Effective Strategies for the Prevention of Nosocomial Sepsis in Extremely Premature Infants / 한양의대학술지

Nosocomial sepsis or late onset sepsis is among the leading causes of mortality and morbidity in extremely low birth weight infants hospitalized to neonatal intensive care units (NICU). Prevention of nosocomial sepsis is based on strategies that aim to limit susceptibility to infections by enhancing functional maturities, and ameliorating extrinsic risk factors by limiting transmission of organisms and by promoting the judicious use of antimicrobials. Several clinical strategies which are available include; hand hygiene practices; prevention of central venous catheter-related septicemia; judicious use of therapeutic or prophylactic antimicrobials; proper skin care; and early trophic enteral feeding with human milk. The implementation of these proper clinical strategies and maintaining of surveillance system in individual NICU for prevention of nosocomial infection is quite effective and important to reduce the incidence of noscomial sepsis of extremely premature infants and ultimately to improve their survival and quality of life.

Antenatal Steroid Treatment to Prevent Early Non-oliguric Hyperkalemia in Extremely Low Birth Weight (ELBW) Infants / 医学研究杂志

Objective To explore the effect of prenatal steroid (PNS) treatment on preventing early severe non-oliguric hyperkalemia in Extremely-Low-Birth-Weight (ELBW) infants.Methods Retrospective comparative analysis was performed on 31 ELBW infants who had been admitted to the hospital’s NICU between July 2001 and Jun 2005. Infants whose mothers received a full course of steroids before delivery (PNS group; n=18) were compared with those infants whose mothers did not receive steroids (NSG group; n=13). Infants were included in the PNS group if their mother was given one full course of dexamethasone ( 10 mg q12h4 doses) before delivery. The last dose must have been given at least 24 hours before delivery. The arterial blood gas , serum concentrations of potassium, sodium and creatinine were measured every 24 hours, and fluid intakes, urine outputs were monitored every day. Results Hyperkalemia was significantly lower in the PNS than in the NSG infants at the first 72 hours of age [5/18 cases ( 27.78%) vs 9/13 cases (69.23%)],P=0.023). However, the serum concentrations of sodium, creatinine, fluid intakes, urine outputs were not significantly difference in both groups. Conclusions Prenatal steroids treatment can reduce early severe non-oliguric hyperkalemia in EVBL infants.

A Survival Case of a 630 gram Extremely Low Birth Weight Neonate after Surgery for the Small Bowel Perforation

The surgical care of neonates, born weighing less then 1000 gram (Extremely Low Birth Weight; ELBW), is a very challenging problem to the pediatric surgeons. We report a survival case in which a successful operation for the spontaneous intestinal perforation was performed at the time when the baby weighed 630 g after 25.6 weeks' gestation. The child not only survived but also appears developmental normal at two years of age. The case is the smallest reported survivor in Korea after surgery. The cooperation between the pediatric surgeon and neonatologist is very important in the surgical management of ELBW neonate.

Recent Outcome of Extremely Low Birth Weight Infants at Asan Medical Center

PURPOSE: Survival rate of infants weighing less than 1, 000 g has been increased due to advanced neonatal care. We evaluated the outcome of extremely low birth weight (ELBW) infants who were born at Asan Medical Center. METHODS: We retrospectively reviewed survival, morbidities, and catch-up growth of the 105 ELBW infants from 1999 to 2002. RESULTS: Overall survival rate of ELBW infants was 65.7%. In respect to birth weight, the survival rates for or = grade III, periventricular leukomalacia, severe retinopathy of prematurity > or = stage III and clinical or proven sepsis were 8.7%, 4.3%, 47.8%(n=33), 69.6%, respectively. 29 infants required laser photocoagulation due to retinopathy of prematurity. Duration of total parenteral nutrition (TPN) was 44.0 +/- 22.3 days. The incidences of TPN-associated cholestasis and necrotizing enterocolitis were 34.8%, 7.2%, repectively. At 18 months, 78.3% of ELBW infants showed catch-up growth. CONCLUSION: Survival rate of ELBW infants was 65.7%, which was much improved but lower than that of western and Japanese outcome. Further efforts must be made to increase their survival rates and to reduce morbidities.