Evolution of ARDS definition and establishment of diagnostic criteria for neonatal ARDS / 国际儿科学杂志

Acute respiratory distress syndrome (ARDS) is a common clinical critical illness and is one of the important causes of neonatal death.Since the first report of ARDS in 1967,its definition and diagnostic criteria have been controversial.The AECC diagnostic criteria proposed by American-European Consensus Conference in 1994 and the Berlin diagnostic criteria issued in 2012 are of great significance for the clinical diagnosis and scientific research of ARDS.In 2017,the first international diagnostic criteria for ARDS in neonates was released,which will play an active role in promoting basic research and clinical practice of neonatal ARDS.This article reviews the evolution of ARDS definitions and diagnostic criteria,as well as the establishment and clinical applications of diagnostic criteria for neonatal ARDS.

Clinical Utility of Rapid Plasma Neutrophil Gelatinase-Associated Lipocalin Assays for Diagnosing Acute Kidney Injury in Critically Ill Newborn Infants

PURPOSE: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early marker of acute kidney injury (AKI). This study was designed to evaluate the clinical utility of the rapid plasma NGAL assay for diagnosing AKI in critically ill newborn infants in the neonatal intensive care unit (NICU). METHODS: The medical records of 178 critically ill newborn infants >34 weeks of gestational age who underwent plasma NGAL measurement during the first week of life in the Korea University Ansan Hospital NICU from February 2011 to August 2015 were retrospectively reviewed. Plasma NGAL levels were measured at bedside by using a commercial competitive immunoassay kit simultaneously with serum creatinine (Cr) level determination. RESULTS: Of 178 newborn infants enrolled in this study (study group), 25 infants had AKI (AKI group) while 153 infants had no AKI (control group). The plasma NGAL level in the AKI group (114.0 [76.5–281.5] ng/mL) was significantly higher than that in the control group (74.0 [52.5–122.5] ng/mL, P=0.001). Moreover, plasma NGAL levels were found to be correlated with serum Cr levels in the study group (r=0.208, P=0.005). Plasma NGAL achieved an area under the receiver operating characteristic curve of 0.705 for detecting AKI (95% confidence interval: 0.593–0.817). The best cutoff plasma NGAL level for AKI diagnosis was 100 ng/mL. CONCLUSION: The rapid plasma NGAL assay has diagnostic value for AKI in critically ill newborn infants >34 weeks of gestational age. Further investigations with a larger population are needed to confirm the potential use of plasma NGAL levels for diagnosing AKI in newborn infants.

Treatment of Auricular Deformities with the EarWell System in Three Newborns

Auricular deformities occur frequently in newborn infants. Typically, most pediatricians explain to parents that these deformities will get better as child grows older. But, only about 30% of auricular deformities are known to be self-correcting, and there is no reliable model to predict them. If ear molding is initiated during the first days of life with the EarWell System, successful treatment could be possible without pain in a non-surgical way. We present 3 cases of auricular deformities treated with the EarWell System. 2 infants were born with auricular deformities at Gangnam Cha Medical Center and 1 infant visited the outpatient clinic for the treatment of auricular deformities. 5 ears in 3 infants underwent ear molding using the EarWell System. They had it placed on the 20th day after birth. Average treatment time was 18.7 days, and all of them were corrected. Complications were redness, oozing, erosion and mild pressure ulcerations. Early recognition and treatment of the auricular deformity ensure the great prospect of success. Also, it is important for both the parents and the pediatricians to know that auricular deformities could be successfully treated with Earwell System.

Expectativas de crianza en madres de recién nacidos a término y pretérmino / Parenting expectations in mothers of term and preterm infants

Introducción: cuando la mujer vive la experiencia del nacimiento de un hijo se ve enfrentada a una serie de tareas nuevas relacionadas con el rol de madre; el nivel de seguridad que ella tenga en el inicio de su maternidad puede estar fuertemente ligado a su visión de futuro en la forma de criar a su hijo. Objetivo: determinar las expectativas de crianza en madres de recién nacidos a término y pretérmino. Métodos: estudio de corte transversal realizado durante septiembre de 2013 y enero de 2014. Muestra no probabilística, conformada por 340 madres: 162 (47,65 por ciento) madres de recién nacidos a término y 178 (52, 35 por ciento) madres de recién nacidos pretérmino, nacidos en Bucaramanga (Colombia). La información se recolectó mediante el Inventario de Paternidad para Adultos y Adolescentes. Se utilizó el programa Stata versión 12R para el procesamiento y análisis de la información según instructivo. Resultados: el grupo de madres de recién nacidos pretérmino presentaron mejores expectativas de crianza que el grupo de las madres de recién nacidos a término, cuyos puntajes en las cuatro dimensiones se ubicaron en alto riesgo de negligencia en el cuidado. Conclusiones: el conocimiento de las expectativas de crianza de las madres, tanto de recién nacidos a término como de recién nacidos pretérmino, permitirá establecer intervenciones de enfermería para el fortalecimiento del rol materno(AU)

Introduction: When women live the experience of childbirth is faced with a number of new tasks related to the role of mother; the level of security that she has at the start of her maternity may be strongly linked to its vision on how to raise your child. Objective: To determine parenting expectations of mothers of term and preterm infants. Methods: This was a cross-sectional study conducted between September 2013 and January 2014. The sample was non-probabilistic and included 340 mothers: 162 (47,65 percent) mothers of term infants and 178 (52,35 percent) mothers of preterm infants, from Bucaramanga (Colombia). The information was collected using the Adult-Adolescent Parenting Inventory. The Stata version 12R program was used for data processing and analysis according to the instructions. Results: The group of mothers of preterm infants had better parenting expectations than the group of mothers of term infants, whose scores on the four dimensions indicated a high risk of negligence in child care. Conclusions: Knowing the parenting expectations of mothers of term and preterm infants will allow to establish nursing interventions aimed at strengthening the maternal role(AU)

The application of non-invasive transcutaneous monitoring of oxygen and carbon dioxide in newborns / 国际儿科学杂志

Non-invasive transcutaneous monitoring(TCM) of oxygen and carbon dioxide,with continuous,non-invasive characteristics,is in common use and significant in the neonatal intensive care unit (NICU),which can directly reflect critically ill newborns'changes of respiratory and circulatory function.This review describes how to use TCM appropriately,compares the advantages and disadvantages of TCM with other monitoring devices,introduces its application in neonatal transport and NICU.

Penile length, digit length, and anogenital distance according to birth weight in newborn male infants

PURPOSE: Anogential distance (AGD) and the 2:4 digit length ratio appear to provide a reliable guide to fetal androgen exposure. We intended to investigate the current status of penile size and the relationship between penile length and AGD or digit length according to birth weight in Korean newborn infants. MATERIALS AND METHODS: Between May 2013 and February 2014, among a total of 78 newborn male infants, 55 infants were prospectively included in this study. Newborn male infants with a gestational age of 38 to 42 weeks and birth weight>2.5 kg were assigned to the NW group (n=24) and those with a gestational age<38 weeks and birth weight<2.5 kg were assigned to the LW group (n=31). Penile size and other variables were compared between the two groups. RESULTS: Stretched penile length of the NW group was 3.3+/-0.2 cm, which did not differ significantly from that reported in 1987. All parameters including height, weight, penile length, testicular size, AGD, and digit length were significantly lower in the LW group than in the NW group. However, there were no significant differences in AGD ratio or 2:4 digit length ratio between the two groups. CONCLUSIONS: The penile length of newborn infants has not changed over the last quarter century in Korea. With normal penile appearance, the AGD ratio and 2:4 digit length ratio are consistent irrespective of birth weight, whereas AGD, digit length, and penile length are significantly smaller in newborns with low birth weight.

Alterações nos parâmetros fisiológicos dos recém-nascidos sob oxigenoterapia na coleta de gasometria / Alterations in the physiological parameters of newborns using oxygen therapy in the collection of blood gases

Objetivo: Identificar as alterações que ocorrem nos parâmetros fisiológicos dos recém-nascidos sob oxigenoterapia na coleta de gasometria arterial, comparando os momentos imediatamente antes, imediatamente depois, e cinco minutos depois do procedimento. Métodos: Estudo longitudinal, do tipo antes e depois,. Amostra composta por 67 recém-nascidos sob oxigenoterapia que receberam punção arterial para gasometria. Resultados: O grupo de recém-nascidos em Oxi-Hood sofreu alterações significativas (p<0,05) na frequência cardíaca, pulso e saturação de oxigênio. Os recém-nascidos em ventilação mecânica obtiveram alterações de frequência respiratória e pulso e aqueles sob CPAP nasal não mostraram instabilidade dos parâmetros fisiológicos. Conclusão: O estímulo doloroso causado pela coleta de gasometria nos recém-nascidos mostrou variações de todos os parâmetros fisiológicos, porém, para tal procedimento, as alterações foram diferentes em cada modalidade de oxigenoterapia. .

Objective: To identify the changes that occur in the physiological parameters of newborns under oxygen therapy during the collection of arterial blood gases, comparing the moments immediately before, immediately after, and five minutes after the procedure. Methods: A longitudinal study, of the before and after research design. The sample was composed of 67 newborns under oxygen therapy that had an arterial puncture for blood gas analysis. Results: The group of newborns in an Oxyhood experienced significant alterations (p<0.05) in heart rate, pulse and oxygen saturation. Newborns on mechanical ventilation had alterations in respiratory rate and pulse, while those with nasal CPAP showed no instability in physiological parameters. Conclusion: The painful stimulus caused by the collection of blood gases in newborns showed changes in all physiological parameters, however, for such a procedure, the changes were different for each mode of oxygen therapy. .

Meconium-related Ileus in Extremely Low-birth Weight Newborn Infants Meconium-related Ileus in ELBWI

PURPOSE: Meconium-related ileus (MRI) is one of the major causes of bowel obstruction in extremely low-birth weight newborn infants (ELBWI). Hyperosmolar water-soluble contrast (HWSC) enemas been recognized to be an effective treatment for MRI. The purpose of this study is to observe clinical findings of MRI accompanied by ELBWI and evaluate the therapeutic efficacy and complications of HWSC enemas. METHODS: A total of 15 ELBWI with MRI were treated with HWSC enemas under the guidance of ultrasonography at the bedside in the NICU between 2008 and 2011. Clinical findings of 15 patients were reviewed and compared with those of 48 ELBWI without MRI administered to NICU during the same period. Radiological findings, therapeutic efficacy and complications of HWSC enemas in patients with MRI were also reviewed. RESULTS: Patients with MRI, compared to those without MRI, showed the following significantly lower Apgar score at 1 minute, higher incidence of preeclampsia, bronchopulmonary dysplasia and sepsis, and longer duration of the first meconium passing and non-feeding per oral. Fourteen patients with MRI had resolved bowel obstruction successfully following 1-2 trials of enema. One case was not relieved following 3 trials of enema, showed no clinical improvement, and died of severe intraventricular hemorrhage and multi-organ failure at 45 days old. No complications associated with HWSC enemas were observed in all cases. CONCLUSION: Administration of HWSC enemas under the guidance of abdomen ultrasonography in the NICU is safe and efficacious for the rapid diagnosis and treatment of MRI even accompanied by ELBWI.

Analysis of acylcarnitine profiles in umbilical cord blood and during the early neonatal period by electrospray ionization tandem mass spectrometry

Acylcarnitine profiling by electrospray ionization tandem mass spectrometry (ESI-MS/MS) is a potent tool for the diagnosis and screening of fatty acid oxidation and organic acid disorders. Few studies have analyzed free carnitine and acylcarnitines in dried blood spots (DBS) of umbilical cord blood (CB) and the postnatal changes in the concentrations of these analytes. We have investigated these metabolites in healthy exclusively breastfed neonates and examined possible effects of birth weight and gestational age. DBS of CB were collected from 162 adequate for gestational age neonates. Paired DBS of heel-prick blood were collected 4-8 days after birth from 106 of these neonates, the majority exclusively breastfed. Methanol extracts of DBS with deuterium-labeled internal standards were derivatized before analysis by ESI-MS/MS. Most of the analytes were measured using a full-scan method. The levels of the major long-chain acylcarnitines, palmitoylcarnitine, stearoylcarnitine, and oleoylcarnitine, increased by 27, 12, and 109%, respectively, in the first week of life. Free carnitine and acetylcarnitine had a modest increase: 8 and 11%, respectively. Propionylcarnitine presented a different behavior, decreasing 9% during the period. The correlations between birth weight or gestational age and the concentrations of the analytes in DBS were weak (r £ 0.20) or nonsignificant. Adaptation to breast milk as the sole source of nutrients can explain the increase of these metabolites along the early neonatal period. Acylcarnitine profiling in CB should have a role in the early detection of metabolic disorders in high-risk neonates.

Mechanism and regulation of alveolar fluid transport in neonates / 国际儿科学杂志

Alveolar fluid transport is closely associated with neonatal lung development neonatal respiratory diseases,such as wet lung,pulmonary hyaline membrane disease,pneumonia,which are related with decreased lung fluid transport.This review introduces the characteristics of neonatal pulmonary fluid balance,including lung fluid secretion and absorption equilibrium,list clinical factors which can increase pulmonary fluid,explain important lung fluid transport mechanisms and their regulations.Inhaling beta agonists or glucocorticoid is a viable therapeutic strategy.

Endotracheal and upper airways suctioning: changes in newborns’ physiological parameters / Aspiração do tubo orotraqueal e de vias aéreas superiores: alterações nos parâmetros fisiológicos em recém-nascidos / Aspiración del tubo endotraqueal y de las vías aéreas superiores: alteraciones en los parámetros fisiológicos en recién nacidos

This study investigated which physiological parameters change when endotracheal and upper airway suctioning is performed immediately before, immediately after and five minutes after this procedure is performed in newborns hospitalized in a Neonatal Intensive Care Unit (NICU). This is a quantitative and longitudinal study, before and after type, performed in the NICU of a public institution in the city of Fortaleza, CE, Brazil. The sample was composed of 104 newborns using oxigenotherapy and who needed endotracheal and upper airway suctioning. The results showed significant alterations in respiratory and heart rates (p<0.05) in neonates using Oxyhood and nasal CPAP while the pulse significantly changed (p<0.05) in newborns placed in oxyhood, using nasal CPAP and Mechanical Ventilation; oxygen saturation was the only parameter that did not alter significantly. We propose that nurses develop non-pharmacological interventions to reduce potential alterations caused in newborns’ physiological parameters due to this procedure.

Objetivou-se investigar quais são os parâmetros fisiológicos que se alteram na execução da aspiração do tubo orotraqueal (TOT) e das vias aéreas superiores (VAS), comparando-os imediatamente antes, imediatamente depois e cinco minutos após a realização do referido procedimento. Trata-se de estudo quantitativo, longitudinal, do tipo antes e depois, realizado em Unidade de Terapia Intensiva Neonatal (Utin) de uma instituição pública em Fortaleza, CE, Brasil. A amostra constou de 104 recém-nascidos em uso de oxigenoterapia, e que necessitaram de aspiração do tubo orotraqueal e das vias aéreas superiores. Os resultados mostraram alterações significativas (p<0,05) nas frequências respiratória (FR) e cardíaca (FC) dos recém-nascidos, em uso de tenda de oxigênio (Oxi-Hood) e pressão contínua das vias aéreas (CPAP nasal), e também de pulso (p<0,05) para os recém-nascidos em Oxi-Hood, CPAP nasal e ventilação mecânica (VM), sendo a saturação de oxigênio (SpO2) o único parâmetro que não foi estatisticamente significante. Propõe-se aos profissionais enfermeiros o desenvolvimento de intervenções não farmacológicas para reduzir possíveis alterações dos parâmetros fisiológicos dos recém-nascidos, decorrentes desse procedimento.

Se objetivó investigar cuales son los parámetros fisiológicos que se alteran en la ejecución de la aspiración del tubo endotraqueal (TOT) y de las vías aéreas superiores (VAS), comparándolos inmediatamente antes, inmediatamente después y cinco minutos después de la realización del referido procedimiento. Se trata de un estudio cuantitativo, longitudinal, del tipo antes y después, realizado en una Unidad de Terapia Intensiva Neonatal (UTIN) de una institución pública en Fortaleza, CE, Brasil. La muestra constó de 104 recién nacidos que usaban oxigenoterapia, y que necesitaron de aspiración del tubo endotraqueal y de las vías aéreas superiores. Los resultados mostraron, alteraciones significativas (p<0,05) en las frecuencias respiratorias (FR) y cardíaca (FC) de los recién nacidos en uso de Oxi-Hood y CPAP nasal, y también del pulso (p<0,05) para los recién nacidos en Oxi-Hood, CPAP nasal y Ventilación Mecánica (VM), siendo la saturación de oxígeno (SpO2), el único parámetro que no fue estadísticamente significativo. Se propone a los enfermeros desarrollar intervenciones no farmacológicas para reducir posibles alteraciones de los parámetros fisiológicos de los recién nacidos provenientes de este procedimiento.

Desenvolvimento motor de prematuros em unidade neonatal: fatores determinantes e avaliação precoce / Motor development of premature infants in neonatal unit: Determining factors and early evalution

Esta revisão se refere aos fatores biológicos e ambientais envolvidos no atraso do desenvolvimento motor de recém-nascidos prematuros internados em unidades de neonatologia, destacando a importância do diagnóstico precoce e do acompanhamento em longo prazo. As referências foram obtidas por meio dos bancos de dados Medline / Pubmed e SciELO, abrangendo o período de 1998 a 2010, a partir dos descritores recém-nascido prematuro, desenvolvimento infantil, fatores de risco e UTI neonatal, pesquisados de forma isolada e cruzada. O recém-nascido prematuro apresenta imaturidade global de órgãos e sistemas que lhe confere maior vulnerabilidade biológica, com maior predisposição às morbidades, inclusive neurológicas. Assim, muitas vezes necessita de longos períodos de internação em Unidade de Terapia Intensiva, cujo ambiente estressante pode atuar como fator deletério adicional, contribuindo para o comprometimento da maturação e organização do sistema nervoso e, consequentemente, prejudicando seu desenvolvimento neuropsicomotor. Uma série de morbidades maternas e neonatais, além dos longos períodos de internação dos recém-nascidos prematuros em unidades neonatais, pode levar ao atraso do desenvolvimento motor. Diante dessa problemática, torna-se essencial o reconhecimento dos fatores associados a esse atraso, bem como a realização de um diagnóstico precoce. Uma vez que os déficits podem perdurar até a adolescência ou vida adulta, o seguimento em longo prazo é fundamental para o reconhecimento de problemas tardios e para encaminhamento dos casos suspeitos à intervenção interdisciplinar.

This review refers to biological and environmental factors involved in delayed motor development in premature newborn infants hospitalized in neonatal units, highlighting the importance of early diagnosis and long-term monitoring. References were obtained from Medline/Pubmed and SciELO databases, covering the period from 1998 to 2010, using the uniterms premature newborn infants, infant development, risk factors and neonatal intensive care unit, which were investigated in isolated and cross-matched manner. Premature newborn infants suffer from organ and system immaturity, rendering them biologically vulnerable, with greater predisposition to morbidities, including neurological ones. Thus, it is very often necessary for the infant to spend extended periods in intensive care units, where a stressful atmosphere may bring about further deleterious effects, contributing to the impairment of the maturation and organization of the nervous system and, consequently, hinder neuropsychomotor development. A series of maternal and neonatal morbidities, as well as extended hospitalization periods in neonatal units for premature newborn infants may lead to delayed motor development. Given such a situation, it is not only essential to identify the factors associated to this delay, but also to make an early diagnosis. SInce neuromotor deficits persist into adolescence or adulthood, then long-term monitoring is essential in order to identify any future problems that may occur and refer suspected cases for interdisciplinary intervention.

Identificação precoce de sinais neuromotores alterados em crianças nascidas pré-termo / Early identification of altered neuromotor signals in preterm infants

O objetivo deste estudo retrospectivo e descritivo foi identificar, em lactentes nascidos pré-termo, o período mais precoce em que foram observados sinais neurológicos motores comumente presentes em paralisia cerebral (PC) e discutir a rotina de retornos, com a finalidade de detecção e vigilância desses sinais. A amostra foi composta por 28 bebês nascidos com menos de 37 semanas e peso inferior a 2.500g, de ambos os sexos, internados na Unidade de Terapia Intensiva Neonatal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, no período de junho de 2006 a dezembro de 2007, e acompanhados no Ambulatório de Neurodesenvolvimento dessa instituição. Foram coletadas informações dos prontuários referentes à idade gestacional dos bebês, ao processo diagnóstico de PC, quando houvesse, e às idades das principais aquisições posturais. Os resultados mostraram que, em 19 das 28 crianças, foi observado algum sinal de risco ou sequela até o último retorno. Desses 19 pacientes, seis tiveram diagnóstico de PC definido, três pacientes, diagnóstico a definir, cinco apresentaram sinais transitórios de lesão corticoespinhal, e cinco lactentes apresentaram somente atraso postural. Concluiu-se que a rotina de retornos para detectar e vigiar os sinais indicativos de PC nessa amostra revelou a necessidade de um protocolo de avaliação específico e da criação de uma dinâmica de acompanhamento e estimulação de todas as crianças nascidas pré-termo até a idade de marcha sem apoio, independentemente de apresentarem sinais neurológicos perinatais.

This retrospective descriptive study was developed to identify the earlier stages when neuromotor signals commomnly found in cerebral palsy (CP) were registered for preterm infants, as well as to discuss the current follow-up practice I order to detect and monitor such signals. The sample consisted of 28 babies born at less than 37 weeks and weighing less than 2500g, of both genders, admitted to the Intensive Care Unit Neonatal Hospital of the Medical School of Ribeirão Preto, in the period from June 2006 to December 2007, and followed at Neurodevelopment Service of this institution. We collected the medical information regarding the gestational age of these babies, the diagnosis process of CP, when was the case, and the ages when major postural acquisitions occurred. In 19 out of 28 children, signs of risk or sequel were observed until the last follow-up consultation. Among these 19 patients, six were diagnosed with CP, three were to be diagnosed, five showed signs of transient corticospinal lesion, and five infants showed only postural delay. The routine follow-up to detect and monitor signals indicative of PC in this sample revealed need for a more specific assessment protocol, and for the creation of a monitoring and stimulation dynamics for all preterm infants up to the age of walking without support, regardless of presenting perinatal altered neurological signs.

Presence of maternal anti-HBs antibodies does not influence hepatitis B vaccine response in Brazilian neonates

Recently, it was suggested that maternal hepatitis B surface antigen antibodies (anti-HBs) acquired transplacentally could play a negative role in newborn infants' immune response to the hepatitis B vaccine. We compared the hepatitis B virus (HBV) vaccine response in infants born to mothers previously vaccinated against HBV (n = 91) to infants born to mothers who were not previously vaccinated (n = 221). All newborn infants received three intramuscular doses (10 μg) of HBV vaccine (Butang®) at 0,1 and six months. The first dose was administered at the maternity hospital within 12 h of birth. The geometric mean titres of anti-HBs were not different among newborn infants born to mothers who were anti-HBs-negative (492.7 mIU/mL) and anti-HBs-positive (578.7 mIU/mL) (p = 0.38). Eight infants did not respond to the HBV vaccine. Of them, six were born to anti-HBs-negative mothers and two were born to mothers with anti-HBs titres less than 50 mlU/mL. Despite the mother's anti-HBs-positive status, our data show a good immunogenicity of the Brazilian HBV recombinant vaccine in neonates.

Perinatal Care Center System for High Risk Pregnancy and Newborn in Japan / 대한주산의학회잡지

The perinatal period is defined as a specific time period between the late pregnancy and the early neonatal life, which is focused on the special and consistent care for the conception, delivery, maternity and the baby. In Korea, the department of obstetrics and neonatology are separated so there is no formal coordinated perinatal center for the high risk maternity and the neonate. Recently, there has been a remarkable improvement in neonatal, infant, and perinatal mortality rate due to advanced treatment techniques in obstetrics and neonatology, however these are not as sufficient as those of Japan, where the mortality rate is the world's lowest. Several reasons can be cited but the most important is the lack of perinatal center controlled by the nation, which is operated very efficiently in Japan. Nowadays, the importance and necessity of perinatal center is recognized in Korea and the Korean Ministry of Health and Welfare started to investigate and plan the operation of the national perinatal center. Therefore, the authors intended to make review on Japanese perinatal center operation system to obtain more qualified information for the institution of Korean perinatal center.

Risk Factors of Massive Pulmonary Hemorrhage in Newborn Infants / 대한주산의학회잡지

OBJECTIVES: Massive pulmonary hemorrhage (MPH) is a lethal disease, that large amount of blood is spouted from lung with clinical exacerbation, leading to death in newborn infants. Many of its causes were proved but debated. The purpose of this study is to determine the risk factors of Massive pulmonary hemorrhage of the newborn infants. We defined Mild pulmonary hemorrhage (mPH) as small amount of bleeding from lung with no changes in patient's clinical status. METHODS: Risk factors of MPH were estimated by retrospective multivariable analysis among newborn infants with pulmonary hemorrhage in neonatal intensive care unit of Catholic University Hospital of Daegu from January 2001 to December 2007. RESULTS: Pulmonary hemorrhage was developed in 73 neonates (6.3% of total infants admitted to NICU during the study period) and MPH occurred in 25 neonates (34.2%). Gestational age and Birth weights were lower in neonate with MPH than those with mPH. Thrombocytopenia and hypotension were statistically higher in those with MPH than mPH. There were no different significances between MPH and mPH in mean Bomsel grades of respiratory distress syndrome (RDS), Asphyxia, sepsis, disseminated intravascular coagulopathy (DIC), persistent ductus arteriosus (PDA), and intraventricular hemorrhage (IVH). CONCLUSION: The risk factors for massive pulmonary hemorrhage in newborn infants might be thrombocytopenia, and hypotension.

Posição prona e diminuição da assincronia toracoabdominal em recém-nascidos prematuros / Prone position and reduced thoracoabdominal asynchrony in preterm newborns

OBJETIVO: Avaliar a influência das posições prona e supina em recém-nascidos prematuros pós-síndrome do desconforto respiratório, respirando espontaneamente e em estado de sono ativo, sobre variáveis de padrão respiratório, movimento toracoabdominal e saturação periférica da hemoglobina pelo oxigênio. MÉTODOS: Estudo quase experimental. Doze prematuros com peso > 1.000 g no momento do estudo foram estudados nas duas posições, em ordem randomizada. A pletismografia respiratória por indutância foi utilizada para avaliação do padrão respiratório (volume corrente, frequência respiratória, ventilação minuto, fluxo inspiratório médio) e do movimento toracoabdominal (índice de trabalho respiratório, relação de fase inspiratória, relação de fase expiratória, relação de fase respiratória total e ângulo de fase). A oximetria de pulso registrou a saturação periférica de oxigênio. Para a análise estatística foram realizados os testes t de Student para amostras pareadas ou Wilcoxon. Foi considerado significativo p < 0,05. RESULTADOS: Foram analisados 9.167 ciclos respiratórios. Na posição prona, houve redução significativa do índice de trabalho respiratório (-0,84±0,69; p = 0,001; IC95 por cento -1,29 a -0,40), das relações de fase inspiratória (-27,36±17,55; p = 0,000; IC95 por cento -38,51 a -16,20), expiratória (-32,36±16,20; p = 0,000; IC95 por cento -42,65 a -22,06) e total (-30,20±14,76; p = 0,000; IC95 por cento -39,59 a -20,82). Não houve diferença significativa entre as posições nas demais variáveis analisadas. CONCLUSÃO: A posição prona promoveu diminuição significativa da assincronia toracoabdominal, sem influenciar o padrão respiratório e a saturação periférica de oxigênio.

OBJECTIVE: To assess the effect of prone and supine positions on breathing pattern variables, thoracoabdominal motion and peripheral oxygen saturation of hemoglobin of premature newborn infants recovering from respiratory distress syndrome, while breathing spontaneously and in rapid eye movement sleep. METHODS: This was a quasi-experimental study. Twelve preterms weighing > 1,000 g at enrollment were studied in both positions, in random order. Respiratory inductive plethysmography was used to analyze breathing pattern (tidal volume, respiratory rate, minute ventilation, mean inspiratory flow) and thoracoabdominal motion (labored breathing index, phase relation in inspiration, phase relation in expiration, phase relation in total breath and phase angle). Pulse oximetry was used to evaluate peripheral oxygen saturation. Student's t test for paired samples or the Wilcoxon test were used for statistical analysis. Significance was set at p < 0.05. RESULTS: A total of 9,167 respiratory cycles were analyzed. The prone position was associated with significant reductions in labored breathing index (-0.84±0.69; p = 0.001; 95 percentCI -1.29 to -0.40), phase relation in inspiration (-27.36±17.55; p = 0.000; 95 percentCI -38.51 to -16.20), phase relation in expiration (-32.36±16.20; p = 0.000; 95 percentCI -42.65 to -22.06) and phase relation in total breath (-30.20±14.76; p = 0.000; 95 percentCI -39.59 to -20.82). There were no significant differences between the two positions in any of the other variables analyzed. CONCLUSION: The prone position resulted in a significant reduction in thoracoabdominal asynchrony, without affecting breathing pattern or peripheral oxygen saturation.

Patient Distribution and Hospital Admission Costs in Neonatal Intensive Care Units: Collective Study of 7 Hospitals in Korea during 2006

PURPOSE:The characteristics of hospitalized patients in neonatal intensive care units (NICUs), including hospitalization costs (HC) and National Health Insurance (NHI) status were studied. METHODS:We gathered the following data from 7 hospitals in Korea during 2006: the distribution of patients according to birth weight (BW), and the duration of the hospital stay according to BW and HC. RESULTS:The patients who were admitted to the NICU consisted of high-risk neonates, including low birth weight or premature neonates, which comprised 50% of all neonates admitted to the NICU. The duration of hospitalization was 75-90 days for neonates with BW 25% of the total HC. For this matter, additional NHI is needed.

The Guiding Sense of Umbilical Artery Blood pH in the Evaluation of Neonatal Asphyxia Diagnosis and Prognosis / 医学研究杂志

Objective To explore the effect of umbilical artery blood pH on the diagnosis of neonatal asphyxia and the evaluation of its prognosis. Methods Blood samples were obtained from 108 normal newborns and 51 asphyxial newborns,who were randomly chosen among newborns delivered in our hospital from november 2007 to may 2008. Umbilical artery blood gas was measured and compared with apgur rating. Results With the degression of umbilical blood pH, the incidence rate of neonatal asphyxia increased and the normal apgar rating decreased(P < 0.01), which suggesting that there was tight relevant between umbilical blood pH and neonatal asphyxia. Conclusion Compared with apgur rating, umbilical artery blood pH could reflect the asphyxia degree of newborns more objectively andsensitively and it might play a guiding role in the prognosis of neonatal asphyxia.

Infecciones por Streptococcus agalactiae en un servicio de neonatología abierto / Infections due to Streptococcus agalactiae at an open neonatology service

El objetivo del presente estudio fue conocer las características clínicas y epidemiológicas de las infecciones por estreptococo del grupo B en recién nacidos egresados de los hospitales maternos. Se realizó un estudio descriptivo, que incluyó a recién nacidos consecutivos con infecciones por Streptococcus agalactiae, ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario Juan M Márquez entre febrero de 1992 y diciembre del 2007. Se procesaron y analizaron distintas variables clínicas y epidemiológicas, con cálculo de tasas de incidencia y letalidad, así como relación entre variables categóricas. Hubo 76 recién nacidos con infección por Streptococcus agalactiae, lo cual constituyó una tasa promedio anual de 1,9 x 100 ingresos. Predominaron las infecciones de inicio tardío y las adquiridas en la comunidad (89,5 por ciento y 93,4 por ciento, respectivamente). La meningitis fue la forma clínica más frecuente, seguida de la bacteriemia aislada. Hubo 56 de 76 recién nacidos con bacteriemia (73,7 por ciento). El Streptococcus agalactiae tuvo elevada sensibilidad ante la penicilina, la eritromicina, la vancomicina, la cefotaxima y el cloranfenicol. Hubo 7 fallecidos (9,2 por ciento) y todos fueron pacientes con infección del sistema nervioso central. Streptococcus agalactiae es un agente causal de infecciones que afectan al recién nacido, tanto en la comunidad como en el medio hospitalario. Estas infecciones pueden ser letales en algunos pacientes con infección del sistema nervioso central con bacteriemia o sin ella, aún manteniendo un patrón de elevada susceptibilidad a los antibióticos betalactámicos.

The objective of the present study was to know the clinical and epidemiological characteristics of the infections caused by group B Streptococcus in newborns discharged from maternal hospitals. A descriptive study that included consecutive infants with infections due to Streptococcus agalactiae admitted in the Neonatology Service of ½Juan M. Mßrquez¼ University Pediatric Hospital from February 1992 to December 2007 was conducted. Different clinical and epidemiological variables were processed and analyzed, with calculation of incidence and lethality rates and relation among the categoric variables. There were 76 newborns with infection due to Streptococcus agalactiae for an average annual rate of 1,9 x 100 admissions. It was observed a predominance of late onset infections and of those acquired in the community (89,5 percent y 93,4 percent, respectively). Meningitis was the most common clinical form followed by isolated bacteriemia. 56 of the 76 newborn infants had bacteriemia (73,7 percent). Streptococcus agalactiae showed a high sensitivity to penicillin, erythromycine, vancomycin, cefotaxime and cloranphenicol. There were 7 deaths (9,2 percent). All of them had infection of the CNS. Streptococcus agalactiae is an agent that causes infections affecting the newborn infant, both in the community and in the hospital. These infections may be lethal in some patients with infection of the CNS with o without bacteriemia, even when they maintain a pattern of elevated susceptibility to betalactamic antibiotics.