospitalizationin this particular infant population. A prospective observational study was conducted between September 2007 and April 2008 in seven Korean hospitals. Children with a history of very low birth weight, a diagnosis of BPD and who were <2 yr old at the onset of the RSV season were included in this study. Palivizumab injections were administered monthly for a maximum of five months during the RSV season. RSVhospitalization rates were reviewed, and RSVhospitalization rates between subgroups were categorized by gestational age, birth weight, and duration of ventilator care. A total of 90 subjects completed the follow-up interviews. The mean gestational age at birth was 26.1+/-1.7 weeks, and the mean birth weight was 889.4+/-222.2 g. The incidence of RSVhospitalization in the study population was 8.9% (8/90), and the mean hospital stay was 11.0+/-5.5 days, including one death. There were no statistically significant differences in the patients' demographic characteristics or risk factors for RSV hospitalization. When subgroup analyses were conducted, there were still no statistically significant differences. The administration of palivizumab prophylaxis during the entire RSV season is important in VLBWI with BPD, regardless of their gestational age and birth weight, or previous ventilator dependency.

Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

BACKGROUND: The purpose of this study was to evaluate maternal and neonatal outcomes in Korean women with type 1 diabetes and type 2 diabetes. METHODS: We performed a retrospective survey of 163 pregnancies in women with type 1 diabetes (n=13) and type 2 diabetes (n=150) treated from 2003 to 2010 at Cheil General Hospital & Women's Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups. RESULTS: Differences in glycosylated hemoglobin between type 1 and type 2 diabetes were not significant. Birth weight (3,501+/-689.6 g vs. 3,366+/-531.4 g) and rate of major congenital malformations (7.7% vs. 5.6%) were not significantly different. However, women with type 1 diabetes had higher rates of preeclampsia (38.5% vs. 8.2%, P=0.006), large for gestational age (LGA; 46.2% vs. 20.4%, P=0.004), macrosomia (38.5% vs. 13.4%, P=0.032), and admission for neonatal care (41.7% vs. 14.8%, P=0.03) than women with type 2 diabetes. CONCLUSION: Maternal and neonatal outcomes for women with type 1 diabetes were poorer than for women with type 2 diabetes, especially preeclampsia, LGA, macrosomia and admission to the neonatal intensive care unit.

Comparison of Quantitation of Cytomegalovirus DNA by Real-Time PCR in Whole Blood with the Cytomegalovirus Antigenemia Assay

BACKGROUND: Quantitation of cytomegalovirus (CMV) DNA using real-time PCR has been utilized for monitoring CMV infection. However, the CMV antigenemia assay is still the 'gold standard' assay. There are only a few studies in Korea that compared the efficacy of use of real-time PCR for quantitation of CMV DNA in whole blood with the antigenemia assay, and most of these studies have been limited to transplant recipients. METHOD: 479 whole blood samples from 79 patients, falling under different disease groups, were tested by real-time CMV DNA PCR using the Q-CMV real-time complete kit (Nanogen Advanced Diagnostic S.r.L., Italy) and CMV antigenemia assay (CINA Kit, ArgeneBiosoft, France), and the results were compared. Repeatedly tested patients were selected and their charts were reviewed for ganciclovir therapy. RESULTS: The concordance rate of the two assays was 86.4% (Cohen's kappa coefficient value=0.659). Quantitative correlation between the two assays was a moderate (r=0.5504, P<0.0001). Among 20 patients tested repeatedly with the two assays, 13 patients were transplant recipients and treated with ganciclovir. Before treatment, CMV was detected earlier by real-time CMV DNA PCR than the antigenemia assay, with a median difference of 8 days. After treatment, the antigenemia assay achieved negative results earlier than real-time CMV DNA PCR with a median difference of 10.5 days. CONCLUSIONS: Q-CMV real-time complete kit is a useful tool for early detection of CMV infection in whole blood samples in transplant recipients.

Neonatal Bacterial Conjunctivitis: Pathogenic Distribution / 대한주산의학회잡지

PURPOSE: To study the causative microorganism of neonatal bacterial conjunctivitis and its correlation with maternal factors. METHODS: We retrospectively reviewed the medical records of 55 neonates diagnosed with bacterial conjunctivitis and the records of mothers from January 2008 to July 2013. We investigated microbiologic culture of conjunctival discharge, time of occurrence, the mode of delivery, premature rupture of membrane (PROM), microbiologic culture of vaginal swab and the sensitivities to antibiotics. RESULTS: The most common organism was Staphylococcus epidermidis, isolated in 24 (36.4%) neonates, followed by other Coagulase-negative Staphylococcus (CNS) 10 (15.2%), E. cloacae 6 (9.1%), S. marsescens 6 (9.1%), and P. aeruginosa 5 (7.6%). Concerning the time of occurrence, 23 (41.8%) were founded with conjunctivitis within 1 week of life. By mode of delivery, 18 (32.7%) were delivered through vaginal route and 37 (67.3%) delivered by Cesarean section. The most common organism grown in conjunctival discharge of both group was S. epidermidis. Of these 55 neonates' mothers, 9 (16.4%) had history of PROM. Regardless of the presence of PROM, the most common organism was S. epidermidis. A total of 22 (40.0%) microbiologic culture of vaginal swab were examined and 6 (27.2%) of them had detected organisms. The results of vaginal swabs were in discord with results of conjunctival swabs of neonates. CONCLUSION: S. epidermidis was the most common infectious organism of neonatal bacterial conjunctivitis. We could not identify the correlation between neonatal bacterial conjunctivitis and maternal factors. Further comprehensive studies are needed to investigate the risk factors related to bacterial conjunctivitis of neonates.

Hemolytic Disease of the Newborn Caused by Anti-M in 2 Male Siblings / 대한주산의학회잡지

Hemolytic disease of the newborn (HDN) caused by anti-M is rare and clinical manifestations are variable ranging from mild anemia and hyperbilirubinemia to hydrops fetalis and intrauterine fetal death. There were few reports of HDN caused by anti-M in Korea but no case in siblings. We experienced a case of 2 male siblings, both of whom had anti-M induced HDN and prolonged anemia persisted for over a month. We report this case with a brief review of literature. This report documents the first case of HDN caused by anti-M in siblings in Korea.

Unusual Presentation of Calcinosis Cutis: Venous Calcification Following intravenous Calcium Gluconate Administration in a Preterm Baby

Neonatal hypocalcemia is not uncommon, especially in premature neonates. It is usually treated by intravenous calcium gluconate administration. However, complications caused by the extravasation of intravenous calcium gluconate include calcinosis cutis, calcium deposition in the dermis, which is irritating to soft tissues and can produce tissue necrosis. We report a case of iatrogenic calcinosis cutis in a 27-day-old preterm baby following the extravasation of calcium gluconate. In this case, calcinosis cutis occurred along the venous pathway in a rare vascular calcification pattern but spontaneously resolved 2 months later. Although iatrogenic calcinosis cutis is generally benign, early recognition of the extravasation of calcium gluconate is important to avoid severe complications. This report aimed to provide a warning about the risks associated with intravenous calcium gluconate and information about the course of a rare presentation of the common disease calcinosis cutis with vascular calcification.