• Title/Summary/Keyword: Extremely Low Birth Weight

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Genetic association of swine leukocyte antigen class II haplotypes and body weight in Microminipigs

  • Matsubara, Tatsuya;Takasu, Masaki;Imaeda, Noriaki;Nishii, Naohito;Takashima, Satoshi;Nishimura, Takashi;Nishimura, Toshiaki;Shiina, Takashi;Ando, Asako;Kitagawa, Hitoshi
    • Asian-Australasian Journal of Animal Sciences
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    • v.31 no.2
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    • pp.163-166
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    • 2018
  • Objective: Microminipigs are a novel animal model with extensive applications in laboratory studies owing, in part, to their extremely small body sizes. In this study, the relationship between swine leukocyte antigen (SLA) class II haplotype and body weight was evaluated in the Microminipig population. Methods: A total of 1,900 haplotypes, covering SLA class II haplotypes Lr-0.7, Lr-0.23, Lr-0.17, Lr-0.37, Lr-0.16, Lr-0.11, Lr-0.13, and Lr-0.18, were analyzed in 950 piglets. Birth weights and weights on postnatal day 50 were examined in piglets with eight different SLA class II haplotypes. Results: The mean birth weight of piglets with the Lr-0.23 haplotype (0.415 kg, n = 702) was significantly lower than that of piglets with Lr-0.17 (0.445 kg, n = 328) and Lr-0.37 (0.438 kg, n = 383) haplotypes. At postnatal day 50, the mean body weight of piglets with the Lr-0.23 haplotype (3.14 kg) was significantly lower than that of piglets with the Lr-0.13 haplotype (3.46 kg, p<0.01). There were no significant differences in daily gains (DGs) among the eight haplotypes. However, piglets with the Lr-0.11 and -0.18 haplotype combination or any heterozygous haplotype combinations containing Lr-0.23 had significantly lower DGs than those of piglets with the Lr-0.18, 0.37 haplotype combination. Conclusion: Piglets with the Lr-0.23 haplotype had relatively low body weights at birth and on postnatal day 50 and slightly lower DGs than those of piglets with other haplotypes. Therefore, the Lr-0.23 SLA class II haplotype may be a suitable marker for the selective breeding of Microminipigs with small body sizes.

Effective Ways of Performing Surveillance Surface Cultures in Extremely Low Birth Weight Infants

  • Lee, Ju-Young;Kim, Ee-Kyung;Lee, Jin-A;Choi, Chang-Won;Kim, Han-Suk;Kim, Beyong-Il;Choi, Jung-Hwan
    • Neonatal Medicine
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    • v.18 no.2
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    • pp.240-247
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    • 2011
  • Purpose: The rationale for skin surface cultures is that bacterial colonization precedes infection and, as a result, that identification of a potential pathogen is predictive of later systemic infection in preterm infants. We aimed to analyze results of surveillance surface cultures in extremely low birth weight (ELBW) infants and seek for effective ways of performing surveillance surface cultures. Methods: We analyzed the surveillance surface cultures of 113 ELBW infants over a 4-year period. Surveillance cultures were obtained routinely from five sites: axilla, external ear canal, nasopharynx, throat (or tracheal aspirate if intubated) and anus. Each surface culture obtained during the 13 days, prior to the date of the blood culture, was compared with the blood culture obtained when sepsis was suspected. The sensitivity, specificity and positive predictive value (PPV) of the surveillance cultures were calculated among 1894 blood-surface culture pairs by surface sites, recovered organisms and interval between surveillance samples and blood cultures. Results: The overall sensitivity, specificity and PPV of surface cultures were 45.9, 22.4 and 6.8%, respectively. The PPV was highest for the throat/tracheal cultures (11.0%) and lowest for the anal cultures (2.3%). As the time of culturing progressed toward the day of blood culturing, the sensitivity and specificity of the surface cultures significantly increased. Only axillary and throat/tracheal cultures were useful in predicting the microorganisms causing sepsis. Conclusion: Surface cultures could help to predict sepsis pathogens and infection surveillance in preterm infants could be continued with a reduced number of cultured sites focusing on the axilla and throat/trachea.

Analysis of prognostic factors of laparotomy for necrotizing enterocolitis in extremely low birth weight infants (괴사성 장염으로 수술한 초극소저체중출생아(<1,000 g)의 예후인자 분석)

  • Kim, Jin Kyu;Kim, Yi Sun;Yoo, Hye Soo;Ahn, So Yoon;Seo, Hyun Ju;Choi, Seo Heui;Park, Soo Kyung;Jung, Yu Jin;Kim, Myo Jing;Jeon, Ga Won;Koo, Soo Hyun;Lee, Kyung-Hoon;Chang, Yun Sil;Park, Won Soon
    • Clinical and Experimental Pediatrics
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    • v.53 no.2
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    • pp.167-172
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    • 2010
  • Purpose : With improved survival of extremely low birth weight infants (ELBWI), there is an increase in the incidence of necrotizing enterocolitis (NEC) requiring laparotomy, and the risk of morbidity and mortality in these ELBWI is increased. Thus, we determined the prognostic factors in ELBWI who underwent laparotomy for NEC. Methods : We retrospectively reviewed the medical records of 35 ELBWI who underwent laparotomy for NEC from January 2001 to December 2008 at Samsung Medical Center. Results : Of 480 ELBWI, 35 required laparotomy for NEC; the mortality rate was 20% (Alive group n=28, Dead group n=7). The values of preoperative score for neonatal acute physiology-II (P =0.022) and fraction of inspired oxygen (P <0.001) were significantly higher in the dead group and values of base excess (P =0.004) were significantly lower in the dead group. Values of preoperative heart rate, respiration rate, mean blood pressure, pH, $CO_2$, and potassium ion were not significantly different between the study groups. Intraoperative fluid volume was significantly higher in the alive group than in the dead group (P =0.045). Postoperative infusion rate was significantly lower in the alive group than in the dead group (P =0.022). Conclusion : Good preoperative condition, more intraoperative fluid infusion, and stable postoperative hemodynamic condition were factors associated with favorable prognosis of laparotomy for NEC in ELBWI.

The Significance of Maturation Score of Brain Magnetic Resonance Imaging in Extremely Low Birth Weight Infant (초극소 저체중 출생아의 뇌 MRI 상 Maturation Score의 의의)

  • Song, In-Gu;Kim, Su-Yeong;Kim, Cur-Rie;Kim, Yoon-Joo;Shin, Seung-Han;Lee, Seung-Hyun;Lee, Jae-Myoung;Lee, Ju-Young;Kim, Ji-Young;Sohn, Jin-A;Lee, Jin-A;Choi, Chang-Won;Kim, Ee-Kyung;Cheon, Jung-Eun;Kim, Woo-Sun;Kim, Han-Suk;Kim, Byeong-II;Kim, In-One;Choi, Jung-Hwan
    • Neonatal Medicine
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    • v.18 no.2
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    • pp.310-319
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    • 2011
  • Purpose: The aim of this study was to investigate the effect of perinatal risk factors on brain maturation and the relationship of brain maturation and neurodevelopmental outcomes with brain maturation scoring system in brain MRI. Methods: ELBWI infants born at the Seoul National University Children's Hospital from January 2006 to December 2010 were included. A retrospective analysis was performed with their medical record and brain MR images acquired at near full term. We read brain MRI and measured maturity with total maturation score (TMS). TMS is a previously developed anatomic scoring system to assess brain maturity. The total maturation score was used to evaluate the four parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. Results: Images from 124 infants were evaluated. Their mean gestational age at birth was 27.1${\pm}$2.1 weeks, and mean birth weight was 781.5${\pm}$143.9 g. The mean TMS was 10.8${\pm}$2.0. TMS was significantly related to the postmenstrual age (PMA) of the infant, increasing with advancing postmenstrual age (P<0.001). TMS showed no significance with neurodevelopmental delay, and with brain injury, respectively. Conclusion: TMS was developed for evaluating brain maturation in conventional brain MRI. The results of this study suggest that TMS was not useful for predicting neurodevelopmental delay, but further studies are needed to make standard score for each PMA and to re-evaluate the relationship between brain maturation and neurodevelopmental delay.

Investigation of False Positive Rates Newborn Screening using Tandem Mass Spectrometry (TMS) Technology in Single Center (단일기관에서 이중 질량 분석법(tandem mass spectrometry technology)을 이용한 선천성 대사이상 검사의 위양성율에 대한 연구)

  • Kim, Hyunsoo;Shin, Son Moon;Ko, Sun Young;Lee, Yeon Kyung;Park, Sung Won
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.16 no.1
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    • pp.18-23
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    • 2016
  • Objective: Newborn screening leads to improved treatment and disease outcomes, but false-positive newborn screening results may impact include parental stress and anxiety, perception of child as unhealthy, parent-child relationship dysfunction, and increased infant hospitalizations. The purpose of this study was to investigate of the false positive rates and the causative factors of false positive results in Tandem Mass Spectrometry (TMS) in single center. Methods: Records were reviewed for all 18,872 subjects who were born in Cheill General Hospital, during January 1st, 2012 to December 31st, 2014. 17,292 neonates (91.62%) were tested for tandem mass screening almost in 2-5th day of life. Newborn babies whose first results were abnormal had been tested repeatedly by same methods in 7-14 day. If the results were abnormal again, further evaluation was performed. TMS analysis included data for the 43 disorders screened for using TMS broken down into three categories: fatty acid oxidation disorders, organic acidurias, and aminoacidopathies. The impact of several factors on increased false positive rates was analyzed using a multivariate analysis: time from birth to sample collection, birth weight, birth height, BMI, gender, gestational age, delivery type. Results: Males of the subjects were 8942 (51.7%), female 8350 (48.3%), the mean gestational age was $38.6{\pm}1.7$ weeks, the average birth weight $3,155.6{\pm}502.4g$, the average birth height $49.1{\pm}2.9cm$, and the average BMI $13.0{\pm}3.8(kg/m^2)$. Vaginal delivery cases were 9713 (56.2%), caesarean section 7,579 (43.8%). The average date of the inspection was $2.8{\pm}1.1$ days. 224 cases were identified as TMS positive. All the subjects were false positive (222/17,292, 1.30%) except 2 cases (1 male; benign phenylketonuria and 1 female; Short chain acyl-CoA dehydrogenase deficiency). The false positive rates were 0.61% in fatty acid oxidation disorders, 0.25% in organic acidurias, and 0.45% in aminoacidopathies. In our study, the date of inspection got late, the false positive rates got higher. Because almost the cases of late test date were in treatment in neonatal intensive care unit so their test date was affected by their medical conditions. False positive rate was higher in extreme immaturity${\leq}27$ weeks than newborns of gestational age >27 weeks [OR=6.957 (CI=1.273-38.008), p<0.025] and extremely low birth weight<1,000 g than newborns of birthweight ${\geq}1,000g$ [OR=5.616 (CI=1.134-27.820), p<0.035]. Conclusion: False positive rate of TMS was 1.30% in Cheil General Hospital. Lower gestational age and birth weight impacted on increased false positive rates. Better understanding of factors that influence the reporting of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting. of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting.

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Cerebral Hemodynamics in Premature Infants

  • Rhee, Christopher J.;Rios, Danielle R.;Kaiser, Jeffrey R.;Brady, Ken
    • Neonatal Medicine
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    • v.25 no.1
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    • pp.1-6
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    • 2018
  • Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure--the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.

Enteral Feeding for Preterm Infants-Benefits and Risks (미숙아의 장관영양)

  • Sin, Jong-Beom
    • Neonatal Medicine
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    • v.16 no.2
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    • pp.121-130
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    • 2009
  • Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.

Effect of severe neonatal morbidities on long term outcome in extremely low birthweight infants

  • Koo, Kyo-Yeon;Kim, Jeong-Eun;Lee, Soon-Min;NamGung, Ran;Park, Min-Soo;Park, Kook-In;Lee, Chul
    • Clinical and Experimental Pediatrics
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    • v.53 no.6
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    • pp.694-700
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    • 2010
  • Purpose: To assess the validity of individual and combined prognostic effects of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition associated cholestasis(PNAC). Methods: We retrospectively analyzed the medical records of 80 extremely low birthweight (ELBW) infants admitted to the neonatal intensive care unit (NICU) of the Severance Children's Hospital, and who survived to a postmenstrual age of 36 weeks. We analyzed the relationship between 4 neonatal morbidities (severe BPD, severe brain injury, severe ROP, and severe PNAC) and poor outcome. Poor outcome indicated death after a postmenstrual age of 36 weeks or survival with neurosensory impairment (cerebral palsy, delayed development, hearing loss, or blindness) between 18 and 24 months of corrected age. Results: Each neonatal morbidity correlated with poor outcome on univariate analysis. Multiple logistic regression analysis revealed that the odds ratios (OR) were 4.9 (95% confidence interval [CI], 1.0-22.6; $P$=0.044) for severe BPD, 13.2 (3.0-57.3; $P$<.001) for severe brain injury, 5.3 (1.6-18.1; $P$=0.007) for severe ROP, and 3.4 (0.5-22.7; $P$=0.215) for severe PNAC. Severe BPD, brain injury, and ROP were significantly correlated with poor outcome, but not severe PNAC. By increasing the morbidity count, the rate of poor outcome was significantly increased (OR 5.2; 95% CI, 2.2-11.9; $P$<.001). In infants free of the above-mentioned morbidities, the rate of poor outcome was 9%, while the corresponding rates in infants with 1, 2, and more than 3 neonatal morbidities were 46%, 69%, and 100%, respectively. Conclusion: In ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.

Delayed closure effect in preterm infants with patent ductus arteriosus (미숙아 동맥관개존증의 지연된 폐쇄가 예후에 미치는 영향)

  • Lee, Hyun Ju;Sim, Gyu Hong;Jung, Kyung Eun;Lee, Jin A;Choi, Chang Won;Kim, Ee Kyung;Kim, Han Suk;Kim, Beyong Il;Choi, Jung-Hwan
    • Clinical and Experimental Pediatrics
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    • v.51 no.10
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    • pp.1065-1070
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    • 2008
  • Purpose : This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d). Methods : Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively. Results : The mean gestational age (GA) was $26{\pm}2weeks$ (range, 23-32 wk), and the birth weight was $782{\pm}146g$ (range, 430-990 g). The delayed closure group was associated with early GA ($25.7{\pm}1.7wk$ vs $27.1{\pm}2.0wk$, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010). Conclusion : Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.

Improved survival rate with decreased neurodevelopmental disability in extreme immaturity (초극소저출생체중아의 생존율 향상에 따른 장기 신경발달 장애의 감소)

  • Jeon, Ga Won;Kim, Myo Jing;Kim, Sung Shin;Shim, Jae Won;Chang, Yun Sil;Park, Won Soon;Lee, Mun Hyang
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1067-1071
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    • 2007
  • Purpose : The aim of this study was to determine whether improved survival of extremely low birth weight infants (ELBWI) was associated with decreased neurodevelopmental disability later in life, and also to identify the factors influencing this disability. Methods : ELBWI admitted to the neonatal intensive care unit of Samsung Medical Center, survived, and followed up until the corrected age of 18 months were enrolled. They were divided into two groups according to admission time: period I (1994-1999, n=36) and period II (2000-2004, n=98). Clinical data were collected retrospectively from the medical records. Results : Survival rates increased from 60.0% to 74.7%, cerebral palsy rates decreased from 22.2% to 8.2% and catch-up growth rate increased from 25.0% to 51.0% during period I and II. Despite less gestational age and birth weight, ELBWI during period II had less periventricular leukomalacia (PVL), sepsis and bronchopulmonary dysplasia compared to period I. The highest risk factors for cerebral palsy were intraventricular hemorrhage (IVH) (${\geq}$Grade III), failure of catch-up growth and PVL. Conclusion : In summary, improved viability was associated with decreased neurodevelopmental disability in ELBWI. Improved neonatal care with resultant decrease in PVL and IVH, and better nutritional support seem to be primarily responsible for this improved outcome.