Clinical significance of alveolar-arterial oxygen gradients for late preterm and full-term infants with acute respiratory distress syndrome / 中国新生儿科杂志

Objective:To study the clinical significance of alveolar-arterial oxygen gradients (P A-aO 2) for late preterm and full-term infants with acute respiratory distress syndrome (ARDS). Methods:From January 2020 to June 2022, infants (gestational age ≥34 weeks) diagnosed with ARDS were admitted to the Neonatology Department of our hospital. The infants were assigned into the invasive group and the non-invasive group according to the ventilation mode. The infants with the same gestational age and diagnosed with neonatal wet lung were assigned into the control group. P A-aO 2 levels within 1 h after birth were compared among the three groups. The correlation of P A-aO 2 with ARDS, ventilation mode and duration were studied. Receiver operating characteristic (ROC) curve was used to determine the predictive value of P A-aO 2 within 1 h after birth for ARDS and the need of invasive ventilation. Results:A total of 36 cases were enrolled in the invasive group, 19 cases in the non-invasive group and 50 cases in the control group. Within 1 h after birth, P A-aO 2 in the invasive group was significantly higher than the non-invasive group and the control group ( P<0.05), and the non-invasive group higher than the control group ( P<0.05). Correlation analysis showed that P A-aO 2 within 1 h after birth in the invasive group was positively correlated with the duration of invasive ventilation and total mechanical ventilation ( r=0.601, P<0.001; r=0.504, P=0.002); P A-aO 2 before successful withdrawal of invasive ventilation was not correlated with subsequent non-invasive ventilation duration; and no correlation existed between P A-aO 2 within 1 h after birth and the duration of non-invasive ventilation in the non-invasive group. The area under the ROC curve for P A-aO 2 within 1 h after birth to predict ARDS was 0.875, with a sensitivity of 87.3% and a specificity of 72.0% at a cutoff value of 50.0 mmHg. The area under the ROC curve for predicting the need for invasive ventilation in infants with ARDS was 0.851, with a sensitivity of 80.0% at a cutoff value of 73.3 mmHg and a specificity of 75.0%. Conclusions:Late preterm and full-term infants have a higher risk of ARDS at P A-aO 2>50.0 mmHg within 1 h after birth. Infants with ARDS are more likely to require invasive ventilation if P A-aO 2>73.3 mmHg. The higher the level of P A-aO 2, the longer the duration of invasive ventilation and total duration of mechanical ventilation.

Study on colonization of Group B Streptococcus in pregnant women of Mongolian and Han nationality and the status of neonatal early-onset septicemia / 中华急诊医学杂志

Objective:To explore the carrier status of group B streptococci (GBS) in pregnant women of Mongolian and Han nationality and the neonatal GBS infection in order to identify the high risk factors of GBS infection in Mongolian and Han newborns in this area.Methods:Totally 7289 pregnant women and their newborns born alive were tested for GBS in the Affiliated Hospital of Inner Mongolia Medical University from June 2017 to June 2020, and their newborns were cultured for GBS, and the venous blood of newborns delivered by GBS positive women were detected for anti-GBS capsular polysaccharide antibody level, in order to determine the high risk factors of neonatal GBS infection.Results:Among the 7289 pregnant women, 3136 were Mongolian pregnant women (2599 full-term delivery and 537 premature delivery) and 4153 were Han pregnant women (3541 full-term delivery and 612 premature delivery). The results of GBS test showed that the GBS carrier rate was 8.19% in the Mongolian preterm delivery group, 4.35% in the Mongolian term group, 11.93% in the Han preterm group, and 5.76% in the Han term group, indicating that the carrier rate of GBS in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality ( P < 0.05). Further comparing the GBS carrier rate of Mongolian and Han pregnant women, the GBS carrier rate of Mongolian pregnant women was significantly lower than that of Han pregnant women regardless of the premature delivery group and term group ( P < 0.05). (2) A total of 434 newborns were born by GBS positive parturients. The positive rates of GBS in Mongolian premature infants, Mongolian full-term infants, Han premature infants and Han full-term infants were 29.55%, 14.16%, 31.51% and 17.65%, respectively, suggesting that the positive rate of GBS in premature infants was significantly higher than that in full-term infants, regardless of Mongolian and Han nationality ( P<0.05). Further comparing the positive rate of GBS in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns, no matter the premature delivery group and the full-term group. (3) This study compared the incidence of early-onset GBS septicemia in Mongolian and Han newborns. The results showed that the incidence of early-onset GBS septicemia in Mongolian premature infants was 23.08%, and none in full-term infants. The incidence of early-onset GBS septicemia in Han premature infants was 26.09%. The incidence of early-onset GBS septicemia in term infants was 5.56%. The incidence of neonatal GBS septicemia in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality. By further comparing the incidence of GBS septicemia in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns regardless of the premature delivery group and the term group. (4) In both Mongolian and Han nationality, the level of anti-GBS capsular polysaccharide antibody in premature infants was significantly lower than that in term infants ( P < 0.05). (5) Regardless of the Mongolian and Han nationality, compared with GBS negative group, GBS positive rate was higher in pregnant women aged≥35 years old, with history of menstruation, miscarriage, vaginitis, floating population, and those who had not undergone pre-pregnancy examination,,which were the high risk factors for GBS-positive pregnant women during pregnancy. (6) In both Mongolian and Han nationality, the incidence of chorioamnionitis, puerperal infection, premature delivery and premature rupture of membranes in the GBS positive group was higher than that in the GBS negative group, and the incidence of fetal distress and neonatal asphyxia in the GBS positive group was also higher than that in the GBS negative group. Conclusions:The carrier rate of GBS in Mongolian pregnant women is lower than that in Han pregnant women, and positive GBS during pregnancy will increase the incidence of adverse maternal and fetal outcomes such as chorioamnionitis, puerperal infection, premature delivery, premature rupture of membranes, fetal distress, neonatal asphyxia and neonatal early-onset GBS septicemia. The high risk factors are maternal age ≥ 35 years old, history of menstruation, abortion, vaginitis, floating population, and infection without pre-pregnancy examination. We should attach great importance to the perinatal high risk factors and formulate corresponding intervention measures accordingly, and make rational use of antibiotics for prenatal prevention, so as to further reduce the incidence of early-onset GBS septicemia in newborns.

Comparison of the predictive value of vasoactive-inotropic score, shock score and lactate level for the outcome of septic shock in term infants / 中国新生儿科杂志

Objective:To study the predictive value of vasoactive-inotropic score (VIS), shock score and lactate level for the outcome of term infants with septic shock.Methods:From January 2019 to October 2020, clinical data of term infants with septic shock admitted to our department were reviewed. According to their clinical outcome, the infants were assigned into the survival group and the deceased group and the differences of the two groups were compared. Logistic regression was used to determine the risk factors of mortality in term infants with septic shock. Receiver operating characteristic curve was used to compare the predictive efficacy of VIS, shock score and lactate level for the outcome of septic shock.Results:Significant differences existed between the survival group and the deceased group in the following: maximum VIS, maximum shock score, maximum lactate level, the mean value of VIS during the second 24 h, the mean value of lactate during the first and second 24 h ( P < 0.05). Meanwhile, maximum VIS ( OR = 1.038, 95% CI 1.014~1.063), maximum shock score ( OR = 2.372, 95% CI 1.126~4.999) and the mean value of lactate during the first 24h ( OR = 2.983, 95% CI 1.132~7.862) were correlated with mortality in the infants ( P < 0.05). The area under the curve of maximum VIS was the most prominent, with 58.5 as cut-off. Conclusions:Among the three indicators, VIS has the best predictive value for mortality outcome in term infants with septic shock, followed by shock score and lactate level.

"Vou para casa. E agora?" A difícil arte do Método Canguru no domicílio / Me voy a mi casa ¿Y ahora qué pasa? El difícil arte del Método Canguro en el domicilio / "I'm going home. And now?" The difficult art of the Kangaroo Method at home

Objetivo: conhecer a experiência dos pais na aplicação do Método Canguru no domicílio. Método: pesquisa qualitativa cujos dados foram obtidos entre março e dezembro de 2016, por meio de entrevistas com 12 mães e três pais de recém-nascidos pré-termos e/ou baixo peso, participantes da terceira etapa do Método Canguru, que foram submetidas à técnica de análise de conteúdo temática. Resultados: os pais mantiveram a posição canguru no domicílio. Apesar de cada família desenvolvê-la de forma diferente, não deixaram de realizá-la. Também conseguiram adaptar-se à nova rotina de cuidados com a chegada do filho em casa e relataram satisfação com as consultas da terceira etapa e de seguimento realizadas no hospital. Conclusão: os pais, mesmo diante dos desafios diários com os cuidados no domicílio, detêm uma significação clara sobre a importância da Posição Canguru para os recém-nascidos pré-termos e/ou baixo peso e sua capacidade de impactar na qualidade do cuidado oferecido.

Objective: to get to know the parents' experience in applying the Kangaroo Mother Care at home. Method: qualitative research with data obtained between March and December 2016, by means of interviews with 12 mothers and three fathers of preterm and/or low-birth-weight newborns, participants in the third stage of the Kangaroo Method. The interviews were submitted to thematic content analysis technique. Results: the parents maintained the kangaroo position at home. Although each family developed it differently, they have not failed to implement it. They were also able to adapt to the new care routine with the arrival of the child at home and reported satisfaction with the medical appointments of the third stage and the follow-up carried out at the hospital. Conclusion: the parents, despite the daily challenges with home care, have a clear meaning about the importance of the Kangaroo Position for preterm and / or low-birth-weight newborns and its ability to affect the quality of care offered.

Objetivo: conocer la experiencia de los padres durante la puesta en práctica del Método Canguro en el domicilio. Método: investigación cualitativa cuyos datos se obtuvieron entre marzo y diciembre de 2016, por medio de entrevistas con 12 madres y tres padres de recién nacidos pretérminos y/o bajo peso, participantes de la tercera etapa del Método Canguro, que se sometieron a la técnica de análisis de contenido temático. Resultados: los padres mantuvieron la posición canguro en el domicilio. Aunque cada familia la haya desarrollado de forma diferente, no dejaron de realizarla. También lograron adaptarse a la nueva rutina de cuidados con la llegada del hijo a casa y relataron satisfacción con las consultas de la tercera etapa y de seguimiento realizadas en el hospital. Conclusión: los padres, aunque estén ante los desafíos diarios con los cuidados en el domicilio, detienen una preocupación clara sobre la importancia de la Posición Canguro para los recién nacidos pretérminos y/o bajo peso y su capacidad de afectar la calidad del cuidado ofrecido.

A comparison between preterm and full-term infants' preference for faces / Uma comparação entre recém-nascidos prematuros e a termo na preferência por faces

Abstract: Objective: Visual preference for faces at birth is the product of a multimodal sensory experience experienced by the fetus even during the gestational period. The ability to recognize faces allows an ecologically advantageous interaction with the social environment. However, perinatal events such as premature birth, may adversely affect the adequate development of this capacity. In this study, we evaluated the preference for facial stimuli in preterm infants within the first few hours after birth. Methods: This is a cross-sectional observational study of 59 newborns, 28 preterm and 31 full-term infants. The babies were assessed in the first hours of life, with two white boards in the shape of a head and neck: one with the drawing of a face similar to the human face (natural face), and one with the drawing of misaligned eyes, mouth and nose (distorted face). After the newborn fixated the eyes on the presented stimulus, it was slowly moved along the visual field. The recognition of the stimulus was considered present when the baby had eye or head movements toward the stimulus. Results: The preterm infants, in addition to showing a lower occurrence of orientation movements for both stimuli, on average (1.8 ± 1.1 to natural faces and 2.0 ± 1.2 for distorted ones) also showed no preference for any of them (p = 0.35). Full-term newborns showed a different behavior, in which they showed a preference for natural faces (p = 0.002) and a higher number of orientations for the stimulus, for both natural (3.2 ± 0.8) and distorted faces (2.5 ± 0.9). Conclusion: Preterm newborns recognize facial stimuli and disclose no preference for natural faces, different from full-term newborns.

Resumo: Objetivo: A preferência visual por faces ao nascimento é produto de uma experiência sensorial multimodal vivenciada pelo feto ainda no período gestacional. A habilidade de reconhecer faces possibilita uma interação ecologicamente vantajosa com o ambiente social. Entretanto, eventos perinatais, como o nascimento prematuro, podem prejudicar o desenvolvimento adequado dessa habilidade. Neste trabalho, avaliamos a preferência por estímulos faciais de recém-nascidos prematuros nas primeiras horas após o nascimento. Métodos: Trata-se de um estudo observacional transversal feito com 59 recém-nascidos, 28 prematuros e 31 nascidos termos. Os bebês foram avaliados, nas primeiras horas de vida, com duas pranchas brancas em formato de cabeça e pescoço: uma com o desenho de uma face similar ao rosto humano (face natural) e outra com o desenho de olhos, boca e nariz desalinhados (face distorcida). Após o recém-nascido fixar o olhar no estímulo apresentado, era lentamente movimentado ao longo do campo visual. O reconhecimento do estímulo foi considerado presente quando o bebê apresentou movimentos dos olhos ou cabeça em direção ao estímulo. Resultados: Os recém-nascidos prematuros, além de apresentar menor ocorrência de movimentos de orientação para ambos os estímulos, em média (1,8 ± 1,1 para faces naturais e 2 ± 1,2 para faces distorcidas), também não apresentaram preferência por qualquer um deles (p = 0,35). Diferente foi o comportamento dos recém-nascidos a termo, que apresentaram preferência por faces naturais (p = 0,002) e um número maior de orientações para o estímulo, tanto para faces naturais (3,2 ± 0,8) quanto para faces distorcidas (2,5 ± 0,9). Conclusão: Recém-nascidos prematuros reconhecem os estímulos faciais e não apresentam preferência por faces naturais, diferentemente de recém-nascidos a termos.

Measurement of tidal respiration in ＜ 34 weeks premature infants with respiratory clistress syndrome at 40 weeks corrected gestational age / 中华急诊医学杂志

Objective To investigate pulmonary function in terms of tidal respiration and the influencing factors on it in ＜ 34 weeks premature infants with RDS at corrected gestational age of 40 weeks.Methods A total of 49 of ＜ 34 weeks premature infants with RDS (RDS group) and 36 of ＜ 34 weeks premature infants without RDS (non-RDS group) followed throughout entire twelve months were collected fromn December 2013 to October 2015.Of them,35 RDS patients and 20 non-RDS patients had the pulmonary function examination.A total of 26 full term infants with hyperbilirubinemia (full term group) were recruited for comparison study.The differences in parameters of tidal respiration were compared among the three groups.The RDS patients were further divided into the mild RDS subgroup and severe RDS subgroup according to the severity of illness.Result ①The TPEF [(0.17 ± 0.04) s vs.(0.23 ± O.09) s],VPEF [(6.74±2.70) mLvs.(9.33±2.92) mL],TPEF/TE [(29.06±4.21)％ vs.(38.27± 7.16) ％],VPEF/VE [(32.54 ± 4.43) ％ vs.(39.64 ± 5.88) ％] in RDS group were significantly lower than those in full term group (P ＜0.05).The TPEF [(0.19 ±0.06) s vs.(0.23 ±0.09) s],TPEF/TE [(30.31 ±11.53)％ vs.(38.27±7.16)％],VPEF/VE [(34.39±8.44)％ vs.(39.64±5.88)％] in non-RDS group were significantly lower than those in full termn group (P ＜ 0.05).The TPEF,TPEF/TE,VPEF/VE in RDS group were lower than those in non-RDS group,but the differences were not significant (P ＞ 0.05).②The TPEF,VPEF,TPEF/TE,VPEF/VE in mild RDS group were higher than those in severe RDS group,but the differences were.not significant (P ＞ 0.05).③ Logistic regression analysis indicated that the gestational age was the protective factor of pulmonary function in premature infants with RDS.Conclusions Small airway resistance in ＜ 34 weeks premature infants with RDS is higher than that in full term infants.There was no significant difference in pulmonary function between RDS premature infants and non-RDS premature infants.The gestational age was the influencing factor of pulmonary function in premature infants with RDS.

Risk factors and prevention of neonatal respiratory distress / 中国小儿急救医学

In recent years, with the increase of elective cesarean section rate and other factors,the rate of neonatal respiratory distress in full-term neonates is rising,which has aroused widespread concern.The risk factors and related mechanisms of respiratory distress syndrome in full-term infants were reviewed from two aspects of maternal and infant.Selective cesarean section, gestational age, fetal sex and some pregnancy complications can affect the rate of respiratory distress syndrome in full-term infants.Timely use of respiratory support and early use of pulmonary surfactant, and the combined use of comprehensive measures can reduce the mortality of neonatal respiratory distress syndrome rate.

Impact of early repetitive painful procedures on pain response in full-term infants / 中华实用儿科临床杂志

Objective To explore the impact of early repetitive painful procedures on subsequent pain behaviors and physiological indicators in full-term infants.Methods Sixty-two full-term neonates were enrolled (male 36 cases,female 26 cases) from the medical center of neonatal care at Nanjing Children's Hospital Affiliated to Nanjing Medical University from March to May in 2009.The data of all painful procedures were performed on those neonates and their responses to them were collected by using digital video recording were collected.The Neonatal Facial Coding System C(NFCS) and Neonatal Infant Pain Scale(NIPS) were used prospectively to evaluate the pain response to painful procedures.Results The average experience of pain caused by operation on newborn at the hospital was 56.5 times (12-249 times),and the daily average was 5.9 times (4-26 times).After they were exposed to more than 10 repetitive pain procedures,the full-term neonates showed the declining pain response assessed by NFCS and NIPS during the subsequent painful procedures (NFCS:P10=0.012,P20=0.015,P30=0.041;NIPS:P10=0.006,P20=0.015,P30=0.049),and the temporarily enhanced pain response was observed in the preparation phase of the subsequent painful procedures (NFCS:P2＜0.001,P3＜0.001,P4=0.004,P5=0.009;NIPS:P2＜0.001,P3＜0.001,P4=0.045,P5 =0.031).Bnt there was no difference in preparation phase.There was no alternation in latency and crying time after repetitiing painful procedures,but the proportion of crying neonates in the preparation phase of the painful procedures was increased(P=0.032).Conclusions After exposed to repetitive pain,full-term neonates expressed hypoalgesia during subsequent painful procedures,but the temporary irritation was enhanced during the following phases exposed to stress.

Nutritional Strategies for Optimal Growth of Small for Gestational Age Infants: Updates / 대한주산의학회잡지

Babies born small for gestational age (SGA) are at risks of developing growth failure and impaired neurodevelopment as long-term outcomes when nutritional supply is inadequate during postnatal period. However, metabolic outcomes and cardiovascular risks later in life also do matter when excessive nutritional intake induces rapid catch-up growth after birth. Preterm infants born SGA and still small at hospital discharge need more nutrients than term infants to catch up within the first 2 years, whereas term infants born SGA should be cautious in gaining weight anytime. Therefore, nutritional strategies for optimal growth of SGA infants should be planned individually based on evidences.

Advances in research on the early and late effect of delayed umbilical cord clamping on neonatal / 国际儿科学杂志

Neonatal is separated from the maternal by clamping the umbilical cord after delivery.And traditionally,the clinical practice is clamping the umbilical cord immediately after delivery.With the futher study of optimal timing of umbilical cord clamping,the effect of delayed umbilical cord clamping attracts more and more attention.This paper discussed about the subject of the early and late effect of delayed umbilical cord clamping on neonatal.We found that a briefly delay in clamping the umbilical cord increased the placental transfusion and blood volume,decreased the prevalence of anemia,promoted the stability of circulation and internal environment,without adversely affecting health of neonatal.

Changes in cortisol, adrenocorticotropic hormones in term infants with critical illness and their clinical significance / 中华实用儿科临床杂志

Objective To investigate the changes in cortisol, adrenocorticotropic hormones (ACTH) in term infants with critical illness and to evaluate their functional status.Methods One hundred and fifty term infants who were transferred to the hospital within 72 hours after birth were involved (gestational age ≥ 37 weeks).These term infants were evaluated by neonatal critical illness scores (NCIS) at the time of admission, and they were divided into a mild group and a severe group according to the NCIS scores.Serum cortisol and ACTH concentrations were measured at the time of admission on day 7 and day 14 after birth.Results (1) Within 72 hours after birth, the basic serum cortisol concentration of severe illness infants [(283.5 ± 196.0) μg/L] was significantly higher than that of the infants with mild illness[(175.0 ± 186.5) μg/L], and there was a significant difference (t =-3.830, P =0.000).The basic serum cortisol concentration of the term infants with severe illness was higher than that of the term infants with mild illness,but there was no significant difference[7 d:(94.1 ±41.3) μg/L vs (62.5 ±37.9) μg/L,14 d:(68.6 ±47.7)μg/L vs (50.9 ± 38.4) μg/L, all P ＞ 0.05].(2) Among the infants with critical illness, the basic serum cortisol concentration within 72 hours after birth was significantly higher than those of day 7 and day 14 after birth (t--5.994, 2.848;P =0.000,0.036).(3) Among the mild infants, the basic serum cortisol concentration within 72 hours after birth was significantly higher than those of day 7 and day 14 after birth (t =4.691,3.076;P =0.000,0.037).(4) The basic serum ACTH concentrations had no significant difference between the severe group and the mild group[≤72 h: (101.55±61.52) ng/Lvs (85.54±59.83) ng/L,7 d:(54.91±22.75) ng/Lvs (71.07±20.51) ng/L,14 d: (44.67 ± 28.30) ng/L vs (44.92 ± 24.68) ng/L, all P ＞ 0.05].(5) The serum cortisol and ACTH concentration within 72 hours after birth of the dead infants[(351.9 ± 179.7) μg/L, (215.5 ± 165.9) ng/L] were significantly higher than those of the survivors [(201.4 ± 161.4) μg/L, (83.5 ± 54.0) ng/L], and there were significant differences(t =-2.547,-3.833;P =0.012,0.000).(6) The basic serum cortisol concentration within 72 hours after birth had a negative correlation with NCIS(r =-0.293, P =0.043), pH (r =-0.336, P =0.000) and base excess (BE) (r =-0.261 ,P =0.002);but it had a positive correlation with ACTH concentration within 72 hours after birth (r =0.443 ,P =0.000).The serum basic ACTH within 72 hours after birth had a negative correlation with BE (r =-0.181 ,P =0.031) ,and had positive correlation with the basic serum cortisol concentration within 72 hours and day 7 (r =0.443,0.268;P =0.000,0.048).Conclusions The term infants have the ability to response to external stimuli by regulating cortisol secretion.The basic serum cortisol concentration of term infants is related to the critical illness.The worse the condition is,the higher the base serum cortisol concentration is.

Clinical observation and nursing care of calf pulmonary surfactant for injection on respiratory distress syndrome in full term infant of cesarean section / 中国实用护理杂志

Objective To evaluate the efficacy and safety of calf pulmonary surfactant for injection on respiratory distress syndrome (RDS) in full term infant of cesarean section.Methods A total of 30 RDS in full term infant of cesarean section were divided into 2 groups according to family members intend.A group with 17 cases was given endotracheal drip into the calf pulmonary surfactant for injection and breath machine treatment according to the illness needs.B group with 13 cases was given the same treatment with A group except for calf pulmonary surfactant for injection.The changes of blood gas analysis before and after treatment,mechanical ventilation time,X-ray recovery time and hospital stays were compared between 2 groups.Results Arterial blood oxygen partial pressure after treatment in A,B group were (75.6±16.2),(54.8±12.4) mmHg (1 mmHg=0.133 kPa),and there was significant difference between 2 groups,t=3.84,P＜0.01.The incidence of cure,ventilation related lung injury and oxygen time needs,hospital stays were 16/17,1/17,(3.2±1.4) d,(7.2±1.8) d in A group,and 7/13,6/13,(5.6±2.1) d,(14.7±2.4) d in B group,and there were significant differences,P＜0.05 or ＜0.01.Conclusion Calf pulmonary surfactant for injection in treatment of RDS in full term infant of cesarean section,which is safe and effective and is worthy of promotion.

Vitamin D in Full-term Neonates in Daegu and Gyeongbuk Province of Korea and the Association with Maternal and Neonatal Diseases / 대한주산의학회잡지

PURPOSE: This study aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of full-term neonates in Daegu and Gyeongbuk province of Korea to determine the association between maternal and neonatal diseases, known to be affected by low 25(OH)D3 levels. METHODS: Serum 25(OH)D3 levels were evaluated in full-term neonates (n=122) who were born at Kyungpook National University Hospital. Normal full-term neonates (control group, n=38) were classified by sex, season of birth, and delivery mode (normal or caesarean section). Serum 25(OH)D3 levels in neonates (n=84) with maternal diseases (gestational diabetes mellitus, hypothyroidism, pregnancy induced hypertension, premature rupture of membrane and systemic lupus erythematosus) and neonatal diseases (small for gestational age, transient tachypnea of newborn and pneumonia) were compared with those in control group. RESULTS: The mean serum 25(OH)D3 level in the control group was 9.2+/-5.0 ng/mL. There were no statistically significant differences of serum 25(OH)D3 level between the control group and the disease group. In the control group, 63.2% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 34.2% referred to vitamin D insufficiency. In the maternal disease group and the neonatal disease group, 56.1% and 63.0% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 35.0% and 33.3% referred to vitamin D insufficiency. CONCLUSION: High percentages of neonates were found to be deficient or insufficient in vitamin D. Although low 25(OH)D3 levels have previously been associated with maternal and infant diseases, the association was not observed in this study.

Effect of delayed cord clamping in term infants:a meta-analysis / 临床儿科杂志

Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.

Comparison of Clinical Findings of Gastric Perforation between Preterm and Term Neonates / 대한주산의학회잡지

PURPOSE: The purpose of this study was to compare the clinical findings and mortality of gastric perforation between preterm and term infants. METHODS: The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastric perforation between July 1992 and June 2012, were reviewed retrospectively. The admission records of clinical findings and mortality were reviewed and statistically analyzed between preterm and term infants. RESULTS: Nine infants were diagnosed with neonatal gastric perforation. Of the nine infants, the number of term infants was five and the number of male was eight. Of the four infants diagnosed with spontaneous gastric perforation, the number of preterm and term infants was three and one respectively. The anatomical location of perforation was greater curvature in all four preterm infants. However, various sites such as greater curvature (three infants) and antrum (two infants) were observed in five term infants. Mortality rate was tended to be lower in preterm infants compared to term infants, without statistical significance (25.0% vs. 40.0%, P>0.1). There was no mortality in four infants diagnosed with spontaneous gastric perforation. However, two infants diagnosed with necrotizing enterocolitis (NEC) all died. CONCLUSION: There was no significant difference in clinical findings and mortality of gastric perforation between preterm and term infants. The prognosis of spontaneous gastric perforation was good, however, mortality rate was tended to be higher in NEC than other causes (P=0.083).

Decreased heart sound in a healthy newborn: Spontaneous multiseptated cystic pneumomediastinum with delayed respiratory distress / 소아과

Spontaneous pneumomediastinum in the absence of predisposing risk factors has been rarely observed in full-term neonates. A 3-day-old neonate, delivered vaginally at term without any perinatal complications or signs of respiratory difficulty, was referred to the Seoul National University Children's Hospital because of reduced heart sound detected during routine neonatal examination. Chest computed tomography (CT) showed air collection in the anterior mediastinum. The baby developed respiratory distress on the fourth day and required supplemental oxygen. On the seventh day, there was no sign of respiratory difficulty, and x-ray examination showed no demonstrable pneumomediastinum. Hence, careful neonatal physical examination is essential during the postnatal assessment of newborns, and spontaneous pneumomediastinum should be considered when a healthy newborn presents with reduced heart sound.

Staphylococcus epidermidis Necrotizing Pneumonia and Pneumatocele in a Term Infant

Staphylococcus epidermidis is emerging as an increasingly important pathogen in the immunocompromised host. We report here a case of S. epidermidis necrotizing pneumonia complicated by pneumatoceles in a term male infant who had earlier undergone surgical repair of tracheo-esophageal fistula. He was treated with intravenous teicoplanin and gentamicin for four weeks followed by two weeks of erythromycin. No percutaneous aspiration or pleural drainage was required. He had complete clinical and radiologic recovery when seen at follow-up six months later. Aggressive antimicrobial therapy for this condition without surgical drainage resulted in complete resolution and avoided complications such as pneumothorax and bronchopleural fistula.

Readmission in Neonatal Period among the Normal Full-term Neonates / 대한주산의학회잡지

PURPOSE:This study was conducted to analyse the characteristics of the full-term neonates admitted in neonatal period and to evaluate the relationship between readmission and perinatal, maternal factors. METHODS:We studied retrospectively the neonatal readmissions who were born in Il Sin Christian Hospital during the 18-months period (January 1, 2007 to June 30, 2008). RESULTS:After discharge, 415 neonates were readmitted during the first month of life. The most common cause for readmission was jaundice (82.7%). Among them, 211 (61.5%) neonates were fully breast feeding and 119 (34.7%) were mixed feeding infants. The second cause was rota enteritis (6.3%). Others included dehydration (4.1%), suspected sepsis (3.1%), other enteritis (1.7%), pneumonia (0.7%), cardiac problem (0.5%), meningitis (0.5%), urinary tract infection (0.2%), and other urinary problem (0.2%). There were no significant relationships between readmission and neonatal, maternal factors. CONCLUSION:While newborns discharged from hospital are at risk for readmission, but relationship among neonatal, maternal, and other factors are not proven. Education of risk factors for jaundice to parents should be done and prevention of hospital acquired infection is important. Further research should include relationships between neonatal, maternal factors and the other factors influencing neonatal readmission.

A Case of Transient Acrodermatitis Enteropathica in A Breast-fed Full-term Infant / 대한피부과학회지

A 5 month-old, breast-fed, full-term female infant presented with an acral and periorificial dermatitis. Her serum zinc level was low. Her mother's serum zinc level was normal and breast milk zinc was slightly reduced. The infant responded rapidly to zinc therapy. After interruption of zinc therapy, she showed slightly reduced zinc levels, but no relapse, while receiving powdered milk and other baby foods. To maintain zinc serum level, zinc was readministered for 4 weeks. Follow-up zinc levels were normal after discontinuation of the zinc readministration. A diagnosis of transient acrodermatitis enteropathica was made based on the above findings.

Frequency and Clinical Outcome of the Respiratory Tract Disease in Full-term Infant

PURPOSE: To investigate the frequency of underlying diseases associated with respiratory distress in full-term infants, as well as its relation to the mode of delivery and clinical outcomes. METHODS: We conducted a retrospective review of 4,264 infants who had been admitted to the neonatal intensive care unit (NICU) of Chonnam University Hospital (CUH) over 5 years from January 2000 to December 2004. Full-term infants with respiratory distress such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), congenital pneumonia, meconium aspiration syndrome (MAS) and pneumothorax were included. We analysed the incidence of underlying disease, its relation to the mode of delivery, rate of mechanical ventilator therapy, prevalence of hypoxic ischemic encephalopathy (HIE), mortality and the length of hospitalization of surviving patients. RESULTS: Of the 4,264 patients who admitted to the NICU of CUH over the last five years, preterm infants made up 2,278 (53.4%) and full-term infants made up 1,982 (46.5%). The number of full-term patients who admitted due to respiratory distress associated with respiratory system problems excluding a congenital anomaly was 246 (12.4%). The most common underlying disease was TTN (n=161, 65.4%), and the next was RDS (n=39, 15.9 %), congenital pneumonia (n=11, 4.5%), MAS (n=7.9, 8.5%), and pneumothorax (n=14, 5.7 %). RDS was more statistically common in full-term infants born by Caesarian section (P<0.05). But there was no difference according to the mode of delivery statistically in other respiratory tract diseases. The rate of mechanical ventilator therapy was significantly higher in RDS and MAS, and the prevalence of HIE was higher in MAS (P<0.05). Mortalities of RDS and MAS were 7.7% and 9.5% each. There was no significant difference in the length of hospitalization of surviving patients. CONCLUSION: TTN was the most common respiratory tract disease in the full-term infant, and RDS was more common in the infant who was born by Cesarean section. The rates of mechanical ventilator therapy and mortality were significantly higher in the infants with RDS and MAS, and HIE was exclusively manifested by infants with MAS.