• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup2
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• pp.35-43
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• 2008

Jaundice is common in breast-fed infants. Any infant noted to be jaundiced at 2 weeks of age need to be evaluated for cholestasis with measurement of total and direct serum bilirubin. The most common causes of cholestatic jaundice in infants are biliary atresia and neonatal hepatitis. Genetic causes of the neonatal hepatitis syndrome are increasingly recognized and idiopathic neonatal hepatitis is decreasing. Cholestasis should be investigated using a structured protocol. Early detection and timely, accurate diagnosis is important for successful treatment and a favorable prognosis. In particular, a Kasai portoenterostomy for biliary atresia has the best outcome if performed before the infant is 8 weeks of age. The management of cholestasis is mainly supportive, including nutritional support and alleviation of symptoms to improve the quality of life. Specific treatments are available for some causes of neonatal hepatitis syndrome and should be started as soon as possible. For decompensated liver disease, liver transplantation yields a better outcome.

• Neonatal Medicine
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• v.28 no.3
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• pp.139-142
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• 2021

Macrophage activation syndrome (MAS) is a potentially life-threatening complication in many autoimmune diseases. Early recognition and intervention are essential for a favorable outcome. Neonatal lupus, an acquired autoimmune disease in neonates caused by the transplacental passage of maternal autoantibodies, is rare and usually self-limited. Herein, we report a case of MAS in a patient with neonatal lupus, which improved with intravenous immunoglobulin.

• Clinical and Experimental Pediatrics
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• v.64 no.5
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• pp.239-246
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• 2021

Background: The consequences of severe acute respiratory syndrome corona virus 2 on mother and fetus remain unknown due to a lack of robust evidence from prospective studies. Purpose: This study evaluated the effect of coronavirus disease 2019 (COVID-19) on neonatal outcomes and the scope of vertical transmission. Methods: This ambispective observational study enrolled pregnant women with COVID-19 in North India from April 1 to August 31, 2020 to evaluate neonatal outcomes and the risk of vertical transmission. Results: A total of 44 neonates born to 41 COVID-19-positive mothers were evaluated. Among them, 28 patients (68.3%) (2 sets of twins) were delivered within 7 days of testing positive for COVID-19, 23 patients (56%) (2 sets of twins) were delivered by cesarean section; 13 newborns (29.5%) had low birth weight; 7 (15.9%) were preterm; and 6 (13.6%) required neonatal intensive care unit admission, reflecting an increased incidence of cesarean delivery and low birth weight but zero neonatal mortality. Samples of cord blood, placental membrane, vaginal fluid, amniotic fluid, peritoneal fluid (in case of cesarean section), and breast milk for COVID-19 reverse transcription-polymerase chain reaction tested negative in 22 prospective delivery cases. Nasopharyngeal swabs of 2 newborns tested positive for COVID-19: one at 24 hours and the other on day 4 of life. In the former case, biological samples were not collected as the mother was asymptomatic and her COVID-19 report was available postdelivery; hence, the source of infection remained inconclusive. In the latter case, all samples tested negative, ruling out the possibility of vertical transmission. All neonates remained asymptomatic on follow-up. Conclusion: COVID-19 does not have direct adverse effects on the fetus per se. The possibility of vertical transmission is almost negligible, although results from larger trials are required to confirm our findings.

• Clinical and Experimental Pediatrics
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• v.60 no.11
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• pp.344-352
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• 2017

Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction abnormalities, and genetic arrhythmia such as congenital long-QT syndrome are classified as nonbenign arrhythmias. Although most neonatal arrhythmias are asymptomatic and rarely life-threatening, the prognosis depends on the early recognition and proper management of the condition in some serious cases. Precise diagnosis with risk stratification of patients with nonbenign neonatal arrhythmia is needed to reduce morbidity and mortality. In this article, I review the current understanding of the common clinical presentation, etiology, natural history, and management of neonatal arrhythmias in the absence of an underlying congenital heart disease.

• Child Health Nursing Research
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• v.9 no.1
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• pp.96-106
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• 2003

Advances in neonatal care system and research have resulted in an increased survival rate among low birth weight infants in the industrialized countries. Recent Korean neonatal mortality and morbidity statistics, and current status of Korean neonatal intensive care facilities were reviewed here for the sake of future improvement and research. Morbidity statistics revealed that perinatal diseases accounted for 80％ of the death of premature infants implying the possibility of its reduction by the vigorous prenatal care service in future.On the basis of extensive studies of nutritional support and growth rate of premature infants, commercial formulas for premature infants have been developed and various aspects of feeding techniques are standardized. However, problem of growth deficit of premature infants remains unsolved as medical problem. NICU specialists are challenged with the tasks of prenatal education or provision of care that minimizes the neurodevelopmental problems seen in preterm infants, various short-term outcome researches have been reported and those are reviewed here to promote research interest in the field of neonatal nursing. Systemic long-term outcome studies are also awaited in Korea for the formulation of welfare policy in future. Nursing science has to embrace all these interdisciplinary studies as their own research field in collaboration with neonatologist, nutritionist, rehabilitation therapist, social workers and teachers.

• Journal of Nutrition and Health
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• v.32 no.8
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• pp.877-886
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• 1999

To assess the effect of an antenatal nutritional status on pregnancy outcome, especially neonatal birty weight, one-day 24hr-recall and two-day recording methods for dietary survey and interview for general and obstetric characteristics of each subject were completed and pregnancy outcome was recorded by phone after delivery. 147 pregnant women attending routinely public health centers in Ulsan were divided into 1st trimester(n=36), 2nd trimester(n=102), 3rd trimester(n=71) by LMP(Last Menstrual Period) because some subjects attended repeatedly in different trimester. The subjects were aged 27.9$\pm$2.9 as mean and the level of education was senior high school and more. 20.4% of subjects experienced spontaneous abortion and 30.0% experienced induced abortion in previous pregnancy. Mean intakes of all nutrients except ascorbic acid were significantly different but dietary composition of energy intakes was not different between trimester. Mineral of calcium, iron and zinc did not meet the RDA for pregnancy outcome was about 20%, which consists of spontaneous abortion (3.4%), caesarian section(15.6%), premature delivery(0.7%) and still births(0.7%). The mean birth weight of neonates is 3.31kg the rate of neonatal birth weight below 10th percentile was 8.4% and the rate of low birth weight(<2.5kg) was 3.1%. By analysis of nutrient factors that influence on the neonatal birth weight (NBW), iron intake correlated negatively and zinc intake correlated positively with NBW in 1st trimester but fat and iron intakes correlated with NBW positively in 3rd trimester. Prepregnancy weight, gestational age at delivery and No. of induced abortion had a positive effects on NBW and No. of spontaneous abortion and te severity of morning sickness had a negative effects on NBW.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.137-142
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• 2003

Purpose : This study was performed to determine the sensitivity of neonatal electroencephalography (EEG) in detecting underlying brain disease, to compare the sensitivity and specificity of EEG with those of brain ultrasonography and to determine the prognostic value of EEG for neonatal neurologic diseases. Methods : Eighty-seven newborn babies were subjected to a electroencephalographic examination for the evaluation of underlying neurological diseases and EEGs were recorded at least before three days of life. The findings of early ultrasonography performed within three days after birth were compared with those of magnetic resonance imaging(MRI) or ultrasonography after seven days of life. Results : The EEG results were more sensitive and specific than ultrasonography for the detection of neonatal brain damage. The EEG results showed 91.7% sensitivity for mild grade neurological sequelae and 100.0% sensitivity for moderate and severe-grade neurological sequelae in predicting the neurological outcome. However, early ultrasonography results showed 20.8% and 18.8% of sensitivity and specificity, respectively. Conclusion : EEG is a highly sensitive diagnostic tool for detecting neonatal brain disease and is valuable for predicting the long-term outcome of neurologic sequelae.

• 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.964-970
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• 2009

Neonatal seizures are generally not only brief and subtle but also not easily recognized and are usually untreated. In sick neonates, seizures are frequently not manifested clinically but are detected only by electroencephalography (subclinical EEG seizures). This phenomenon of electroclinical dissociation is fairly common in neonates. On the other hand, neonates frequently show clinical behaviors such as stiffening, apnea, or autonomic manifestations that mimic seizures, which is usually associated with underlying encephalopathy and non-epileptic seizures. Therefore, it might be difficult to confirm the diagnosis of neonatal seizures. Early recognition of neonatal seizures is important to minimize poor neurodevelopmental outcomes, including cognitive, behavioral, and learning disabilities, as well as the development of postnatal epilepsy. EEG is a reliable tool in the determination of neonatal seizures. Continuous EEG monitoring is essential for the identification of seizures, evaluation of treatment efficacy, and prediction of the neurodevelopmental outcome. However, there is not yet a wide consensus on the optimal "standard" lead montage for the continuous EEG monitoring.