• Clinical and Experimental Pediatrics
• /
• v.63 no.2
• /
• pp.56-62
• /
• 2020

Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.

• Journal of Yeungnam Medical Science
• /
• v.14 no.1
• /
• pp.77-84
• /
• 1997

We measured the blood flow velocity of the anterior cerebral artery via anterior fontanelle approach of fifty five preterm neonates with duplex Doppler sonography and analyzed the waveform and calculated pulsatility index, resistive index. Intracranial velocities and pulsatility indexes were increased with increasing gestational age, birth weight, and age of the neonate, but resistive indices decreased. In sick babies, characteristic resistive index increment were seen in patients with intraventricular hemorrhage, but no statistical difference was seen in patients with respiratory distress syndrome. Our results suggest that duplex Doppler sonography is a useful noninvasive means of monitoring cerebrohemodynamics in normal preterm neonates and flow change of sick babies.

• Clinical and Experimental Pediatrics
• /
• v.54 no.9
• /
• pp.368-372
• /
• 2011

Necrotizing enterocolitis (NEC) is one of the most critical morbidities in preterm infants. The incidence of NEC is 7% in very-low-birthweight infants, and its mortality is 15 to 30%. Infants who survive NEC have various complications, such as nosocomial infection, malnutrition, growth failure, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental delays. The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity. In preterm infants with immature gastrointestinal tracts, development of NEC may be associated with a variety of factors, such as colonization with pathogenic bacteria, secondary ischemia, genetic polymorphisms conferring NEC susceptibility, anemia with red blood cell transfusion, and sensitization to cow milk proteins. To date, a variety of preventive strategies has been accepted or attempted in clinical practice with regard to the pathogenesis of NEC. These strategies include the use of breast feeding, various feeding strategies, probiotics, prebiotics, glutamine and arginine, and lactoferrin. There is substantial evidence for the efficacy of breast feeding and the use of probiotics in infants with birth weights above 1,000 g, and these strategies are commonly used in clinical practice. Other preventive strategies, however, require further research to establish their effect on NEC.

• Child Health Nursing Research
• /
• v.23 no.4
• /
• pp.470-478
• /
• 2017

Purpose: This study was conducted to describe parenting stress in mothers of preschoolers who were born prematurely and to determine factors affecting parenting stress in child's problem behavior, mother-child interaction and parenting alliance. Methods: An exploratory survey study was conducted with 66 mothers of preschool children (5~6 years) with preterm births (PTB). Data were collected using Parenting Stress Index (PSI), Child Behavior Checklist (CBCL), Mother-Preschool Child Interaction Scale (MPIS), and Parenting Alliance Inventory (PAI). Results: Of the 66 mothers, 8(12.1%) showed high scores that were more than borderline for the PSI total score. In the multiple linear regression analysis, lower scores on the PAI (${\beta}=-.41$, p<.001), higher scores on the externalizing problem behavior of the CBCL (${\beta}=.40$, p=.001), and lower scores on the MPIS (${\beta}=-.21$, p=.043) were statistically significant contributors to maternal parenting stress. Conclusion: Findings indicate that mothers of PTB preschool children are at risk for parenting stress. Child's externalizing problem behavior, poor maternal-child interaction and parenting alliance were independent factors raising maternal parenting stress. More attention is needed on paternal parenting support, child's behavioral development, interaction with children for effective prevention and management of maternal parenting stress of PTB young children.

• Child Health Nursing Research
• /
• v.24 no.2
• /
• pp.220-228
• /
• 2018

Purpose: This study was conducted to measure adiposity and to investigate related factors in preschoolers born prematurely. Methods: A longitudinal follow-up study was conducted with 52 preschoolers at 5 years of corrected age among 343 preterm infants. Their adiposity status was evaluated based on measurements of body mass index, subscapular and triceps skin fold thickness (SFT), waist circumference, waist-to-height ratio, and mid-arm circumference at a home visit. Results: The findings showed that SFT measurements, particularly at the triceps, reflected the degree of adiposity more accurately than other conventional measures. A shorter gestation, older maternal age, and the mother having more years of formal education were associated with higher levels of adiposity in the preschoolers. Conclusion: The adiposity of children born prematurely needs to be thoroughly monitored with additional SFT measurements, considering the risk of accelerated growth patterns overriding regular catch-up growth in children born prematurely.

• Clinical and Experimental Pediatrics
• /
• v.57 no.3
• /
• pp.101-109
• /
• 2014

The use of glucocorticoids (GCs) in the perinatal period is suspected of being associated with adverse effects on long-term neurodevelopmental outcomes for preterm infants. Repeated administration of antenatal GCs to mothers at risk of preterm birth may adversely affect fetal growth and head circumference. Fetal exposure to excess GCs during critical periods of brain development may profoundly modify the limbic system (primarily the hippocampus), resulting in long-term effects on cognition, behavior, memory, co-ordination of the autonomic nervous system, and regulation of the endocrine system later in adult life. Postnatal GC treatment for chronic lung disease in premature infants, particularly involving the use of dexamethasone, has been shown to induce neurodevelopmental impairment and increases the risk of cerebral palsy. In contrast to studies involving postnatal dexamethasone, long-term follow-up studies for hydrocortisone therapy have not revealed adverse effects on neurodevelopmental outcomes. In experimental studies on animals, GCs has been shown to impair neurogenesis, and induce neuronal apoptosis in the immature brains of newborn animals. A recent study has demonstrated that dexamethasone-induced hypomyelination may result from the apoptotic degeneration of oligodendrocyte progenitors in the immature brain. Thus, based on clinical and experimental studies, there is enough evidence to advice caution regarding the use of GCs in the perinatal period; and moreover, the potential long-term effects of GCs on brain development need to be determined.

• Child Health Nursing Research
• /
• v.25 no.4
• /
• pp.468-476
• /
• 2019

Purpose: This study was conducted to evaluate cognitive ability in preschoolers born prematurely and to investigate related factors. Methods: A prospective, longitudinal study was conducted with 64 children at 5-6 years of corrected age (CA) (second follow-up) among 76 children who had been assessed at 2.0~3.5 years of CA (first follow-up) from a sample of 343 preterm infants born from 2008 to 2010. To evaluate each child's cognitive ability, during a home visit, we used the Kaufman Assessment Battery for Children-II (KABC-II) at the second follow-up. To explore factors related to cognitive ability, we measured children's hemoglobin level at the second follow-up and used the data collected in our previous study, including the Bayley Scale of Infant Development-II (BSID-II) at the first follow-up. Results: The mean total KABC-II quotient was $117.0{\pm}14.4$. The 5-minute Apgar score (${\beta}=.29$, p=.006), hemoglobin level (${\beta}=.22$, p=.032), and the mental development index quotient of the BSID-II (${\beta}=.51$, p<.001) were statistically significant predictors of the KABC-II quotient in multiple linear regression analysis. Conclusion: The cognitive function of young children born prematurely was influenced by early neurodevelopment and factors reflecting their health status, such as anemia and a low 5-minute Apgar score.

• Perinatology
• /
• v.29 no.4
• /
• pp.170-174
• /
• 2018

Objective: Progesterone is used to prevent recurrent preterm delivery, however the molecular mechanisms of its effect are incompletely understood. The objective of this study was to determine the effect of progesterone on tumor necrosis factor $(TNF)-{\alpha}$-induced matrix metalloproteinase (MMP)-9 activity in human choriodecidual (CD) membranes. Methods: We collected CD membranes from women with uncomplicated term pregnancies who were scheduled for elective cesarean delivery (n=10). CD membranes ($1{\times}1cm$) were incubated in tissue culture media at $37^{\circ}C$. We pre-treated the CD membranes with progesterone (P4), $17{\alpha}$-hydroxyprogesterone caproate (17P), promegestone (R5020), or vehicle (ethanol) for 24 hours. The CD membranes were subsequently treated with $TNF-{\alpha}$ (with continued progesterone treatment) for 48 hours, then media was harvested for measuring MMP-9 activity by zymography and total protein was isolated from CD membrane tissues for MMP-9 expression by western blot analysis. Results: P4, 17P, and R5020 significantly reduced $TNF-{\alpha}$-induced MMP-9 activity in fetal membrane tissue samples (P=0.0078, P=0.0156, and P=0.0391, respectively) by zymography. Western blot analysis also showed decreased expression of MMP-9 in progesterone pretreated groups (P=0.0313). Conclusion: Progesterone reduces $TNF-{\alpha}$-induced MMP-9 activity in human CD membranes. These findings may provide further support for the role of progesterone in preventing preterm birth.

• Neonatal Medicine
• /
• v.25 no.4
• /
• pp.178-185
• /
• 2018

Purpose: We aim to assess the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), Adaptive Behavior (AB) and Social-Emotional (SE) scales at 18 to 24 months of corrected age (CA) to examine their associations with school-age cognitive and behavioral outcomes in children born preterm. Methods: Eighty-eight infants born with a very low birth weight (<1,500 g) or a gestational age of less than 32 weeks who were admitted to the neonatal intensive care unit from 2008 to 2009 were included. Of the 88 children who completed school-age tests at 6 to 8 years of age, 37 were assessed using the Bayley-III, including the AB and SE scales, at 18 to 24 months of CA. Correlation, cross-tabulation, and receiver operating characteristic analyses were performed to assess the longitudinal associations. Results: A significant association was observed between communication scores on the Bayley-III AB scale at 18 to 24 months of CA and the Korean version of the Wechsler Intelligence Scale for Children (K-WISC) full-scale intelligence quotient (FSIQ) at school age (r=0.531). The total behavior problem scores of the Korean version of the Child Behavior Checklist (K-CBCL) at school age were significantly negatively related to the Bayley-III SE and AB scales but not to the cognitive, language, or motor scales. Conclusion: Our findings encourage AB and SE assessments during the toddler stage and have important implications for the early identification of children in need of intervention and the establishment of guidelines for follow-up with high-risk infants.

• Obstetrics & gynecology science
• /
• v.61 no.6
• /
• pp.655-661
• /
• 2018

Objective There is concern regarding the safety of delayed cord clamping (DCC) in babies born at less than 34 weeks' gestation. Therefore, the primary objective of this study was to compare the rates of hyperbilirubinemia and polycythemia during initial 7 days in infants born at less than 34 weeks' gestation and randomized to receive DCC by 120 seconds or early cord clamping (ECC) within less than 30 seconds. Methods One hundred pregnant women were randomly subjected to DCC or ECC at the time of birth in a tertiary referral hospital setting. Blood samples were obtained from each newborn at 48 hours and 7 days for hematocrit measurement. Serum bilirubin levels were estimated once the infant had clinically significant jaundice or at 72 hours. For the statistical analysis, the ${\chi}^2$ test, Student's t-test, or Wilcoxon rank sum test was used. Results The hematocrit was significantly higher in the DCC group than in the ECC group (P<0.001). None of the babies had polycythemia. Mean total serum bilirubin level was 6.6 mg/dL in the DCC group and 8.7 mg/dL in the ECC group (P<0.001). There was no increased risk of hyperbilirubinemia in the DCC group. Conclusion DCC benefits preterm neonates with no significant adverse effects.