Factors associated with Advanced Bone Age in Overweight and Obese Children / 대한소아소화기영양학회지

Epidemiological Characteristics of Influenza in Children during the 2017– 2018 and 2018–2019 Influenza Seasons in Jeju, Korea

Purpose@#In Korea, seasonal influenza is an important respiratory illness afflicting children every year. We aimed to investigate the childhood epidemiology in Jeju during the 2017–2018 and 2018–2019 seasons. @*Methods@#Children aged <13 years, who were tested for influenza at the Jeju National University Hospital during the 2017–2018 and 2018–2019 influenza seasons, were included. Demographics and the influenza test results were retrospectively reviewed from their medical records. @*Results@#This study included 5,219 cases of influenza-like illness (ILI) (2017–2018: n=2,279; 2018–2019: n=2,940). The mean age of the eligible children was 2.85±2.79 years, and the most common age among ILI patients in each season was 1 year group. There were 902 (17.3%, 902/5,219) confirmed influenza cases during the 2 seasons. The rate of influenza confirmed by rapid influenza diagnostic test or polymerase chain reaction among ILI patients in the 2017–2018 and 2018–2019 seasons was 10.4% (236/2,279) and 10.3% (303/2,940) for influenza A, and 9.1% (208/2,279) and 5.3% (155/2,940) for influenza B, respectively. The mean age of influenza-confirmed cases was 4.09 years and 5.05 years in the 2017–2018 and 2018–2019 seasons, respectively (P<0.05). Weekly distribution of influenza was similar to that of ILI in the clinical sentinel surveillance system in both seasons. @*Conclusion@#The difference in the influenza epidemic trend and age-group distribution between the 2017–2018 and 2018–2019 seasons was distinct in Jeju. Steady epidemiological studies on influenza in Jeju are needed for comparison with other regions of Korea.

Epidemiological Characteristics of Influenza in Children during the 2017– 2018 and 2018–2019 Influenza Seasons in Jeju, Korea

Purpose@#In Korea, seasonal influenza is an important respiratory illness afflicting children every year. We aimed to investigate the childhood epidemiology in Jeju during the 2017–2018 and 2018–2019 seasons. @*Methods@#Children aged <13 years, who were tested for influenza at the Jeju National University Hospital during the 2017–2018 and 2018–2019 influenza seasons, were included. Demographics and the influenza test results were retrospectively reviewed from their medical records. @*Results@#This study included 5,219 cases of influenza-like illness (ILI) (2017–2018: n=2,279; 2018–2019: n=2,940). The mean age of the eligible children was 2.85±2.79 years, and the most common age among ILI patients in each season was 1 year group. There were 902 (17.3%, 902/5,219) confirmed influenza cases during the 2 seasons. The rate of influenza confirmed by rapid influenza diagnostic test or polymerase chain reaction among ILI patients in the 2017–2018 and 2018–2019 seasons was 10.4% (236/2,279) and 10.3% (303/2,940) for influenza A, and 9.1% (208/2,279) and 5.3% (155/2,940) for influenza B, respectively. The mean age of influenza-confirmed cases was 4.09 years and 5.05 years in the 2017–2018 and 2018–2019 seasons, respectively (P<0.05). Weekly distribution of influenza was similar to that of ILI in the clinical sentinel surveillance system in both seasons. @*Conclusion@#The difference in the influenza epidemic trend and age-group distribution between the 2017–2018 and 2018–2019 seasons was distinct in Jeju. Steady epidemiological studies on influenza in Jeju are needed for comparison with other regions of Korea.

Sequential Cases of Staphylococcal Scalded Skin Syndrome in Very Low Birth Weight Infants

Staphylococcal scalded skin syndrome (4S) is an exfoliative skin disease caused by Staphylococcus aureus toxins. 4S usually has a benign course in young infants and children; however, it could be fatal in preterm infants, especially very low birth weight infants. We experienced two sequential 4S cases that occurred in the neonatal intensive care unit. One of the patients had complications such as bacteremia and acute kidney injury.

Is the Diagnostic Trial with Proton Pump Inhibitors Reasonable for School Age Children with Gastroesophageal Reflux Symptoms? / 대한소아소화기영양학회지

PURPOSE: On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD). METHODS: We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or upper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%≤ RI <10%), or abnormal (RI ≥10%) groups. RESULTS: Fifty six were female and 29 were male. Their mean age was 12.6±0.5 (±standard deviation) years (range: 6.8–18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was 5.93±4.65, 14.68±7.86 and 40.37±12.96 for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was 5.56±6.00 minutes, 9.53±7.84 minutes, and 19.46±8.35 minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C. CONCLUSION: The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.

Minimally Invasive Treatment of Falciform Ligament Abscess in a 25-Day-Old Neonate: A Case Report

The falciform ligament is a hepatic suspensory ligament that extends from the umbilicus to the diaphragm, containing the ligamentum teres and a vestigial remnant of the umbilical vein. Among the rarely-occurring pathologies of the falciform ligament, which include ligament cyst, tumor, abnormal vascularization, and congenital ligament defect, a falciform ligament abscess is even more sporadic. Accordingly, the definitive diagnosis of the falciform ligament abscess is rather challenging and may easily be misinterpreted as an infected choledochal cyst or a liver abscess. We present a 25-day-old infant with the falciform ligament abscess, which developed after the umbilical venous catheter insertion and was successfully treated with percutaneous drainage and antibiotic administration.

Risk factors for persistent otitis media with effusion in children: a case-control study / 영남의대학술지

BACKGROUND@#Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.@*METHODS@#Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.@*RESULTS@#A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at < 1 year of age (odds ratio=9.96; 95% confidence interval=2.44–39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.@*CONCLUSION@#Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Risk factors for persistent otitis media with effusion in children: a case-control study / 영남의대학술지

BACKGROUND: Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.METHODS: Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.RESULTS: A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at < 1 year of age (odds ratio=9.96; 95% confidence interval=2.44–39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.CONCLUSION: Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Kawasaki Disease Shock Syndrome with Acute Kidney Injury and Hypertension

Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome that commonly presents with stable hemodynamic status during the acute phase. An 8-year-old boy initially presented with severe hypotension and acute kidney injury. He was placed in the intensive care unit and was diagnosed with KD. Observed clinical features were defined as KD shock syndrome. His coronary artery was dilated during the subacute phase. Furthermore, he was given anti-hypertensive medications, owing to hypertension as an unusual complication of KD. We knew the importance of monitoring for blood pressure considering vasculitis as an aspect of the main pathogenesis of KD.

Clinical Characteristics of Macrolide-Resistant Mycoplasma pneumoniae from Children in Jeju

Mycoplasma pneumoniae is the major pathogen of community-acquired pneumonia in children. The prevalence of macrolide-resistant M. pneumoniae (MRMP) is important owing to the limited alternative therapies for children. We analyzed 111 M. pneumoniae obtained from 107 children admitted for lower respiratory tract infection at Jeju National University Hospital between 2010 and 2015. Macrolide resistance of M. pneumoniae was searched for using polymerase chain reaction (PCR) and sequencing. Of 107 clinical M. pneumoniae, 11 (10.3%) carried macrolide resistance mutations in the 23S rRNA gene. All macrolide resistance mutations were A2063G transitions. We found an acquired A2063G mutation of M. pneumoniae from a patient during macrolide treatment. Patients' characteristics and clinical severity did not differ between those with MRMP and macrolide-sensitive M. pneumoniae, with the exception of frequent pleural effusion in the MRMP group. The prevalence of MRMP (10.3%) in Jeju Island was relatively lower than those of surrounding countries in East Asia. Previous antimicrobial usage and timing of diagnostic test should be considered when determining of macrolide resistance of M. pneumoniae.

Enoxaparin Therapy for Arterial Thrombosis After Umbilical Cord Catheterization in Preterm Infants

The incidence of symptomatic thrombosis of umbilical arterial catheterization is 1-3%. Therapeutic options may include: using heparin or low molecular weight heparin, using a thrombolytic agent, or surgical thrombectomy. However, there are insufficient data to recommend any one treatment over the others. Recently, enoxaparin, a low molecular weight heparin, has emerged as a drug of choice for the treatment of neonatal thrombosis due to pharmacologic stability over unfractionated heparin or thrombolytic agents. We report a case of successful treatment of aortic thrombosis after umbilical arterial catheterization with enoxaparin in preterm infants.

Risk Factors for Late-onset Hyponatremia and Its Influence on Neonatal Outcomes in Preterm Infants

Late-onset hyponatremia (LOH), hyponatremia occurring after two weeks of age with the achievement of full feeding, is the result of a negative sodium balance caused by inadequate salt intake or excessive salt loss due to immature renal or intestinal function in preterm infants. The aims of our study were to identify the risk factors for LOH and its influence on neonatal outcomes. This was a retrospective cohort analysis of 161 preterm infants born before 34 weeks of gestation between June 2009 and December 2010 at Seoul National University Hospital. LOH was defined as a sodium level < or = 132 mEq/L or 133-135 mEq/L with oral sodium supplementation. LOH occurred in 49 (30.4%) of the studied infants. A lower gestational age, a shorter duration of parenteral nutrition, the presence of respiratory distress syndrome, the use of furosemide, and feeding with breast milk were significant risk factors for LOH. In terms of neonatal outcomes, the infants with LOH had longer hospital stays and higher risks of bronchopulmonary dysplasia and retinopathy of prematurity requiring surgery. LOH lasting at least 7 days significantly increased moderate to severe bronchopulmonary dysplasia, periventricular leukomalacia, and extra-uterine growth retardation. LOH is commonly observed in preterm infants; it may be a risk factor for bronchopulmonary dysplasia and retinopathy of prematurity or a marker of illness severity.

Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006-2013 / 소아감염

PURPOSE: This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. METHODS: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. RESULTS: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. CONCLUSIONS: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.

Comparison of the Incidences of Neonatal Morbidities by Different Criteria of Histologic Chorioamnionitis in Extremely Low Gestational Age Newborns

PURPOSE: The objective of the study was to compare the incidences of the neonatal morbidity, using the various criteria of histologic chorioamnionitis (HC) in the extremely low gestational age newborns (ELGANs), who were born before the 28 weeks of gestational age. METHODS: Sixty two ELGANs who were born and admitted to the Seoul National University Bundang Hospital from 2007 to 2011 were included. A total of seven criteria of HC were made according to the site within the placenta and the extent of the neutrophil infiltration. The incidence of the major neonatal morbiditiy was compared between the HC-exposed and the HC-unexposed ELGANs according to each criterion of HC. RESULTS: There were no significant differences in the birth weight, gestational age, and sex between the HC-exposed and the HC-unexposed ELGANs by any criteria. The incidence of respiratory distress syndrome (RDS) was significantly lower in the HC-exposed ELGANs only in the criterion of any extent of the umbilical cord inflammation (funisitis). The incidence of retinopathy of prematurity (ROP) was significantly higher in the HC-exposed ELGANs in the criterion of any extent of amnionitis or funisitis. The incidences of other major morbidities did not differ between the HC-exposed and the HC-unexposed ELGANs by any criteria. CONCLUSION: The presence of funisitis reflected the lung maturation effect of chorioamnionitis, as indicated by the decreased incidence of RDS. Among other major neonatal morbidities, only ROP was significantly associated with HC. The ROP occurred more frequently in the funisitis or amnionitis-exposed ELGANs.

The Clinical Characteristics and the Neurodevelopmental Outcomes of the Neonates with Cerebellar Hemorrhage

PURPOSE: We present our experience of 14 neonates with cerebellar hemorrhage and describe the clinical characteristics and the neurodevelopmental outcomes. METHODS: Fourteen neonates were identified as having cerebellar hemorrhage, based on the brain MRI findings at the two university hospitals from January 2007 to July 2011. Twelve preterm infants with the brain MRI taken before the discharge, and 2 term infants having taken the brain MRI with birth asphyxia were enrolled. The electronic medical records of the infants were reviewed. RESULTS: Ten (71.4%) infants were found to have multifocal or lobar cerebellar hemorrhage involving both hemispheres. Three infants had unilateral lesions in the right hemisphere, and one infant had a left hemisphere lesion. Six infants (42%) had co-existing high grade IVH (> or =grade III); 6 infants (42%) had periventricular leukomalacia (PVL); and 6 infants (42%) had posthemorrhagic hydrocephalus (PHH). After discharge, 12 infants (85.7%) were followed at the outpatient clinics for at least 6 months. Two out of 9 infants (22.2%) with other neurological co-morbidities (IVH> or =grade III, PVL, or PHH) had cerebral palsy, and 5 infants (55.6%) had developmental delay assessed by the Bayley scales. None of the infants without other neurological co-morbidities had cerebral palsy or developmental delay. CONCLUSION: Neonatal cerebellar hemorrhage is often diagnosed incidentally on the brain MRI in the preterm infants. If there is no concomitant high-grade IVH, PVL or PHH, cerebellar hemorrhage seems to hardly accompany its own specific symptoms, and the neurodevelopmental outcomes seem to be favorable as well. However, further long-term, large scale studies are necessary.

Application of Calculated Panel Reactive Antibody Using HLA Frequencies in Koreans

BACKGROUND: Introduction of the Luminex panel reactive antibody (PRA)-single antigen (SA) assay has increased the detection rates of unacceptable antigens in sensitized patients; the calculated PRA (CPRA) level represents the percentage of actual organ donors that express 1 or more of these unacceptable antigens. We developed a CPRA calculator based on the HLA frequencies in Koreans to measure sensitization levels in Korean patients. METHODS: To develop the calculator, we obtained the HLA-A, HLA-B, and HLA-DR phenotypes of 1,622 Koreans, and compared these with previously reported frequencies in Koreans. Sera from patients awaiting kidney transplantation were tested for HLA antibodies by Luminex PRA-screen, PRA-identification (ID), and PRA-SA assays. The measured %PRA from the PRA-screen (N=55) and PRA-ID (N=71) were compared to the %CPRA for the unacceptable antigens obtained from PRA-SA. RESULTS: Phenotype frequencies used for the CPRA calculator agreed with previously reported data. The concordance rates among the 3 PRA methods for the detection of class I and class II antibodies were 76.1-81.8% (kappa, 0.519-0.636) and 72.7-83.6% (0.463-0.650), respectively. For the detection of broadly sensitized sera (>50% or >80%), the concordance rates were over 80%. In sera with 80-100% CPRA, 91.7% and 94.4% of the samples had concordant results (80-100% PRA) in the PRA-screen and PRA-ID assay, respectively. CONCLUSIONS: Although further clinical studies are required to confirm the benefits of CPRA values, adoption of CPRA analysis based on HLA frequencies in Koreans may be useful for sensitization measurements and organ-allocation algorithms.

A case of mucolipidosis II presenting with prenatal skeletal dysplasia and severe secondary hyperparathyroidism at birth / 소아과

Mucolipidosis II (ML II) or inclusion cell disease (I-cell disease) is a rarely occurring autosomal recessive lysosomal enzyme-targeting disease. This disease is usually found to occur in individuals aged between 6 and 12 months, with a clinical phenotype resembling that of Hurler syndrome and radiological findings resembling those of dysostosis multiplex. However, we encountered a rare case of an infant with ML II who presented with prenatal skeletal dysplasia and typical clinical features of severe secondary hyperparathyroidism at birth. A female infant was born at 37(+1) weeks of gestation with a birth weight of 1,690 g (T (p.Arg1031X) and c.3456_3459dupCAAC (p.Ile1154GlnfsX3), the latter being a novel mutation. The infant was treated with vitamin D supplements but expired because of asphyxia at the age of 2 months.

Outpatient Follow-up Status and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants

PURPOSE: To report the follow-up status and neurodevelopmental outcomes of extremely low birth weight (ELBW) survivors at 18 months' corrected age (CA). METHOD: We performed a retrospective study of 130 ELBW infants admitted to neonatal intensive care unit of Seoul National University Children's Hospital between January 2005 and May 2009. The follow-up status and neurodevelopmental outcomes were evaluated until the CA of 18 months. The assessment of outcomes included cerebral palsy, cognitive developmental delay, blindness, deafness and catch-up growth. Clinical data were collected to identify the factors influencing neurodevelopmental disability. RESULTS: Of the 130 survivors at discharge, 122 (93.8%) participated in the follow-up at 18 months' CA. Study characteristics included a mean birth weight of 783 g and a mean gestation of 27 weeks. One hundred and eleven infants (85.4%) were evaluated for cerebral palsy (CP) and 11 (9.9%) were identified with CP. Eighty five infants (74.6%) were assessed with the Bayley Scales of Infant Development-III (BSID-III) at 8 months' CA and 2 (2.4%) had a cognitive scale <70. Fifty four infants (41.9%) were assessed with BSID-III at 18 months' CA and 2 (3.7%) had a cognitive scale <70. There were 2 (1.2%) cases of blindness and the case of deafness was not present in this study. The failure of catch-up growth was seen in 40 (32.8%) infants. Severe intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus and shunt insertion were the most important risk factors for neurologic abnormality. CONCLUSION: In our institution, neurodevelopmental outcomes of ELBW survivors were comparable to recent reports from the USA. ELBW infants need to be monitored on multidisciplinary follow-up programs and more efforts should be made to improve the follow-up.

Neonatal Mortality and Morbidity of Twin-Twin Transfusion Syndrome

PURPOSE: This study was aimed to evaluate the neonatal mortality and morbidity of infants affected by twin-twin transfusion syndrome (TTTS) compared to the control twins matched for gestational age. Also the perinatal outcomes of donor parts of TTTS twins with their counterpart recipients were compared. METHODS: A retrospective case-control study was conducted from infants born at Seoul National University Children's Hospital and Seoul National University Bundang Hospital between April 2005 and July 2011. Eighteen pairs of TTTS infants were allocated to the TTTS group. The control group consisted of 36 pairs of twin infants unaffected by TTTS who were matched for gestational age. Neonatal deaths and morbidities were recorded. RESULTS: The mortality in TTTS group was significantly higher than control group (27.8% vs. 4.2%, P=0.001). The incidence of acute renal failure (41.2% vs. 9.7%, P or =2 intraventricular hemorrhage (33.3% vs. 11.1%, P=0.012) and grade > or =2 periventricular leukomalacia (24.2% vs. 2.8%, P=0.001) were significantly higher in TTTS group than control group. There was no significant difference in mortality and morbidities between donors and recipients except significantly higher incidence of acute renal failure in donors (70.6% vs. 11.8%, P=0.001). CONCLUSION: Twin infants affected by TTTS have higher risk of neonatal death and several severe morbidities. These results indicate that alert monitoring and checking about possible morbidities are very important in newborns with TTTS and early intervention is critical for improving the overall outcome of the affected infants.

The Significance of Maturation Score of Brain Magnetic Resonance Imaging in Extremely Low Birth Weight Infant

PURPOSE: The aim of this study was to investigate the effect of perinatal risk factors on brain maturation and the relationship of brain maturation and neurodevelopmental outcomes with brain maturation scoring system in brain MRI. METHODS: ELBWI infants born at the Seoul National University Children's Hospital from January 2006 to December 2010 were included. A retrospective analysis was performed with their medical record and brain MR images acquired at near full term. We read brain MRI and measured maturity with total maturation score (TMS). TMS is a previously developed anatomic scoring system to assess brain maturity. The total maturation score was used to evaluate the four parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. RESULTS: Images from 124 infants were evaluated. Their mean gestational age at birth was 27.1+/-2.1 weeks, and mean birth weight was 781.5+/-143.9 g. The mean TMS was 10.8+/-2.0. TMS was significantly related to the postmenstrual age (PMA) of the infant, increasing with advancing postmenstrual age (P<0.001). TMS showed no significance with neurodevelopmental delay, and with brain injury, respectively. CONCLUSION: TMS was developed for evaluating brain maturation in conventional brain MRI. The results of this study suggest that TMS was not useful for predicting neurodevelopmental delay, but further studies are needed to make standard score for each PMA and to re-evaluate the relationship between brain maturation and neurodevelopmental delay.