• Clinical and Experimental Pediatrics
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• 제49권1호
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• pp.1-5
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• 2006

Several physiological skin changes such as vernix caseosa, cutis marmorata, physiologic desquamation, and sebaceous hyperplasia have been described in the neonatal period. There are also clinical characteristics of skin peculiar to neonate and infancy. Skin disorders observed during neonatal and infancy period can be divided into transient skin lesions, birth marks, and other diseases. Transient skin lesions include milia, sebaceous gland hyperplasia, erythema neonatorum, transient neonatal pustular melanosis, and acne neonatorum. Nevocellular nevus, mongolian spot, vascular malformation, hemangioma, epidermal nevus, and sebaceous nevus belong to birth marks. There are several common skin diseases such as miliaria, diaper dermatitis, atopic dermatitis, seborrheic dermatitis, and cutaneous candidiasis.

• Advances in pediatric surgery
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• 제12권2호
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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.

• Neonatal Medicine
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• 제16권1호
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• pp.1-9
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• 2009

Seizures are the most common clinical manifestation of a neurologic insult during the neonatal period. Neonatal seizures continue to present a diagnostic and therapeutic challenge to pediatricians because the recognition and classification of neonatal seizures remains problematic, particularly when clinicians rely only on clinical criteria. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity, and "prime" the brain to increased damage from seizures later in life. Since neonatal seizures, particularly status epilepticus, predict an increased risk for later epilepsy and other neurologic sequelae, accurate diagnoses are needed for aggressive antiepileptic drug use. The present review summarizes the pathophysiology, etiology, and diagnosis of neonatal seizures.

• Neonatal Medicine
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• 제25권4호
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• pp.191-195
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• 2018

Leukocyte adhesion deficiency is a rare primary immunodeficiency and autosomal recessive disorder caused by a mutation in the gene encoding CD18, which is a constituent of leukocyte integrins. Clinical features usually begin with a delay in the separation of the umbilical cord in the neonatal period, and are characterized by marked leukocytosis with infection, delayed wound healing, and repeated bacterial and fungal infections. We experienced a case of leukocyte adhesion deficiency diagnosed in the neonatal period, in which a late preterm infant admitted to neonatal intensive care unit presented with a septic hip. Flow cytometry analysis of whole blood showed a decrease in the expression of CD11b/CD18. This is the first case of leukocyte adhesion deficiency with neonatal septic hip diagnosed in Korea.

• 대한유전성대사질환학회지
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• 제14권1호
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• pp.10-18
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• 2014

Recent advances in the diagnosis and treatment of inborn errors of metabolism have improved substantially the prognosis of many of these diseases, if diagnosed early enough before irreversible damage occurs. This makes it essential that the practicing pediatrician, especially neonatologists be familliar with the clinical presentations and systematic approaches of these disorders. Characteristic clinical presentations, methods of systematic approach and typing of various disorders is discussed in this review. The signs of neurological dysfunctions of many IEMs manifesting in the neonatal period is very nonspecific, such as poor feeding, poor sucking, apnea or tachypnea, vomiting, hypertonia, hypotonia, seizure, letharginess, consciousness change and coma. Many other non-metabolic severe disorders of neonatal period such as neonatal sepsis and intracerebral hemorrhage share these nonspecific symptoms. Hyperammonemia, metabolic acidosis, ketosis and hyperlatic acidemia are observed in many of these conditions but there are exceptions in which conditions all basal laboratory tests are normal, such as NKH, sulfite oxidase deficiency and peroxisomal disorders. According to the results of basal laboratory tests, IEMs in the neonatal period can be categorized in to 6 types. Grouping of IEMs into 6 types will make confirmatory tests and early emergency treatment more efficient.

• Pediatric Infection and Vaccine
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• 제9권2호
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• pp.163-174
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• 2002

목 적: 본원 신생아실 및 신생아 중환자실에서 10년간 발생한 신생아 패혈증을 조사하여 환아들의 특징, 패혈증의 원인균 및 항생제 감수성의 변화를 파악하고 신생아 패혈증을 치료하는데 도움되고자 하였다. 방 법: 1989년부터 1998년까지의 10년간 본원 신생아실 및 신생아 중환자실에 입원하였던 환아 15,144명에 대해 의무기록을 확인하여 신생아 패혈증으로 진단된 환아를 선별하였다. 조사 기간을 1989년부터 1993년까지(전반기)와 1994년부터 1998 년까지(후반기)로 나누어 패혈증으로 진단된 환아 들의 임상적 특징, 균의 종류와 빈도, 항생제 감수성의 변화 양상을 관찰하였다. 결 과 : 신생아 패혈증은 총 15,144명 중 170명에서 진단되어 1.1%(전반기 91명, 1.2%, 후반기 79명 1.0%)이었으며, 186회(전반기 99회, 후반기 87회)에 걸쳐 200개의 균주(전반기 109균주, 후반기 91균주)가 분리동정 되었다. 평균 발병시기는 생후12.3일로 전반기 8.8일, 후반기 16.3일이었고, 조발형은 전반기 34.7%, 후반기 23.0%로 나타나 전반기에 더 빨리 발병하였다. 분리된 균주는 그람양성균 132회 (66.0%), 그람음성균 60회(30.0%), 진균 8회(4.0%)이었으며, Coagulase negative Staphylococcus(CNS)가 총 69회(34.5%)로 가장 많은 빈도를 나타내었고, Staphylococcus aureus(S. aureus) 36회(18.0%), Klebsiella pneumoniae(K. pneumoniae) 17회(8.5%), Enterococcus 12회(6.0%), Enterobacter cloacae(E. cloacae) 8회(4.0%), Escherichia coli(E. coli) 6회(3.0%), Pseudomonas aeruginosa(P. aeruginasa) 5회(2.5%) 등의 순이었다. 진균으로는 Candida parapsilosis, Candida albicans, Trichosporon pullulans 가 분리되었다. CNS, S. aureus 및 Acinetobacter baumannii(A. baumanii), Candida는 전반기에 비해 후반기에 더 많이 분리 동정되었으며, CNS 및 S. aureus의 methicillin 및 1세대 cephalosporin에 대한 항생제 감수성은 전반기에 비해 후반기에 감소하였고 aminoglycosides에 대한 감수성은 후반기에 증가하였으며, vancomycin 내성균은 분리되지 않았다. K. pneumoniae, Enterococcus, E. coli 및 P. aeruginosa는 전반기에 비해 후반기에 감소하였으며 K. pneumoniae는 1세대 cephalosporin에 대해 전, 후반기 모두 낮은 감수성을 보였고 tobramycin과 gentamicin에는 후반기에 감수성이 증가하였으며 amikacin, ceftriaxone, trimethoprim-sulfamethoxazole에는 전, 후반기 모두 높은 감수성을 보였다. Enterococcous는ampicillin, penicillin 및 1세대 cephalosporin에 대한 감수성이 후반기에 감소하였으나 vancomycin 내성균은 분리되지 않았다. 결 론 : 지난 10년간의 신생아 패혈증의 발생 빈도는 1.1%이었으며, CNS와 S. aureus가 신생아 패혈증의 주 원인균이었고, 일차 항생제에 대한 감수성은 전반기에 비해 후반기에 감소하였으나 vanco- mycin 내성균은 발견되지 않았다. 신생아 패혈증의 주요 원인균으로 알려진 group B Streptococcus는 발견되지 않았으며, K. pneumoniae에 의한 신생아 패혈증은 후반기에 더 많이 발생하였으나 항생제 감수성은 감소되지 않았다.

• Neonatal Medicine
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• 제16권1호
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• pp.10-17
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• 2009

The immature neonatal brain is susceptible to the development of seizures. Seizures occur in 1% to 5% of infants during the neonatal period. Neonatal seizures are most commonly associated with serious acute illnesses, such as hypoxic-ischemic encephalopathy, birth trauma, metabolic disturbances, or infections. Thus, newborn infants with seizures are at risk for neonatal death and survivors are at risk for neurologic impairment, developmental delay, and subsequent epilepsy. Experimental data have also raised concerns about the potential adverse effects of the currently used anticonvulsants in neonates on brain development. Therefore, in the management of neonatal seizures, confirmatory diagnosis and optimal, but shorter, duration of anticonvulsant therapy is essential. Nevertheless, there has been substantial progress in understanding the developmental mechanisms that influence seizure generation and responsiveness to anticonvulsants. The currently used therapies have limited efficacy and the treatment of neonatal seizures has not significantly changed in the past several decades, This review includes an overview of current approaches to the treatment of neonatal seizures.

• 한국인구학
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• 제11권1호
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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.

• Clinical and Experimental Pediatrics
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• 제50권3호
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• pp.230-235
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• 2007

In the early neonatal period, the neonate is challenged by the loss of the placental calcium transport and manifests a quick transition, from an environment in which PTHrP plays an important role to a PTH- and 1,25-dihydroxyvitamin D-controlled neonatal milieu. Disturbances in mineral homeostasis are common in the neonatal period, especially in premature infants and infants who are hospitalized in an intensive care unit. In many cases these disturbances are thought to be exaggerated responses to the normal physiological transition from the intrauterine environment to neonatal independence. Some disturbances in calcium and phosphate homeostasis are the result of genetic defects, which in many instances can now be identified at the molecular level. Although fetus develop remarkably normally in the presence of maternal calcium, PTH and vitamin D deficiency, the neonates demonstrate abnormalities that are consequences of the prior abnormal maternal calcium homeostasis. Evaluation and management of hypocalcemia and hypercalcemia in neonate requires specific knowledge of perinatal mineral physiology and the unique clinical and biochemical features of newborn mineral metabolism.

• Clinical and Experimental Pediatrics
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• 제52권9호
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• pp.971-975
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• 2009

Seizures in the neonatal period are common and frequently indicate serious underlying brain injury. Neonatal seizures continue to present a diagnostic and therapeutic challenge to pediatricians because recognition and classification of neonatal seizures remain problematic, particularly when clinicians rely only on clinical criteria. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity, and "prime" the brain to increased damage from seizures later in life. Since neonatal seizures predict an increased risk for later epilepsy and other neurological sequelae, accurate diagnoses are needed for aggressive antiepileptic drug use. The present review summarizes the treatment and prognosis of neonatal seizures.