• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.685-690
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• 2005

Recently, twinning rate increases in Korea since the early 1990s by delayed marriage and prevailing of assisted reproductive technology. But twin and higher-order multiples are at increased risk for perinatal and neonatal mortality over 5 fold despite of dramatic improvement of perinatal and neonatal care. Because twins are born more prematurely and have lower birth weights than singleton. In addition, twins are at increased risk for cerebral palsy mainly in monochorionic twins due to co-twin fetal death, twin to twin transfusion and congenital anomaly. So, this article reviews the factors contributing to the mortality and morbidity of the twins and the efforts to decrease the neonatal mortality of twins.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.137-146
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• 2006

Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods: from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7:1 to 2.1:1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.

• Clinical and Experimental Pediatrics
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• v.54 no.11
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• pp.443-455
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• 2011

Neonatal mortality rate (NMR) or infant mortality rate (IMR) are the rate of deaths per 1,000 live births at which babies of either less than four weeks or of one year of age die, respectively. The NMR and IMR are commonly accepted as a measure of the general health and well-being of a population. Korea's NMR and IMR fell significantly between 1993 and 2009 from 6.6 and 9.9 to 1.7 and 3.2, respectively. Common causes of infantile death in 2008 had decreased compared with those in 1996 such as other disorders originating in the perinatal period, congenital malformation of the heart, bacterial sepsis of newborns, disorders related to length of gestation and fetal growth, intra-uterine hypoxia, birth asphyxia. However, some other causes are on the increase, such as respiratory distress of newborn, other respiratory conditions originating in the perinatal period, other congenital malformation, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. In this study, we provide basic data about changes of NMR and IMR and the causes of neonatal and infantile death from 1983 to 2009 in Korea.

• Korea journal of population studies
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• v.11 no.1
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• pp.76-86
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• 1988

The primary objective of this study was to estimate the level of infant mortality rate and to find the cause of infant deaths prevailed in 1981~86 from vital registration data. In the course of that undertaking we have considered the non-registered portion of infant deaths especially for the non-registered portion of neonatal deaths. The main reason is that deaths occurring in the neonatal period and prior to the registration of the birth leave little incentive for the registration of either the birth or the death. From several ad-hoc survey's results and other countries' experiences it was, however, found that the proportion of neonatal deaths was 69.3%, the proportion of deaths in the period of first month in infanty was 7%, and the proportion of deaths in the period of 2 months and over in infancy was 23.7% respectivily. Thus, adoption the hypothesis that post-neonatal mortality is completly registered, we obtained the extimated number of infant deaths. Attempt to test the hypothesis was also made using the Brougeois- Pichats's function. The result was that the registered number of deaths in the post-neonatal period is almost compatible with the expected number. The major finding in this study was that the level of infant mortality rate in Korea was 19 per thousand live births in 1981 and 13 in 1986. This level of 1986 was almost identical with the level of Japan in 1970. It was also found that there was a difference in the level of infant mortality rate between sexes during 1981-83 but the difference was disappeared in 1985-86. Looking into the cause of infant deaths, it was found from registration that 21.2% of all infant deaths was due to congenital snomalies, 11.5% was due to pneumonia and 5.1% was due to the conditions originating in the perinatal period in that order. This pattern seems to be different with that of U.S.A., Japan and France. However, if we consider the non-registered neo-natal deaths, the order of the cause of infant deaths in Korea will be the same as compared countries. Finally, every efforts should should be made to obtain a good quality of data on infant mortality, making the non-registered events reported completely through hospitals.

• Neonatal Medicine
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• v.16 no.1
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• pp.18-24
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• 2009

Seizures are the most common clinical symptom of a neurologic insult and have long been recognized as an obvious marker of brain dysfunction in newborns. Presence of seizures in newborn infants may signify substantial risk for subsequent neurodevelopmental impairment including postneonatal epilepsy and death. The outcomes of seizures in neonates are determined mainly by the etiology of the seizures. Despite the decreasing trend of mortality of neonatal seizures, the prevalence of long-term neurodevelopmental sequelae in survivors has remained unchanged over time. Clinical studies have contributed to identifying significant prognostic factors for neurodevelopmental outcome. The underlying etiology of the seizures and electroencepaphalography background pattern are considered as most reliable early predictors of later neurologic sequelae. However, clinicians managing neonatal seizures are still challenged by difficult therapeutic and prognostic questions because of many unresolved issues in seizure recognition, terminology, relationships to the underlying brain lesion, effect of current management, particularly antiepileptic drugs on long-term outcomes. This review presents the prognosis of neonatal seizures, especially about mortality and neurodevelopmental deficit, and predictors of outcomes.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.957-963
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• 2009

Neonatal seizures are the most common and distinctive clinical sign of prenatal and/or neonatal brain disorders. Newborn infants with seizures are at risk of mortality and survivors at risk for neurologic impairment, developmental delay, and subsequent epilepsy. Fifteen reports on neonatal seizures in Korea from 1983 to 2009 were analyzed. A total of 731 neonatal seizure cases were reported. Day of seizure onset, etiology, type of seizures, electroencephalogram findings, and outcomes were analyzed. It is necessary to establish a basic report for a future nationwide study of neonatal seizures.

• Neonatal Medicine
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• v.25 no.1
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• pp.16-22
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• 2018

Purpose: This study investigated predictive factors for severe neonatal thrombocytopenia, which greatly increases the need for intensive care and is associated with a high mortality rate in premature infants. Factors adopted for prompt identification of at-risk newborns include blood test results and birth history. This study analyzed the relationship between the presence of severe neonatal thrombocytopenia and the mortality rate. The causes of thrombocytopenia in premature infants were also examined. Methods: This retrospective study evaluated 625 premature infants admitted to the neonatal intensive care unit (NICU) at Chung-Ang University Medical Center. The neonates were classified into 3 groups according to the severity of thrombocytopenia: mild ($100{\times}10^9/L{\leq}platelet<150{\times}10^9/L$), moderate ($50{\times}10^9/L{\leq}platelet<100{\times}10^9/L$), or severe (platelet<$50{\times}10^9/L$). Analysis of blood samples obtained at the onset of thrombocytopenia included platelet count, white blood cell (WBC) count, hemoglobin level, hematocrit level, absolute neutrophil count, and high-sensitivity C-reactive protein level. Results: Of the 625 premature infants admitted to our NICU, 214 were detected with thrombocytopenia. The mortality rate in thrombocytopenic neonates was 18.2% (39/214), whereas a mortality rate of only 1.0% was observed in non-thrombocytopenic neonates. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants. Severe thrombocytopenia was noted more frequently in premature infants with higher WBC counts and in those with a younger gestational age. Conclusion: Platelet count, WBC count, and gestational age are reliable predictors for severe neonatal thrombocytopenia. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants.

• Pediatric Infection and Vaccine
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• v.30 no.1
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• pp.12-19
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• 2023

Purpose: Sepsis is the most common cause of neonatal death accounting for 30-50% of mortality annually in developing countries. This study was to determine the prognostic factors of neonatal sepsis mortality. Methods: A retrospective cohort was conducted in Dr. R. Sosodoro Djatikoesoemo Governor Hospital from April 2021 to September 2021 on 121 neonates in the neonatal intensive care unit (NICU) diagnosed with sepsis. The inclusion criteria were neonates aged 0-28 days, admitted to the NICU, and diagnosed with sepsis. The exclusion criteria were incomplete data and the presence of congenital abnormalities. A χ² test was performed on the sex, gestational age, mode of delivery, birth weight, APGAR score, birthplace, and blood culture. A normality test was performed on leukocytes, lymphocytes, neutrophils, platelets, C-reactive protein (CRP), and length of stay. Then performed a Mann-Whitney test. Results: Birth weight (P=0.038), gestational age (P=0.009), and blood culture (P=0.014) showed a significant relationship with the neonatal sepsis outcome while Mann-Whitney test showed significant differences in the platelets (P=0.018), CRP (P=0.002), and length of stay (P<0.001). Multivariate analysis showed that 3 prognostic factors associated with neonatal sepsis mortality were prematurity (odds ratio [OR], 3.906; 95% confidence interval [CI], 1.344-11.356; P=0.012), low birth weight (LBW, OR, 2.833; 95% CI, 1.030-7.790; P=0.044), and gram-negative bacteria (OR, 4.821; 95% CI, 1.018-22.842; P=0.047). Conclusions: Prematurity, LBW, and gram-negative bacteria were associated with the prognostic factors of neonatal sepsis.

• Neonatal Medicine
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• v.16 no.2
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• pp.154-162
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• 2009

Purpose: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. Methods: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. Results: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. Conclusion: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.

• Advances in pediatric surgery
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• v.10 no.2
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• pp.87-91
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• 2004

As prenatal ultrasonography becomes popular, the number of prenatal diagnosis of congenital surgical diseases is also increasing. To evaluate the impact of antenatal ultrasonography on outcome the mortality rate in neonatal surgical emergencies was studied. The authors retrospectively reviewed 281 patients (congenital diaphragmatic hernia: 44, tracheoesophageal fistula: 78, intestinal atresia: 98, omphalocele: 28 and gastroschisis: 33 who had been managed at Seoul National University Childrens Hospital, from January 1991 to December 2000. The patients were divided into two groups; group A (1991 to 1995; 139 patients) and group B (1996 to 2000; 142 patients). These two groups were subdivided into prenatally diagnosed subgroup and postnatally diagnosed subgroup. We analyzed the changes of prenatal diagnosis rate, total mortality rate, and mortality rate of subgroups. Prenatal diagnosis rate was increased significantly in group B (Group A: 24.5 % and Group B: 45.1 %). Total mortality rate of group A was 21.6 %, and that of group B was 10.6 %, showing a significant decrease in group B. However, in both group A and B, when compared antenatally diagnosed subgroup with postnatally diagnosed subgroup, the mortality rate was lower in postnatally diagnosed subgroups but statistically not significant. The authors conclude that although prenatal diagnosis rate has been increased, prenatal diagnosis itself has not resulted in significant improvement in outcome.