Maternal and Neonatal Outcome of Twin Pregnancies after in vitro Fertilization and Embryo Transfer

PURPOSE: To examine various neonatal outcomes and perinatal factors resulting from assisted reproduction compared to that of spontaneous conception. METHODS: This is a retrospective study. The control cases were all twins of spontaneous conception born between periods from January 1995 to June 2000. The study cases were identified from twins conceived by assisted reproduction in the same time peried. A total of 460 sets of twins consisted of 250 twins of spontaneous conception and 156 twins of assisted reproduction were studied. The primary outcomes were neonatal morbidity and mortality and the secondary outcomes were perinatal factors including number, length and cost of hospitalization for the delivery. RESULTS: No differences were seen in various neontal factors including gestational age, birth weight and incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, hyperbilirubinemia, sepsis, intraventricular hemorrhage and the length of hospitalizations. Lower one minute and five minute Apgar scores and frequently encountered electrolyte abnormalities were observed in neonates of assisted reproduction. In general, the second twin of assisted reproduction had increased incidences of respiratory distress syndrome, sepsis and necrotizing enterocolitis than the first twin. Increased frequencies of preterm labor, hospitalization and elective cesarean section were seen among mothers who underwent artifical conception. However, overall hospital costs in terms of mothers hospitalization for the delivery and neonates hospitalization did not show differences. CONCLUSION: Assisted reproduction twins had similar neonatal morbidities, mortalities and perinatal morbidities compared to those born by spontaneous conception.

Diagnostic Efficacy of Anorectal Manometry for the Diagnosis of Hirschsprung's Disease / 대한소아소화기영양학회지

PURPOSE: As diagnostic tools for Hirschsprung's disease (HD), barium enema and rectal biopsy have radiation exposure and invasiveness respectively; however anorectal manometry does not have these disadvantages. We therefore performed this study to evaluate the diagnostic efficacy of anorectal manometry. METHODS: We reviewed medical records of infants with one or two symptoms of vomiting, abdominal distension, chronic diarrhea or constipation who had a anorectal manometry followed by barium enema and/or biopsy from July 1995 to May 2002. We evaluated the sensitivity, specificity and predictive value of anorectal manometry and barium enema for diagnosis of HD. We also measured sphincter length, median value of balloon volume at which rectoanal inhibitory reflex (RAIR) occurred. RESULTS: All 61 patients received anorectal manometry, 33 of 61 received barium enema. 18 of 61 were diagnosed as HD according to histology and 43 of 61 were evaluated as a control. The sensitivity, specificity, positive predictive value, negative predictive value of anorectal manometry and barium enema for diagnosis of HD were 1.00, 0.91, 0.82, 1.00 and 0.93, 0.67, 0.70, 0.92 respectively. The mean value of sphincter length in control was 1.68+/-0.67 cm and correlated with age, weight and significantly longitudinal length. The median value of balloon volume at which RAIR occurred was 10 mL and did not correlated with age, weight and longitudinal length. CONCLUSION: This study suggests that anorectal manometry is an excellent initial screening test for Hirschsprung's disease because of its safety and accuracy.

Delayed Intraventricular Hemorrhage in Premature Infants

PURPOSE: To determine incidence, characteristics and risk factors associated with delayed intraventricular hemorrage (IVH) in infants under 34 weeks old. METHODS: The medical records of infants with IVH admitted to neonatal intensive care unit of Asan Medical Center from January 1999 to December 2001 were reviewed retrospectively. Infants whose IVH was detected within 7 days of life and after 21 days of life were defined as "early hemorrahge group" and "delayed hemorrhage group", respectively. Various antenatal and neonatal factors were compared between these groups and risk factors leading to delayed IVH were identified. RESULTS: The incidence of delayed IVH was 28/103 (27.2%). The mean gestational age in delayed hemorrhage was 29.2+/-2.8 weeks. Lower birth weight, higher use of postnatal dexamethasone, antenatal dexamethasone and umbilical venous lines were noted in delayed hemorrhage group. Laboratory values associated with delayed IVH included lower platelet counts and hematocrit. Risk factors associated with delayed IVH included low hematocrit and elevated uric acid. Severe IVH (grade III, IV) occurred more in early hemorrhage group and subsequent 12 months follow-up showed developmental delay in 3 (4.0%) and 1 (3.6%) in early and delayed hemorrhage group, respectively. CONCLUSION: Frequent delayed hemorrhage may occur in infants under 34 weeks old. Although degree of delayed IVH is relatively milder than early hemorrhage group, its association with developmental delay merits follow-up head ultrasonogram up to at least 1 month of age or even longer.

Delayed Intraventricular Hemorrhage in Premature Infants

PURPOSE: To determine incidence, characteristics and risk factors associated with delayed intraventricular hemorrage (IVH) in infants under 34 weeks old. METHODS: The medical records of infants with IVH admitted to neonatal intensive care unit of Asan Medical Center from January 1999 to December 2001 were reviewed retrospectively. Infants whose IVH was detected within 7 days of life and after 21 days of life were defined as "early hemorrahge group" and "delayed hemorrhage group", respectively. Various antenatal and neonatal factors were compared between these groups and risk factors leading to delayed IVH were identified. RESULTS: The incidence of delayed IVH was 28/103 (27.2%). The mean gestational age in delayed hemorrhage was 29.2+/-2.8 weeks. Lower birth weight, higher use of postnatal dexamethasone, antenatal dexamethasone and umbilical venous lines were noted in delayed hemorrhage group. Laboratory values associated with delayed IVH included lower platelet counts and hematocrit. Risk factors associated with delayed IVH included low hematocrit and elevated uric acid. Severe IVH (grade III, IV) occurred more in early hemorrhage group and subsequent 12 months follow-up showed developmental delay in 3 (4.0%) and 1 (3.6%) in early and delayed hemorrhage group, respectively. CONCLUSION: Frequent delayed hemorrhage may occur in infants under 34 weeks old. Although degree of delayed IVH is relatively milder than early hemorrhage group, its association with developmental delay merits follow-up head ultrasonogram up to at least 1 month of age or even longer.