• Clinical and Experimental Pediatrics
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• v.62 no.8
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• pp.307-311
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• 2019

Purpose: Necrotizing enterocolitis (NEC) is one of the most serious complications of prematurity. Many risk factors can contribute to the development of NEC. The epidermal growth factor (EGF) plays a major role in intestinal barrier function, increases intestinal enzyme activity, and improves nutrient transport. The aim of this study was to assess the role of epidermal growth factor in the development of NEC in preterm neonates. Methods: In this study, 130 preterm neonates were included and divided into 3 groups, as follows: group 1, 40 preterm neonates with NEC; group 2, 50 preterm neonates with sepsis; and group 3, 40 healthy preterm neonates as controls. The NEC group was then subdivided into medical and surgical NEC subgroups. The serum EGF level was measured using enzyme-linked immunosorbent assay. Results: Serum EGF levels (pg/dL) were significantly lower in the NEC group (median [interquartile range, IQR], 9.6 [2-14]) than in the sepsis (10.1 [8-14]) and control groups (11.2 [8-14], P<0.001), with no significant difference between the sepsis and control groups, and were positively correlated with gestational age (r=0.7, P<0.001). A binary logistic regression test revealed that low EGF levels and gestational ages could significantly predict the development of NEC. The receiver-operating characteristic curve for EGF showed an optimal cutoff value of 8 pg/mL, with 73.3% sensitivity, 98% specificity, and an area under the curve of 0.92. Conclusion: The patients with NEC in this study had significantly lower serum EGF levels (P<0.001), which indicated that EGF could be a reliable marker of NEC in preterm neonates.

• Neonatal Medicine
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• v.25 no.2
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• pp.78-84
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• 2018

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

• Korean Journal of Clinical Pharmacy
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• v.27 no.2
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• pp.63-68
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• 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
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• v.64 no.4
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• pp.172-179
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• 2021

Background: Evidence shows that fluconazole prophylaxis is an effective treatment against invasive fungal infections in preterm neonates, however, the most efficient schedule of fluconazole prophylaxis for the colonization and mortality of invasive candidiasis (IC) is unknown. Purpose: This systematic review and meta-analysis aimed to assess the efficiency of different prophylactic fluconazole schedules in controlling IC colonization, infection, and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units. Methods: We searched the PubMed, Scopus, Embase, and Cochrane databases using the keywords "candida," "invasive candidiasis," "IC," "fluconazole prophylaxis," "preterm infants," "very low birth weight infants," "VLBW," "extremely low birth weight," and "ELBW." Results: Mortality was significantly decreased in a meta-analysis of studies using different fluconazole prophylaxis regimens. The meta-analysis also indicated a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconazole prophylaxis schedules. Conclusion: Future studies should explore the effectiveness of other different fluconazole prophylaxis schedules on IC colonization, infection, and mortality.

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

• Clinical and Experimental Pediatrics
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• v.45 no.3
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• pp.325-330
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• 2002

Purpose : We intended to find out how the red cell transfusion would change the white cell count in preterm neonates under treatment in the intensive care unit. We also speculated whether the magnitude of such a change could indicate a potential neonatal infection. Methods : Total white blood cell count, total neutrophil count, and band count were compared and analyzed retrospectively on 33 preterm neonates who received red cell transfusions in our hospital's intensive care unit over a period of two years and a month. Results : We found a mean change of $1.33{\times}10^3/mm^3$ and $0.55{\times}10^3/mm^3$ in total white blood cell count and total neutrophil count in the first eight hours following the red cell transfusion. No significant change was observed in band count between pre and post-red cell transfusion. Conclusion : A mild increase in the white blood cell count caused by an increase in neutrophil count was observed temporarily following the red cell transfusion. But the white blood cell count returned to the pre-transfusion level in about 24 hours, indicating that such a low level of increase cannot be interpreted as an infection of a preterm neonate.

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

• Perinatology
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• v.29 no.4
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• pp.165-169
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• 2018

Objective: Highly sensitive haptoglobin measurement should be used in neonates because the haptoglobin concentration in neonates is lower than that of adults. The aim of this study was to establish the reference values of haptoglobin levels in the cord blood of uninfected neonates. Methods: The cord blood of 29 preterm and 51 term babies was collected, and data from the mother and the newborn were recorded. The haptoglobin concentrations of 80 cord blood samples were simultaneously measured by enzyme-linked immunosorbent assay (ELISA; Assaypro, St Charles, MO, USA) and immunoturbidimetry assay (Roche Diagnostics, Basel, Switzerland). C-reactive protein (CRP) was also measured by immunoturbidimetry assay (Roche Diagnostics, Switzerland). Results: Mean values of CRP and ELISA haptoglobin were not significantly different between preterm and term babies. The 2.5 percentile and 97.5 percentile values of ELISA haptoglobin concentration were as follows: 80 neonates, 0.01 mg/dL and 0.59 mg/dL; 29 preterm babies, 0.08 mg/dL and 0.18 mg/dL; and 51 term babies, 0.07 mg/dL and 0.23 mg/dL. There were no differences in ELISA haptoglobin concentration according to maternal underlying diseases, delivery method, usage of antibiotics or steroids before delivery, gestational age, gender of baby, or twin gestation. Conclusion: A highly sensitive haptoglobin method should be used to determine the haptoglobin concentration in Korean newborns because the reference values of cord blood haptoglobin concentration in Korean newborns are less than the lower detection limit for commonly used immunoturbidimetric haptoglobin measurement methods.

• Clinical and Experimental Pediatrics
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• v.63 no.4
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• pp.133-134
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• 2020

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