• Neonatal Medicine
• /
• v.15 no.1
• /
• pp.54-60
• /
• 2008

Purpose : To set up an appropriate treatment plan for neonatal sepsis by investigating changes in pathogens and antibiotic sensitivities. Methods : The medical records of very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) of the Eulji University Hospital between January 2000 and June 2006 were retrospectively reviewed. The culture reports were analyzed for causative microorganisms and antibiotic sensitivities. Results : Among 164 neonates, 19 neonates (11.6%) had 26 episodes of culture-proven sepsis. Very late onset sepsis was the most common type. The dominant pathogens of sepsis included Klebsiella pneumoniae, Streptococcus spp., coagulase negative Staphylococcus and Enterobacter spp., and were mostly multi-drug resistant. Conclusion : For the appropriate treatment of neonatal sepsis, proper use of antibiotics through the periodic review and understanding of changes of the microorganisms and antimicrobial sensitivities is necessary to prevent multi-drug resistant microorganisms and to avoid excessive use of broad-spectrum empiric antibiotics.

• Neonatal Medicine
• /
• v.16 no.2
• /
• pp.110-120
• /
• 2009

Mimicking fetal nutrition is the goal of early paretneral nutrition (PN) in very low birth weight infants, however the limited metabolic capacity of immature organs raises concern about the toxicity of metabolites to the developing brain. Starting parenteral amino acids from the first day of life, with a rate of 1.0 to 1.5 g/kg/day, is generally recommended to prevent endogenous protein breakdown by maintaining a positive nitrogen balance. A greater of amino acid infusion rate in the range of the fetal transfer rate (3.5-4.0 g/kg/day) is well tolerated during the early days after birth in VLBWI, however the influence on growth and long-term neurodevelopmental outcome remains unknown. Limited data are available from controlled trials regarding the effects of early supplementation with lipid emulsions on neonatal morbidity. Considering the role of long-chain polyunsaturated fatty acids in the neurodevelopment, the choice of an optimal lipid emulsion should be based on the quality as well as the quantity of the lipid contents. Little is known about the clinical benefit of higher rates of glucose infusion by permitting high serum glucose level or co-administration with insulin.

• Neonatal Medicine
• /
• v.18 no.1
• /
• pp.96-103
• /
• 2011

Purpose: Although infants with bronchopulmonary dysplasia (BPD) are at risk of developing secondary pulmonary hypertension (PH), which is associated with significant morbidity and mortality, little has been reported about the incidence, clinical course and prognosis of PH secondary to BPD in premature infants. This study was done to investigate the incidence, risk factors, clinical course, and the ultimate prognosis of PH developed secondary to BPD in very low birth weight infants (<1,500 g). Methods: Medical records of very low birth weight infant (VLBWI) admitted to Samsung Medical Center NICU from January 2000 to July 2007 were reviewed retrospectively. BPD was defined by Jobe's classification. The diagnosis of pulmonary hypertension was established as velocity of tricuspid valve regurgitation (TR) ${\geq}$3 m/s and a flattening of the intraventricular septum by conducting Doppler echocardiography. Results: The incidence of pulmonary hypertension was 6% in VLBWI with BPD and it developed in moderate to severe BPD. The diagnosis of pulmonary hypertension was made on postnatal 133 days (range 40-224 days) and the risk factors related to developing pulmonary hypertension were severe BPD, small for gestational age and outborn infants. The mortality rate was 57% and especially higher in severe BPD (70%). The time to recovery spent 3 months (range 1-10 months) in survived patients. Conclusion: Based on the results of this research, pulmonary hypertension secondary to BPD in VLBWI related to severity of BPD and had a poor prognosis. We expect that regular long-term echocardiography may be helpful in treating reversible in VLBWI with moderate to severe BPD.

• Neonatal Medicine
• /
• v.16 no.1
• /
• pp.36-46
• /
• 2009

Purpose: To evaluate the neonatal statistics on a national basis, data for birth characteristics and neonatal mortality were collected and analyzed from 57 hospitals in Korea. Methods: Questionnaires were distributed to determine the characteristics of neonatal births and mortality rates in 57 hospitals in Korea during 2007. We analyzed the characteristics of all inborn births and hospitalized neonates in the neonatal care units (NICUs) and compared the results with published Korean data from 1996 and 2002. Results: A total of 40,433 inborn live births were reported from the 57 hospitals during 2007. Pre-term, term, and post-term births comprised 24.2%, 75.6%, and 0.2% of the neonates, respectively. Low birth weight infants (LBWIs), very low birth weight infants (VLBWIs), and extremely low birth weight infants (ELBWIs) made up 22.0%, 4.6%, and 1.7% of the neonates, respectively. A total of 21,957 (collected by gestational period) and 21,356 (collected by birth weight) neonates were hospitalized in the 57 NICUs. Pre-term, term, and post-term neonates comprised 39.8%, 59.8%, and 0.4% of the neonates, respectively. LBWIs, VLBWIs, and ELBWIs made up 37.3%, 9.5%, and 3.3% of the neonates, respectively. Pre-term, term, and post-term neonates had mortality rates of 4.5%, 0.7%, and 3.7%, respectively, while the mortality rates of LBWIs, VLBWIs, and ELBWIs were 4.7%, 15.3%, and 32.2%, respectively. In comparison with prematurity data from 1996 and 2002, LBWIs, and ELBWIs had a marked increase in birth frequency and a decreased mortality rate in Korea during 2007. Conclusion: The number of live births and the survival rate of pre-term neonates, especially VLBWIs and ELBWIs, are increasing. Even though the outcomes of neonatal care are improving, further efforts to manage these premature infants are needed.

• Clinical and Experimental Pediatrics
• /
• v.49 no.1
• /
• pp.29-33
• /
• 2006

Purpose : The aim of this study was to analyze the results and contributing factors of catch-up growth in very low birth weight infants(VLBWI) at the corrected age of 2 years. In addition, we looked for a relationship between the catch-up growth and the development by the bayley scales of infant development II(BSID II). Methods : A retrospective analysis by evaluating medical records was done for the 76 VLBWI whose follow-up was possible up to a corrected age of 2 years, out of the 114 who had been treated in the neonatal intensive care unit during the January of 2000 to December of 2001 at Samsung Cheil Hospital. Based on the Standard Korean Infant's Growth Curve, the catch-up growth group was defined over the 10th percentile of weight at 2 years as the corrected age and the failed catch-up growth group was defined under the 10th percentile. We investigated the clinical factors and courses of each group and compared the scores of the BSID II. Results : The catch-up growth group of the VLBWI was 51 infants and the failed catch-up growth group was 25 infants. In comparison with maternal clinical factors, use of antenatal steroids was significantly higher in the catch-up growth group. In comparisn with clinical factors and courses of VLBWI, two clinical factors were significantly different between the two groups : birth weight and intrauterine growth retardation(IUGR). Numbers of delayed development were increased in the failed catch-up growth group but statistically significant differences could not be observed. Conclusion : The catch-up growth of the VLBWI was affected by the use of antenatal steroids, birth weight and IUGR. No significant differences regarding neurodevelopmental outcome were observed between the catch-up and failed catch-up growth groups.

• Neonatal Medicine
• /
• v.18 no.2
• /
• pp.288-292
• /
• 2011

Purpose: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased in children and in neonates, and is particularly associated with frequent use of central venous catheter in very low birth weight (VLBW) infants. It is known that the morbidity and mortality of MRSA infection are low in neonates, as compared with adults. The objective of this study was to examine the difference in clinical characteristics between VLBW infants that survived and those that did not, a catheter-related bloodstream infection (CRBSI) of MRSA. Methods: Thirty-four VLBW infants had laboratory-confirmed bloodstream infection with S. aureus. We examined the incidence, mortality and morbidity of CRBSI, and predictive factors associated with mortality. Results: Twenty-six infants had same pathogen (24 MRSA, 2 Methicillin-sensitive Staphylococcus aureus) in the blood and in the catheter tip. Eight infants (25.8%) died in the CRBSI and they all had MRSA blood infections. Sex ratio, gestational age, duration between blood collection and identification of pathogens, and WBC and platelet count were not significantly different between patients that died from and patients that survived CRBSI of MRSA. C-reactive protein (CRP) was significantly higher in VLBW infants that died. Mean age of onset and hospital day was earlier (9.1${\pm}$6.6 vs. 26.9${\pm}$20.2; P=0.005) and shorter for patients that died (10.1${\pm}$7.0 vs. 73.0${\pm}$32.4; P=0.000). Two survivors had complications of pyogenic arthritis of the lower extremities and soft tissue infection, respectively. Conclusion: Mortality of CRBSI was likely to be high in VLBW infants and might be anticipated by CRP and early onset of disease.

• Clinical and Experimental Pediatrics
• /
• v.50 no.6
• /
• pp.536-542
• /
• 2007

Purpose : We investigated the effects of restricted fluid in the first 7 days of life on the risk of bronchopulmonary dysplasia (BPD) or patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants. Methods : Eighty three VLBW infants who lived more than 28 days were selected. The amount of daily maintenance fluid was determined by calculation of insensible water loss (IWL) and urine output (UO). Seventy to 80 percent of calculated amount was given to the ventilated infants. Subjects were grouped into low (<25th%), moderate (25-75th%), and high (>75th%) fluid groups for the first 24 hours, 3 days and 7 days. Chi square tests analyzed proportions of subjects with or without morbidities across fluid groups. Multivariate logistic regression was used to analyze the effect of fluid intake on BPD or PDA, controlling for factors that are significantly associated with BPD or PDA by univariate analysis. Results : Rates of BPD and PDA were not significantly associated with fluid groups on each time period. The result was the same after controlling for factors that are significantly associated with BPD or PDA by univariate analysis. For the first 3 and 7 days, fluid intakes were positively related with maximal weight loss, urine output and mechanical ventilation duration. Conclusion : In VLBW infants, when given based on needs reflected from IWL and UO versus intake, relatively low fluid intakes in the first week of life do not decrease the risk of BPD or PDA, and vice versa. We suggest that calculation of daily fluid based on IWL and UO is appropriate for VLBW infants.

• Neonatal Medicine
• /
• v.16 no.2
• /
• pp.190-196
• /
• 2009

Purpose: Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years. Methods: We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients. Results: Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0$\pm$255.9 g and 26.7$\pm$2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and $H_2$ blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection. Conclusion: The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.

• Neonatal Medicine
• /
• v.16 no.2
• /
• pp.205-212
• /
• 2009

Purpose: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. Methods: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. Results: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score ($\leq3$) was lower in the immediate group than the delayed group. Conclusion: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.

• Clinical and Experimental Pediatrics
• /
• v.46 no.11
• /
• pp.1073-1079
• /
• 2003

Purpose : Recently there has been a decrease in ventilator care rate and duration of very low birth weight infants(VLBWI) in Fatima Hospital. The aims of this study were to survey the frequency and duration of ventilation in VLBWI and to develop a non-invasive neonatal intensive care unit (NICU) policy. Methods : We performed a retrospective study of 284 newborn of infants less than 1,500 gm admitted to NICU and discharged from January 1998 to December 2001. Patients were intubated or applied continuous positive airway pressure(CPAP) via nasal prong immediately after presenting signs of respiratory distress. We analyzed epidemiologic data to study the changes in ventilator care rate, duration and outcome of ventilator care groups. Results : Of 284 newborn infants, 146 required invasive management, such as endotracheal intubation and assisted ventilation. The characteristics, the severity of clinical symptoms and laboratory findings in ventilator care groups at birth showed no significant differences. The annual proportion of infants requiring assisted ventilation decreased according to increasing gestational age. The median duration of ventilation decreased markedly from 6.0 days in 1998 to 2.7 days in 2001. Final complications and outcomes in ventilator care groups showed no significant differences. Conclusion : Our study shows a significant reduction in the invasiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. A non-invasive strategy for the VLBW infant with minimal to moderate respiratory distress after birth in NICU is better than immediate invasive management. Non-invasive nasal CPAP is a simpler and safer method than invasive assisted ventilation.