Changes of Mortality and Morbidity of Very Low Birth Weight Infants after Neonatal Intensive Care Unit Strategy Alteration in a Single Center: Comparison with 2015 Korean Neonatal Network Report

PURPOSE: The purpose of this study was to investigate the outcome after changes in the treatment strategies for very low birth weight infant (VLBWI) in a single neonatal intensive care unit (NICU) center. METHODS: We performed a retrospective review of 300 VLBWI born from 1st January 2010 to 31th December 2016. We compared the outcomes including survival rate, birth weight (BW), gestational age (GA), and morbidities between period I (2010–2013, P-I) and period II (2014–2016, P-II). RESULTS: The average survival rate was not different between P-I and P-II. However, the survival rate of ≤24 weeks' GA, 25 weeks' GA, 26 weeks' GA were 57%, 69%, 93% respectively in P-II and 31%, 59%, 87% in P-I respectively. The survival rate of infants with birth weight <500 g, 500–749 g, 750–999 g were 100%, 55%, 90% respectively in P-II and 50%, 24%, 80%, respectively in P-I. The incidence of bronchopulmonary dysplasia (BPD) was higher in P-II than in P-I (P=0.012) and moderate-to-severe BPD was also higher in P-II (P=0.004). Incidence of patent ductus arteriosus (PDA) with treatment, necrotizing enterocolitis (stage≥2), and abnormal brain sonography were significantly lower in P-II (P=0.027, P=0.032, P=0.005). Incidences of retinopathy of prematurity (ROP) with laser treatment and early sepsis were not different. CONCLUSION: The survival rate and complications of VLBWI were improved in period II, especially in less than 750 g and below 26 weeks, except incidence of BPD. Changes of NICU strategies were effective to improve mortality and morbidity in VLBWI.

Posterior Reversible Encephalopathy Syndrome Accompanied by a Cerebral Hemorrhage and Restricted Diffusion in a Child with Uncontrolled Nephrotic Syndrome / 대한소아신경학회지

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome that is characterized by an acute onset of headache, vomiting, visual abnormalities, confusion, and/or seizures and is typically accompanied with edema of predominantly posterior portions of the cerebral hemispheres. Here, we report a case of PRES with cerebral hemorrhage that occurred in a female pediatric patient with uncontrolled nephrotic syndrome. The patient's magnetic resonance imaging (MRI) studies showed asymmetric white matter abnormalities, cerebral hemorrhage, and restricted diffusion. After controlling her hypertension and nephrotic syndrome, her neurologic symptoms improved, and follow-up MRI findings revealed interval resolving of the white matter lesions.