Change in the Limit of Viability of Fetal Infants

PURPOSE: To determine the change in the limit of viability in fetal infants and the incidence of major complications in neonatal intensive care unit(NICU) at Samsung Medical Center(SMC). METHODS: Sevety-three infants weighing less than 800 g at birth and 117 infants born earlier than 27 weeks gestational age, who were admitted to NICU at SMC between November 1994 and December 2002, were enrolled. Their medical records were reviewed with a focus on the survival and major complications, including chronic lung disease, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. The limit of viability in fetal infants was defined as the birth weight or gestational age at which a 50% survival rate is reached and the incidence of major complications were compared by period(period I : Nov. 1994-Dec. 1998, period II : Jan. 1999-Dec. 2002). RESULTS: The limit of viability in fetal infants was markedly lowered from birth weight range of 800-900 g or gestational age range of 26+0-26+6 weeks in period I to birth weight range of 600-700 g or gestational age range of 24+0-24+6 weeks in period II. The incidence rates of major complications at the limit of viability were all less than 50% in period II. There was no definite trend toward increased incidence of major complications as birth weight get smaller and gestational age get younger. CONCLUSIONS: Our results indicate that at present, fetal infants whose body weight is over 600 g, or whose gestational age is over 24 weeks should be resuscitated vigorously. The risk of major complications at this birth weight or gestational age seems to be not greater than that at a bigger birth weight or an older gestational age.

Non-oliguric Hyperkalemia in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study was to investigate the incidence and contributing factors of nonoliguric hyperkalemia in extremely low birth weight infants (ELBW) within 96 hours after birth in very low birth weight infants. METHODS: The incidence of non-oliguric hyperkalemia and difference of clinical feature between hyperkalemic (>or=7.0 mEq/L) and normokalemic (<7.0 mEq/L) groups were determined by reviewing medical records of 35 extremely low birth weight infants admitted in Samsung Medical Center between Jan. 2001 to Dec. 2001. We analyzed the serum levels of sodium, potassium, fluid intake, urine output, blood gas analysis values, and other factors that influenced serum electrolytes. RESULTS: Among 35 ELBW infants, 11 (31%) was hyperkalemia developed and 4 infants (36%) was associated with cardiac arrythmia. The incidence and onset time of hyperkalemia showed inverse correlation with birth weight and gestational age. Perinatal complications and serum levels of sodium, fluid intake, hourly urine output, and other blood gas analysis were no different in both groups. Dopamine administrations, UAC insertion rate, ICH incidence and base deficit were significantly increased in hyperkalemic group. CONCLUSION: Non-oliguric hyperkalemia is a frequent complication of ELBW infant. Serum potassium should be monitored closely to avoid life threatening cardiac arrhythmia in these infants.

Zellweger Syndrome : First Confirmed Neonatal Case in Korea

We describe below a case of Zellweger syndrome case with facial dysmorphism, profound hypotonia, and hepatomegaly. He died at the age of 2 months. Zellweger syndrome is a disease marked by the absence of hepatic and renal peroxisomes. Because peroxisomes have many vital anabolic and catabolic functions within the cell, their absence results in profound cellular dysfunction. A biochemical study of plasma revealed elevation of very long chains of fatty acids and pipecolic acid, consistent with peroxisomal disorder. The cultured skin fibroblasts showed a marked decrease in plasmalogen synthesis enzyme : dihydroxyacetonephosphate acyl transferase(DHAP-AT) The clinical characteristics and biochemical findings led to the diagnosis of Zellweger syndrome. The pattern of inheritance is autosomal recessive, hence genetic counseling can help the families. In infantile hypotonia patients with unknown cause, peroxisomal disorder should be included in the differential diagnosis. We report the first confirmed case of Zellweger syndrome by enzyme assay in Korea.

A Case of Schinzel-Giedion Syndrome

Schinzel-Giedion syndrome is a rare autosomal recessive condition characterized by a typical face including midface retraction, urogenital anomalies, and skeletal manifestations. So far 30 patients have been reported. This is the first report of this syndrome demonstrated in Korea. We describe a male infant with the typical findings of Schinzel-Giedion syndrome, also showing sacrococcygeal teratoma.

Effect of Fluid Restriction Through High Humidification on the Management of Very Low Birth Weight Infant

PURPOSE: The aim of this study is to investigate the effects of high humidification of nearly 100% on insensible water loss and total fluid requirement in very low birth weight infants during their first week of life. METHODS: We retrospectively compared twenty-five infants (GA 28.1+/-1.7 wk, and BW 970+/-186 g) who were cared for in a double walled incubator with high humidification with 24 infants (GA 27.6+/-2.2 wk, and BW 972+/-186 g) who were in a double walled incubator without raised humidity during the first week of their life. We analyzed the changes in body weight, total fluid intake, insensible water loss, urine output, input of sodium and potassium, serum levels of sodium and potassium, and the incidence of complications during the hospitalization in the high humidified group and the control group. RESULTS: High humidification during the first week of life in very low birth weight infants reduced insensible water loss and total fluid requirement. However the imbalance of serum electrolyte or oliguria did not increase. The high humidification group (n=25) acquired more physiologic weight loss during the first two weeks of life than the control group (n=24) but gained more weight than the control group (n=24) on the third month of life. Infants nursed with high humidification showed an increased tendency toward spontaneous closure of the patent ductus arteriosus and a decreased tendency toward surgical ligation of the patent ductus arteriosus and intraventricular hemorrhage without the evidence of an increase in infection. No significant differences were noted in the incidence of patent ductus arteriosus, bronchopulmonary dysplasia and retinopathy of prematurity. CONCLUSION: The high humidification of nearly 100% and fluid restriction therapy during the first week of life were effective in the fluid and electrolyte management of very low birth weight infants.