Analysis of the association between necrotizing enterocolitis and transfusion of red blood cell in very low birth weight preterm infants / 소아과

PURPOSE: To investigate the association between necrotizing enterocolitis (NEC) and red blood cell transfusions in very low birth weight (VLBW) preterm infants. METHODS: We studied were 180 VLBW preterm infants who were admitted to the neonatal intensive care unit of CHA Gangnam Hospital from January of 2006 to December of 2009. The subjects were divided into 2 groups: an NEC group (greater than stage II on the modified Bell's criteria) and a control group (less than stage II on the modified Bell's critieria). We defined red blood cell transfusion before NEC diagnosis as the frequency of transfusion until NEC diagnosis (mean day at NEC diagnosis, day 18) in the NEC group and the frequency of transfusion until 18 days after birth in the control group. RESULTS: Of the 180 subjects, 18 (10%) belonged to the NEC group, and 14 (78%) of these 18 patients had a history of transfusion before NEC diagnosis. The NEC group received 3.1+/-2.9 transfusions, and the control group received 1.0+/-1.1 transfusions before the NEC diagnosis (P=0.005). In a multivariate logistic regression corrected for gestational age, Apgar score at 1 minute, the presence of respiratory distress syndrome, patent ductus arteriosus, premature rupture of membrane, disseminated intravascular coagulopathy and death were confounding factors. The risk of NEC increased 1.63 times (95% confidence interval, 1.145 to 2.305; P=0.007) with transfusion before the NEC diagnosis. CONCLUSION: The risk for NEC increased significantly with increased transfusion frequency before the NEC diagnosis.

Febrile Urinary Tract Infection in Infants Less than Two Months of Age : Characteristics and Factors Related to the Recurrence

PURPOSE: The aim of this study is to characterize and to investigate the factors related to the recurrence of febrile urinary tract infection (UTI) in infants less than 2 months of age. METHODS: We performed a retrospective study in 60 infants, who were treated for the first febrile UTI. Among them, 27 infants were followed for 12 months, and were reviewed concerning the factors related to the recurrence. The factors compared for the recurrence included sex, age at diagnosis, laboratory and radiologic findings like degree of the reflux and renal cortical defect. RESULTS: Among the 60 infants studied, 52 were male (86.7%). Age at diagnosis was 39+/-13 days. The most common pathogen was E.coli (71.7%). The infants underwent an ultrasonography (n=59), DMSA scan (n=55), and voiding cystourethrography (VCUG). Further hydronephrosis, renal cortical defect, vesicoureteral reflux (VUR) were found in 28 (47.4%), 12 (21.8%) and 11 (20.4%) infants, respectively. The hydronephrosis was found frequently in the recurrent UTI group (P=0.012). The VUR was found frequently, but not significantly, in therecurrent UTI group (44.4%) than that of the non-recurrent UTI group (16.7%). CONCLUSION: During the 12 months after the first febrile UTI, hydronephrosis increased the risk of recurrent UTI. The ultrasonography is needed during the follow up of UTI in infants less than two months of age.

Seasonal Variations of Respiratory Syncytial Virus Infection among the Children under 60 Months of Age with Lower Respiratory Tract Infections in the Capital Area, the Republic of Korea, 2008-2011

PURPOSE: Palivizumab prophylaxis has been used in the high risk groups of respiratory syncytial virus (RSV) infections, especially with the prematures, infants with chronic lung diseases or hemodynamically significant congenital heart disease. Substantial variations in timing of RSV outbreaks presents a challenge for the optimized use of palivizumab prophylaxis. This study investigates the epidemiologic characteristics of RSV associated lower respiratory tract infections (LRTI) in children, to help guide in the application of palivizumab prophylaxis in the Republic of Korea. METHODS: This was a retrospective observational study. We performed RSV culture or multiplex RT-PCR from children under 60 months of age admitted for LRTI at three hospitals in the capital area of Korea from May 2008 to April 2011. The study identified RSV infection and analyzed the RSV detection rates. RESULTS: RSV detection rate was 18.8% (1,721/9,178). The RSV season of 2008-2009 is from the second week of August to the fourth week of March and, that of 2009-2010 is from the first week of October to the third week of Apirl and that of 2010-2011 is from the third week of September to the third week of March. The RSV detection rate in preterms and low birth weight infants were significantly higher during the RSV season and non-RSV season. CONCLUSION: The RSV seasons were shown to have variations in onset, offset, and durations in each year. Physicains should determine the timing of the first and final doses of palivizumab on the basis of information about the RSV season in their own area. The real-time surveillance systems to analyze the variations of RSV seasons are necessary for the effective and economical preventions of RSV infections in high risk groups.

Early neurodevelopment in very low birth weight infants with mild intraventricular hemorrhage or those without intraventricular hemorrhage / 소아과

PURPOSE: This study aimed to assess early development in very low birth weight (VLBW) infants with mild intraventricular hemorrhage (IVH) or those without IVH and to identify the perinatal morbidities affecting early neurodevelopmental outcome. METHODS: Bayley Scales of Infant Development-II was used for assessing neurological development in 49 infants with a birth weight <1,500 g and with low grade IVH (< or =grade II) or those without IVH at a corrected age of 12 months. RESULTS: Among the 49 infants, 19 infants (38.8%) showed normal development and 14 (28.6%) showed abnormal mental and psychomotor development. Infants with abnormal mental development (n=14) were mostly male and had a longer hospitalization, a higher prevalence of patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and were under more frequent postnatal systemic steroid treatment compared with infants with normal mental development (n=35, P<0.05). Infants with abnormal psychomotor development (n=29) had a longer hospitalization and more associated PDA compared to infants with normal psychomotor development (n=20, P<0.05). Infants with abnormal mental and psychomotor development were mostly male and had a longer hospitalization and a higher prevalence of PDA and BPD compared to infants with normal mental and psychomotor development (n=19, P<0.05). Using multiple logistic regression analysis, a longer duration of hospitalization and male gender were found to be significant risk factors. CONCLUSION: Approximately 62% of VLBW infants with low grade IVH or those without IVH had impaired early development.

A Case of Acrodermatitis Enteropathica with Normal Serum Zinc Level in a Breastfed Preterm Infant

Acrodermatitis enteropathica due to zinc deficiency is characterized by periorificial dermatitis, alopecia, and intractable diarrhea. Here we report a case of transient acrodermatitis enteropathica in a 2-month-old preterm infant, whose skin is erythematous, scaly, eczematous, with an eruption starting from the periorificial area. While her serum zinc level was normal at 118.2 ug/dL, the serum alkaline phosphatase level was low at 48 IU/L and the serum alkaline phosphatase level get increased concordant with clinical improvement after zinc supplementation. Hence, this case shows that the diagnosis of zinc deficiency can be aided with a low level of serum alkaline phoaphatase although serum zinc level is normal.

A Case of Giant Congenital Melanocytic Nevi in a Neonate

Giant congenital melanocytic nevi are very rare, with an estimated incidence of 1 in 20,000 live births. They have a high risk of malignant melanoma transformation and neurological deficits such as neurocutaneous melanocytosis and epilepsy. Early evaluation, surgical intervention and careful long term follow up are recommended to monitor for malignant transformation. We report one case of giant congenital melanocytic nevi diagnosed at birth with the related literatures.

Predictors of Failed Closure of Patent Ductus Arteriosus with the First Course of Indomethacin in Preterm Infants

PURPOSE: This study was performed to determine the predictors of failed closure of a patent ductus arteriosus (PDA) following the first course of indomethacin in symptomatic preterm infants. METHODS: Forty three of 43 preterm infants, admitted to the neonatal intensive care unit diagnosed with PDA and treated with indomethacin at the Korea University Medical Center between January 1990 and October 2007, ware studied. The perinatal risk factors affecting the failed closure of PDA were retrospectively assessed. RESULTS: The failed PDA closure group included 16 (37%) out of 43 infants three of whom underwent surgery. The closure group included 27 (63%) out of 43 infants. In the failed closure group, the Apgar scores (1 min, 5 min) were significantly higher (P<0.05) and antenatal steroid administration was significantly lower (P<0.05). In addition, dopamine administration was significantly lower (P<0.05) and the mean postnatal age at diagnosis was significantly lower (P<0.05). Multiple logistic regression for the prediction of failed PDA closure found only antenatal steroid administration (OR 0.092, CI 0,010-0.826, P=0.0331) as an associated factor. CONCLUSION: In patients with antenatal steroid administration the failed PDA closure rate was significantly lower. Therefore, antenatal steroid administration can be considered as an important factor for the closure of PDA in preterm pregnancies.

Two cases of Smith-Magenis syndrome / 소아과

SmithMagenis syndrome (SMS) is a rare disorder with multiple congenital anomalies caused by a heterozygous interstitial deletion involving chromosome 17p11.2, where the retinoic acid-induced 1 (RAI1) gene is located, or by a mutation of RAI1. Approximately 90% of the patients with SMS have a detectable 17p11.2 microdeletion on fluorescence in-situ hybridization (FISH). SMS is characterized by mental retardation, distinctive behavioral features, craniofacial and skeletal anomalies, speech and developmental delay, and sleep disturbances. Although there are some intervention strategies that help individuals with SMS, there are no reported specific interventions for improving the outcome in children with SMS. Here, we report two cases of SmithMagenis syndrome.

The Relationship between Thymic Size and Vesicoureteral Reflux in Infants with Febrile Urinary Tract Infection

PURPOSE: Thymus is a lymphoproliferative organ that changes size in various physiological states in addition to some pathological conditions. Thymus is susceptible to involution, and shows a dramatic response to severe stress. Thymic measurements may be helpful in various diseases. UTI (urinary tract infection) is most common bacterial infection in infants and VUR (vesicoureteral reflux) is a common abnormality associated with UTI. In our study, the size of thymus was compared on the premise that a greater stress is exerted on the body when UTI is accompanied by VUR, than when occurs on its own. METHODS: Thymic size was measured on standard chest anteroposterior radiographs and expressed as the ratio between the transverse diameter of the cardiothymic image at the level of the carina and that of the thorax (CT/T). The medical records of 99 febrile urinary tract infection infants without other genitourinary anomalies except VUR were reviewed retrospectively. RESULTS: Among 99 patients with febrile UTIs, 25 were febrile UTI without VUR and 74 with VUR. For the UTI with VUR group, there was a significant decrease in the thymic size compared to the those without VUR group (0.382+/-0.048 vs 0.439+/-0.079, P<0.05). However, there were no differences in the duration of fever and WBC, CRP between the UTI with VUR and UTI without VUR. In addition, there were no differences in the cardiothymic/thoracic ratios between renal defects and renal scars in febrile UTI patients. CONCLUSION: The results of this study show that the shirinkage of thymus was more frequently found in the UTI patients with VUR. Therefore, awareness of the risks associated with thymic size is important for the appropriate work up and management of UTI patients.

A Clinical Study about the Risk Factors of the Neonatal Clavicular Fracture / 대한산부인과학회잡지

No abstract available.