• Korean Journal of Clinical Pharmacy
• /
• v.27 no.2
• /
• pp.63-68
• /
• 2017

Neonates have large inter-individual variability in pharmacokinetic parameters of many drugs due to developmental differences. The aim of this study was to investigate the factors affecting the pharmacokinetic parameters of drugs, which are commonly used in critically ill neonates. Factors that reflect physiologic maturation such as gestational age, postnatal age, postconceptional age, birth weight, and current body weight were correlated with pharmacokinetic parameters in neonates, especially preterm infants. Comorbidity characteristics affecting pharmacokinetics in critically ill neonates were perinatal asphyxia, hypoxic ischemic encephalopathy, patent ductus arteriosus (PDA), and renal dysfunction. Administration of indomethacin or ibuprofen in neonates with PDA was associated with the reduced clearance of renally excreted drugs such as vancomycin and amikacin. Therapeutic hypothermia and extracoporeal membrane oxygenation were influencing factors on pharmacokinetic parameters in critically ill neonates. Dosing adjustment and careful monitoring according to the factors affecting pharmacokinetic variability is required for safe and effective pharmacotherapy in neonatal intensive care unit.

• Clinical and Experimental Pediatrics
• /
• v.64 no.4
• /
• pp.157-164
• /
• 2021

Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, a small number of coronavirus disease 2019 (COVID-19) cases in neonates have been reported worldwide. Neonates currently account for only a minor proportion of the pediatric population affected by COVID-19. Thus, data on the epidemiological and clinical features of COVID-19 in neonates are limited. Approximately 3% of neonates born to mothers with COVID-19 reportedly tested positive for SARS-CoV-2. Current limited data on neonates with COVID-19 suggest that neonatal COVID-19 shows a relatively benign course despite a high requirement for mechanical ventilation. However, neonates with pre-existing medical conditions and preterm infants appear to be at a higher risk of developing severe COVID-19. The greatest perinatal concern of the COVID-19 pandemic is the possibility of vertical transmission, especially transplacental transmission of SARS-CoV-2. Although direct evidence of the vertical transmission of SARS-CoV-2 is lacking, its possibility during late pregnancy cannot be ruled out. This review summarizes available case studies on COVID-19 in neonates and introduces what is currently known about neonatal COVID-19 with focus on its vertical transmission.

• Journal of Korean Critical Care Nursing
• /
• v.9 no.1
• /
• pp.40-50
• /
• 2016

Purpose: Continuous renal replacement therapy (CRRT) has become the preferred dialysis method to support critically ill children and neonates with acute kidney injury. Using CRRT on neonates has increased, but reports about experience are limited. The aim of this study is to describe the clinical application, outcomes, and complications of CRRT in children and neonates. Methods: A retrospective review was performed in 135 children and 36 neonates who underwent CRRT at a tertiary hospital from 2008 to 2015. Results: At the initiation of CRRT, the median age of children was 72 months and the corrected age of neonates was 37.1 weeks. Median body weight of neonates was 3.2 kg. In neonates, initial degree of fluid overload [FO%], blood flow rate [BFR] and ultrafiltration rate [UFR] rate during CRRT were higher than in children. Median real time of CRRT was 90.5 and 53.5 hours in children and neonates, respectively. Downtime of CRRT was 0.7 and 1.3 hours/day. Median mortality rates (44.4% vs.47.2%) and complication rates were similar between the groups. Conclusion: CRRT can be used for a wide range of critically ill children and neonates. Different application methods of CRRT can contribute to increased survival of neonates.

• Clinical and Experimental Pediatrics
• /
• v.61 no.12
• /
• pp.387-391
• /
• 2018

Purpose: Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. Methods: We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. Results: Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was $9.7{\pm}6.9days$. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH<7.0). Intracranial lesions associated with SGH were observed in 15 neonates (75%), including subdural hemorrhage (50%), subarachnoid hemorrhage (15%), intraventricular hemorrhage (5%), cerebral infarct (15%), skull fracture (30%), and cephalohematoma (20%). Twelve neonates (60%) required transfusion, 5 (25%) had seizures, and 3 (15%) died. Eight neonates (40%) had hyperbilirubinemia (mean total bilirubin, $13.1{\pm}7.4$). The mean follow-up period was $8.4{\pm}7.5months$. At follow-up, 10 neonates (58.8%) were healthy with normal development, whereas 7 (41.2%) had neurological deficits. Conclusion: The morbidity rate was 41.2% due to severe metabolic acidosis. Anemia, hyperbilirubinemia, low Apgar scores, and subdural hemorrhage did not affect the prognosis. The long-term outcomes of neonates with SGH are generally good. Only arterial blood pH was significantly associated with death.

• Clinical and Experimental Pediatrics
• /
• v.61 no.9
• /
• pp.265-270
• /
• 2018

Neonates, especially extremely low birth weight infants, are among the groups of patients undergoing transfusion frequently. Since they are exposed to higher specific transfusion risks compared to the patients of other age groups, there are many special aspects that must be considered for transfusion therapy in neonates. The transfusion risks in neonates include adverse outcomes specific for preterm infants as well as increased metabolic, immunologic, and infectious complications. To reduce the risks of transfusion-transmitted cytomegalovirus infection and transfusion-associated graft-versus-host disease, leukoreduced and irradiated cellular blood products should be used for all neonates. This review summarizes the risks of neonatal transfusion therapy, specific methods to reduce risk, and current trends and practices of red blood cell and platelet transfusions in neonates, to facilitate decision-making for neonatal transfusion.

• Advances in pediatric surgery
• /
• v.17 no.1
• /
• pp.15-22
• /
• 2011

Meconium obstruction (MO) in neonates arises from highly viscid meconium and the poor motility of the premature gut. Recently the incidence of the MO in neonates has been Increasing, but, the diagnosis and treatment of this disease have not yet been clarified. Between March 2004 and April 2010, 24 neonates were treated for MO at Severance Children's Hospital. Their clinical characteristics and treatment were reviewed retrospectively. Twenty neonates were diagnosed with MO and 4 neonates were diagnosed with Hirschsprung's disease (HD). The mean birth weight and gestational age of the 20 neonates with MO were $1.45{\pm}0.90kg$ and $31.1{\pm}4.6$ weeks, respectively. Thirteen neonates (65 %) diagnosed with MO weighed less than 1.5 kg and 10 neonates (50 %) weighed less than 1 kg. Half of the neonates with MO were treated by non-operative methods and the other half were treated by operative methods. Compared with the group that weighed over 1.5 kg, the group that weighed less than 1.5 kg were more frequently operated upon (61.5% vs. 28.5%), and contrast enemas were performed later and more frequently. Also the group that weighed less than 1.5 kg had a higher mortality rate (15.4% vs. 0%). Three of the four neonates with HD were diagnosed with long-segment aganglionosis. In conclusion, MO occurred in very low birth weight neonates more often and must be differentiated from HD. Also, MO in very low birth weight neonates should be treated with special attention due to more a complicated clinical course.

• Child Health Nursing Research
• /
• v.7 no.3
• /
• pp.298-307
• /
• 2001

This study assessed behavioral characteristics of 73 normal neonates in Daegu area using the NBAS. Being one of few studies on this topic, the study is to document and to accumulate data on the neonatal behaviors of Korean babies. Overall scores were at moderate levels in 6 behavioral clusters including Habituation, Social Interactive, Motor System, State Organization, and State Regulation. Autonomic Stability showed relative stableness. Scores of Orientation were higher in neonates of working mothers and rural mothers. Neonates of mothers with no abortion history have higher scores in Motor System and State Organization. Score of State Organization was higher in neonates of mothers with no habitual use of amenity during their pregnancy. Scores of Habituation and State Organization, as well as scores of Motor System with State Organization, State Regulation and Autonomic Stability were positively correlated. Scores of Habituation and State Organization indicate that babies are agreeable and even tameable that is advantageous for attachment to caregiver.

• Journal of Photoscience
• /
• v.9 no.2
• /
• pp.472-474
• /
• 2002

Till date the phenomenon of maternal transfer of photic information was reported to regulate the fetal/neonatal growth, however its influence on neonatal immune system is still an enigma. In the present study, we observed an increase in maternal plasma melatonin level under short day length (SOL) condition with a consequent decrease in TLC and LC in their respective neonates. However, a significant decrease in maternal plasma melatonin level was noted under constant darkness (DD) with an increase in TLC and LC of their neonates. The blastogenic response (BGR) to Con A of splenocytes exhibited a significant increase in neonates of SDL females and a significant decrease in the neonates of DD females. Hence, it appears that the increase in maternal plasma melatonin under SOL condition transmitted information to decrease the immune status. Continuous exposure of females to darkness (DD) negatively regulated the maternal pineal gland activity thereby decreasing their plasma melatonin level. This information was transmitted for elevation of immune status in neonates, so that they exhibit better growth and sexual maturation. Therefore, we may suggest that the maternal photic information transmitted either prenatally through placenta or postnatally via the milk regulate the hormonal profile of Melatonin to regulate the immune status of neonates in order to influence their growth and sexual maturation.

• Child Health Nursing Research
• /
• v.12 no.1
• /
• pp.75-83
• /
• 2006

Purpose: This study was done to verify the effect of roller acupuncture stimulation on baesu spots of joktaeyang bangkwang kyeong in the reaction to physiologic pain(heart rate, percutaneous oxygen saturation, respiration rate) in neonates. Method: This study was a nonequivalent control group non-synchronized design. The participants were 40 normal neonates who were born at a hospital in Busan. These neonates were undergoing heel puncture for blood type tests. The neonates were divided into 2 groups: 20 in the experimental group who were stimulated with roller acupuncture before the heel puncture and 20 neonates in the control group who were not stimulated. The heart rate and percutaneous oxygen saturation were measured using a cardiopulmonary monitor and the respiration rate was measured directly. The data were analyzed with SPSS 10.0 program using χ²-test, t-test and Repeated Measure ANOVA. Results: There was a significant difference (F=3.287, p=.043) for heart rate on the interaction between time and group. There was a significant difference (F=5.122, p=.008) for percutaneous oxygen saturation on the interaction between time and group. Conclusion: On the basis of results, it was verified that the roller acupuncture stimulation on baesu spots of joktaeyang bangkwang kyeong had effect of relieving pain in the neonates.

• Korean Journal of Clinical Pharmacy
• /
• v.30 no.3
• /
• pp.143-148
• /
• 2020

Objective: This study aimed to investigate pharmaceutical care for critically ill neonates and suggest targeted strategies compatible with the Korean health-system pharmacy. Methods: Articles that reported pharmacy practices for critically ill neonates were reviewed. Pharmaceutical care practices and roles of neonatal pharmacists were identified, and criteria were developed for neonates in need of specialized care by clinical pharmacists. Results: Neonatal pharmacists play many roles in the overall medication management pathway. For clinical decision support, multidisciplinary ward rounds, clinical pharmacokinetic services, and consultation for pharmacotherapy and nutrition support were conducted. Prevention and resolution of drug-related problems through review of medication charts contributed to medication safety. Pharmaceutical optimization of intravenous medication played an important role in safe and effective therapy. Information on the use of off-label medicine, recommended dosage and dosing schedules, and stability of intravenous medicine was provided to other health professionals. Most clinical practices for neonates in Korea included therapeutic drug monitoring and nutrition support services. Reduction in medication errors and adverse drug reactions, shortening the duration of weaning medicines, decreasing the use and cost of antimicrobials, and improvement in nutrition status were reported as the outcomes of pharmacist-led interventions. The essential criteria of pharmaceutical care, including for patients with potential high-risk factors for drug-related problems, was developed. Conclusion: Pharmaceutical care for critically ill neonates varies widely. Development and provision of standardized pharmaceutical care for Korean neonates and a stepwise strategy for the expansion of clinical pharmacy services are required.