Perinatal Factors Associated with the Preterm Thyroid Screening Test / 대한주산의학회잡지

PURPOSE: The aim of this study was to evaluate the usefulness of thyroid function screening in preterm infants and the relation between thyroid hormone level, perinatal environment, and clinical presentation after preterm birth. METHODS: We retrospectively evaluated 46 preterm infants from March 2013 to December 2014, who had been screened for congenital hypothyroidism during the 1st week with thyroid stimulating hormone (TSH), triiodothyronine (T3) and free thyroxine (fT4) measured by the radioimmunoassay method. The effects of pregnancy associated maternal factors, gestational age, growth parameters, Apgar score, 1st meconium passage time, respiratory distress syndrome and apnea on thyroid hormone levels were assessed by Mann-Whitney U-test and multiple linear regression analysis. RESULTS: With advancing gestational age, T3 and fT4 displayed a tendency to increase. FT4 showed a positive correlation pattern with antenatal steroid therapy, corrected gestational age at examination and a negative correlation pattern with 1st meconium passage time and apnea (P<0.05). TSH displayed a positive correlation pattern with 1st meconium passage time, 5-minute Apgar score and a negative correlation pattern with sampling age (P<0.05). CONCLUSION: In the preterm period, both fT4 and TSH seems to correlate significantly with various perinatal factors and clinical presentation. We recommend that early fT4 screening should be included in the screening for hypothyroidism in preterm infants.

Perinatal Factors Associated with the Preterm Thyroid Screening Test / 대한주산의학회잡지

PURPOSE: The aim of this study was to evaluate the usefulness of thyroid function screening in preterm infants and the relation between thyroid hormone level, perinatal environment, and clinical presentation after preterm birth. METHODS: We retrospectively evaluated 46 preterm infants from March 2013 to December 2014, who had been screened for congenital hypothyroidism during the 1st week with thyroid stimulating hormone (TSH), triiodothyronine (T3) and free thyroxine (fT4) measured by the radioimmunoassay method. The effects of pregnancy associated maternal factors, gestational age, growth parameters, Apgar score, 1st meconium passage time, respiratory distress syndrome and apnea on thyroid hormone levels were assessed by Mann-Whitney U-test and multiple linear regression analysis. RESULTS: With advancing gestational age, T3 and fT4 displayed a tendency to increase. FT4 showed a positive correlation pattern with antenatal steroid therapy, corrected gestational age at examination and a negative correlation pattern with 1st meconium passage time and apnea (P<0.05). TSH displayed a positive correlation pattern with 1st meconium passage time, 5-minute Apgar score and a negative correlation pattern with sampling age (P<0.05). CONCLUSION: In the preterm period, both fT4 and TSH seems to correlate significantly with various perinatal factors and clinical presentation. We recommend that early fT4 screening should be included in the screening for hypothyroidism in preterm infants.

Presentation Time of Necrotizing Enterocolitis Diagnosed by Sonography according to Gestational Age

PURPOSE: In this single center study, we assessed the timing of presentation of necrotizing enterocolitis (NEC) diagnosed by sonography according to the gestational age. METHODS: We retrospectively reviewed the medical records of 49 newborn patients who were diagnosed with NEC (modified Bell's stage II and higher according to abdominal sonography and simple abdominal radiography) and were admitted to the neonatal intensive care unit of St. Mary's Hospital between January 2008 and December 2012. Infants were grouped according to their gestational age (GA): Group I (GA or =37 weeks); early-onset NEC was considered when NEC developed at or =14 days of age. RESULTS: The number of infants in each group were: Group I (n = 16), Group II (n = 20), Group III (n = 11), and Group IV (n = 2). The mean age at diagnosis of NEC was: Group I (31.6 days), Group II (15.9 days), Group III (11.0 days), and Group IV (2.0 days). Early-onset NEC developed at a mean of 5.5 days of age, whereas late-onset NEC developed at a mean of 36.1 days of age. CONCLUSION: Based on early sonographic diagnosis, infants with lower gestational ages developed NEC at a more advanced postnatal age as compared to more mature infants. However, further studies are needed to understand the etiology of this disease process.

The Impact of Anticonvulsants on Neurologic Outcomes in Neonatal Seizures / 대한주산의학회잡지

PURPOSE: Although neonatal seizures can cause epilepsy, neurodevelopmental disability, and mortality with high frequency, the use of anti-epileptic drug is limited and the side effect of the drug is unidentified. Thus, authors investigated the prognosis of the neonatal seizures related with anti-epileptic drugs and electroencephalography. METHODS: Retrospective medical records of 37 infants with neonatal seizures under 44 weeks of gestational age who were hospitalized at neonatal intensive care unit in Seoul St. Mary' Hospital from January to June 2012 were analyzed. RESULT: The mean gestational age was 32.5+/-1.9 weeks and the mean birth weight was 2,010+/-82 g. Seizures occurred in 65% in infants within 7 days of birth and subtle seizures were most common type. Hypoxic ischemic encephalopathy was the most common cause of seizures and 62% showed abnormal electrographic findings. Among 37 of patients, seizures of 57% were able to be controlled by levetiracetam, but 19% were controlled by co-administration of more than three anti-epileptic drugs. After 6 months of treatment, epilepsy was diagnosed in 6% and developmental delay occurred in 19% among patients controlled by one anti-epileptic drug. Epilepsy and developmental delay occurred in 29% and 86%, respectively, among patients with more than three anti-epileptic drugs. In addition 86% of patients with normal electroencephalographic findings show normal development, but 3 patients with severe abnormalities showed abnormal development. CONCLUSION: Neurologic outcome was not good when the number of anti-epileptic drugs were added due to uncontrolled seizures, and the result of electroencephalography showed severe abnormalities.

Follow-up of Full-term Neonatal Seizures: Prognostic Factors for Neurodevelopmental Sequelae

PURPOSE: The objectives of this study were to observe the major neurodevelopmental sequelae of the full-term neonatal seizures, and to identify the risk factors associated with the poor neurodevelopmental outcomes. METHODS: A retrospective review of the medical records of full-term newborns who had clinical and/or electrographic seizures in neonatal intensive care unit of St. Mary's Hospital between June 1994 to July 2007 was performed. To assess the risk factors associated with poor neurological outcome, various factors were analyzed with univariate analysis and multiple regression analysis (SAS for Windows version 9.2). RESULTS: The most common etiology of seizures in full-term infants was hypoxic ischemic encephalopathy (76.2%). The most common type of seizure was subtle (50.9%), followed by multifocal clonic (41.8%), and the seizure type had no significant correlation to the prognosis. Moderate to major EEG abnormalities were significantly related to poor clinical outcome. Additional factors related to neurodevelopmental outcome were Apgar score at five minute, evidence of HIE on brain MRI, Sarnat stages of HIE, number of anticonvulsant drugs used for seizure control and duration for normalization of EEG abnormalities. CONCLUSION: The risk factors observed in this study may be helpful to predict the neurological outcomes in full-term neonates with seizures.