Morbidity and Mortality of Very Low Birth Weight Infants with Congenital Heart Disease

Background and Objectives@#This study aimed to provide morbidity and mortality information on very low birth weight (VLBW) infants with congenital heart disease (CHD-VLBWs). @*Methods@#The study used a 10-year cohort of VLBW infants from a single institution. CHD was classified according to International Classification of Diseases, Version 9, Clinical Modification. Mortality and neonatal outcomes were assessed by comparing the CHD-VLBWs with gestational age- and birth weight-matched controls. @*Results@#The prevalence of CHD-VLBWs was 7.5% (79/1,050), mean gestational age was 31.1±3.2 weeks, and mean birth weight was 1,126.2±268.3 g; 50.6% of the infants were small for the gestational age. The CHD-VLBWs more commonly had bronchopulmonary dysplasia (BPD), and the longer they were exposed to oxygen, the more frequently they developed BPD. Those with cyanotic heart disease developed severe BPD more frequently. Necrotizing enterocolitis (NEC) occurred frequently in the CHD-VLBWs and was not associated with their feeding patterns. CHD-VLBWs had a higher mortality rate; prematurity-related diseases were the leading cause of death before surgery, while heart-related problems were the leading cause of death after surgery. We found no significant difference in mortality from prematurity-related disease between the CHD-VLBWs and controls. In the subgroup analysis of CHD, the cyanotic CHD group had a higher incidence of BPD and higher mortality rate than the acyanotic CHD group. @*Conclusions@#CHD-VLBWs showed higher BPD, NEC, and mortality rates than those without CHD. There was also a higher incidence of BPD and mortality in VLBW infants with cyanotic CHD than in those with acyanotic CHD.

Successful Treatment of Mycoplasma hominis Meningitis, Diagnosed Using Real-Time Polymerase Chain Reaction, with Ciprofloxacin in a Neonate

Mycoplasma hominis can cause life-threatening central nervous system infections in neonates following intrauterine infection or during delivery. In newborns, the dia gnosis and treatment of M. hominis meningitis are challenging, because cultures are often negative and the bacterium is not susceptible to empirical antibiotics. Herein, we describe a case of neonatal M. hominis meningitis diagnosed using real-time polymerase chain reaction (RT-PCR) and treated with ciprofloxacin. The patient was a 3-day-old female hospitalized for a fever and lethargy. Her blood laboratory findings were non-specific; cerebrospinal fluid (CSF) examination showed a white blood cell count of 580/µL and indicated meningitis. Her symptoms could not be controlled with empirical antibiotics. Urine culture on a special medium revealed ciprofloxacinsusceptible M. hominis. Furthermore, the RT-PCR performed with the CSF sample revealed M. hominis. Therefore, the patient was administered cipro­floxacin; after 2 days, the fever subsided. The patient was discharged on day 30 without complications.

Gray-brown skin discoloration following phototherapy for hyperbilirubinemia due to anti-E alloimmunization / 소아과

No abstract available.

Chronic Placental Inflammation as a Risk Factor of Severe Retinopathy of Prematurity

BACKGROUND: Chronic placental inflammation (CPI) has been implicated in the pathogenesis of diseases in premature infants, whereas retinopathy of prematurity (ROP) is a major complication primarily affecting preterm and very low-birth-weight (VLBW) infants. This study aims to investigate the association between CPI and ROP in VLBW infants. METHODS: We performed a retrospective review of clinical records of VLBW infants born between 2013 and 2016. Placental pathology findings including CPI cases were analyzed using logistic regression to study infants’ morbidities and other clinical characteristics. RESULTS: A total of 402 infants with a mean (standard deviation) gestational age of 28.5 (2.8) weeks and birth weight of 1,027.2 (304.4) g were included. The incidence of ROP was 24.1%. CPI was found in 90 infants (22.4%), among which 28.9% (26 of 90) developed ROP, and 21.1% (19 of 90) underwent laser photocoagulation. Lower gestational age, lower birth weight, longer duration of oxygen supply, and presence of CPI were associated with the development of ROP. After adjustment for gestational age, birth weight, sex, duration of oxygen supply, and other overlapping placental pathology, CPI was associated with the odds for type 1 ROP that required laser photocoagulation (adjusted odds ratio, 2.739; 95% confidence interval, 1.112 to 6.749; p = .029). CONCLUSIONS: CPI was associated with severe ROP requiring treatment with laser photocoagulation in VLBW infants.

Clinical Characteristics of Acute Respiratory Tract Infections in Full-Term Newborns without Risk Factors

PURPOSE: This study evaluated the characteristics and symptoms of full-term newborns without risk factors who were diagnosed with acute lower respiratory tract infections (ALRI). METHODS: Nasopharyngeal aspirates were obtained from 72 full-term newborns to 30 days of age who were diagnosed with ALRI from September 2011 to November 2013 and analyzed by multiplex real time-polymerase chain reaction (RT-PCR). RESULTS: Viruses were detected in 60 newborns (83.3%). Single viruses were observed in 56 newborns (77.7%). The most commonly detected viral agent was respiratory syncytial virus (RSV) (63.8%), followed by parainfluenza virus (6.9%), rhinovirus A/B (4.1%), and human coronavirus (2.7%). Clinical diagnoses of ALRI in newborns with a single virus included pneumonia (66.07%), bronchiolitis (30.43%), bronchitis (5.35 %), and croup (1.79%). There were no differences in epidemiological characteristics between RSV and other viruses. However, newborns diagnosed with RSV had prolonged hospitalizations and significantly increased respiratory rates. CONCLUSION: Respiratory viruses, especially RSV, are pivotal causes of ALRI in newborns. Further, studies on RSV severity and vaccination are necessary to reduce hospitalization and mortality of full-term infants.

A Novel MUT Gene Mutation Detected in a Female Infant with Methylmalonic Acidemia

Methylmalonic acidemia (MMA) is an autosomal recessive metabolic disease. MMA results from a deficiency of L-methylmalonyl-CoA mutase (encoded by MUT), its cofactor 5-deoxyadenosylcobalamin (MMAA, MMAB, and MMADHC), or a deficiency of methylmalonyl CoA-epimerase (MCEE). We report the case of a 5-day-old infant with MMA in which a missense and a novel nonsense mutation in MUT were present. Direct sequencing analysis of MUT revealed a heterozygous c.1106G>A (p.Arg369His) mutation in exon 6 and a heterozygous c.362_368dupAGTTCTA (p.Tyr123*) mutation in exon 2; the latter results in a premature stop codon.

Parotid sialolithiasis in a two-year-old boy / 소아과

Sialolithiasis is caused by the obstruction of a salivary gland or its excretory duct by the formation of calcareous concretions or sialoliths; this results in salivary ectasia and provokes subsequent dilation of the salivary gland. Sialolithiasis is relatively common, accounting for 30% of salivary diseases; however, it is rarely observed in childhood. This case report describes a 2-year-old male patient who complained of a painful swelling over the right cheek, and presented with palpable stones and pus discharge from the orifice of the right Stensen's duct. Computerized tomography of the neck confirmed the diagnosis, and the patient received intravenous empiric antibiotics combined with intraoral sialolithotomy. We also provide a review of the spectrum of concepts regarding the pathogenesis, diagnosis, and treatment of sialolithiasis.