• Clinical and Experimental Pediatrics
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• v.62 no.10
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• pp.386-394
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• 2019

Background: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5℃-37.5℃. Purpose: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. Methods: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. Results: The mean admission temperature was 36.1℃±0.6℃, with a range of 31.9℃ to 38.4℃. Approximately 74.1% of infants had an admission hypothermia of <36.5℃. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5℃-37.5℃ and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04-1.83), 1.44 (95% CI, 1.05-1.97) and 1.86 (95% CI, 1.22-2.82) for infants with admission temperatures of 36.0℃-36.4℃, 35.0℃-35.9℃, and <35.0℃, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. Conclusion: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.704-712
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• 2008

Purpose : A prospective, controlled trial was conducted to evaluate growth, efficacy, safety and nutritional status for very low birth weight infants fed with human milk fortified with Maeil human milk fortifier (Maeil $HMF^{(R)}$; Maeil Dairies Co., Ltd.). Methods : We enrolled 45 premature infants with a birth weight <1,500 g and gestational age <33 weeks, who were born at Dong-A University Hospital from October, 2006 through December, 2007. They were divided into 2 groups: infants in one group were fed with human milk fortified with $HMF^{(R)}$, and the second were fed with preterm formula. Growth, biochemical indices, feeding tolerance, and other adverse events in each group were assessed serially and compared relatively. Follow-up data were also collected after discharge at 1, 3, and 6 months corrected age. Results : Characteristics of the 2 groups including average gestational age, birth weight, sex, respiratory distress syndrome, patent ductus arteriosus, and other adverse events (sepsis, retinopathy of prematurity, and intraventricular hemorrhage) showed no significant difference. Average feeding start day ($8.00{\pm}3.27d$ vs. $8.86{\pm}5.37d$) (P=0.99) and the number of days required to reach full feeding after start feeding ($41.78{\pm}20.47d$ vs $36.86{\pm}20.63d$) (P=0.55) were not significantly different in the group fed human milk fortified with $HMF^{(R)}$ when compared with the group that was fed preterm formula. The duration of total parenteral nutrition and the incidence of feeding intolerance also showed no differences between the 2 groups. Although infants fed with human milk fortified with $HMF^{(R)}$ showed faster weight gain than those fed with preterm formula at the end stage of the admission period, other growth indices of the two groups showed no significant difference. No significant correlations were found between the 2 groups with regard to weight gain velocity, height gain velocity, head circumference velocity, and post-discharge follow up growth indices. Conclusion : Premature infants fed human milk fortified with $HMF^{(R)}$ showed no significant difference compared with those fed preterm formula in growth, biochemical indices, and adverse events. Using human milk fortifier can be an alternative choice for very low birth weight infants, who need high levels nutritional support even after discharge from NICU.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.316-323
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• 2023

Objective : Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. Methods : This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. Results : A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. Conclusion : In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

• Pediatric Infection and Vaccine
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• v.23 no.2
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• pp.137-142
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• 2016

Severe cytomegalovirus (CMV) infection involving multiorgan is very rare except in very low-birth weight infants, or in immunocompromised pediatric patients. We report an unusual case of severe CMV infection involving multiple organs including the central nervous system, liver, lung, and gastrointestinal tract in a late-preterm infant at 2 months of age.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.4
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• pp.246-257
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• 2024

Purpose: Administering early parenteral amino acids to very low birth weight (VLBW) premature infants (birth body weight [BBW]<1,500 g) is challenging due to factors such as holidays, cost, and access to sterile compounding facilities. Using advance-prepared parenteral nutrition (PN) may address this issue and should be evaluated for its safety and potential benefits. Methods: We extracted data from medical records collected between July 2015 and August 2019. VLBW infants received PN for at least seven days and were split into two groups: the traditional group (n=30), which initially received a glucose solution and then PN on workdays, and the pre-preparation group (n=16), which received advance-prepared PN immediately upon admission to the neonatal intensive care unit. Results: The median BBWs of the traditional and pre-preparation groups were 1,180.0 vs. 1,210.0 g. In the initial two days, the pre-preparation group had a significantly higher amino acid intake (2.23 and 2.24 g/kg/d) than the traditional group (0 and 1.78 g/kg/d). The pre-preparation group exhibited greater head circumference growth ratio relative to birth (7th day: 1.21% vs. -3.57%, p=0.014; 21st day: 7.71% vs. 3.31%, p=0.017). No significant differences in metabolic tolerance were observed. Conclusion: Advanced preparation of PN can be safely implemented in VLBW preterm infants, offering advantages such as early, higher amino acid intake and improved head circumference growth within the first 21 days post-birth. This strategy may serve as a viable alternative in settings where immediate provision of sterile compounding facilities is challenging.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.882-890
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• 2007

Purpose : Preterm very low birth weight infant have high rate of adverse neurodevelopmental sequale. Recently, there have been lots of reports that human umbilical cord blood transplantation ameliorates functional deficits in animal models as hypoxic ischemic injury. This pilot study was undertaken to determine the clinical efficacy and safety of autologous umbilical cord blood cell transplantation for preventing neurodevelopmental sequale in perterm VLBW. Methods : Subjects were 26 preterm infants whose birth weight are less than 1,500 g and delivered under the intrauterine period 34 weeks. Autologous umbilical mononuclear cells (about $5.87{\times}10^7/kg$) were injected to neonate via the umbilical vein on the postnatal 24-48 hour. The therapeutic efficacy was assessed by numbers of nucleated RBC, urinary uric acid/creatinine ratio, concentration of neuron specific enolase (NSE), interleukin 6 (IL6), interleukin-$1{\beta}$ ($IL-1{\beta}$), and glial cell derived neurotrophic factor (GDNF) in serum and cerebrospinal fluid on day 1 and 7. Results : There were no significant differences in the numbers of the nucleated RBC, urinary uric acid/creatinine ratio, concentration of creatine kinase between the transplanted infants and controls. But the nucleated RBC is more likely to be rapidly discharged in the transplanted group. In the transplanted group, the concentrations of IL6, $IL-1{\beta}$, and GDNF were no significant difference between day 1 and 7, although GDNF seemed to be elevated. Serum NSE concentration was significantly elevated after transplantation, but not in CSF. Conclusion : It is suggested that autologous umbilical cord blood transplantation in preterm very low birth weight infant is safe to apply clinical practice. Long term follow up study should be needed to evaluate the potential therapeutic effect of umbilical cord blood transplantation for neuroprotection.

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

• Neonatal Medicine
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• v.18 no.2
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• pp.234-239
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• 2011

Purpose: Ibuprofen is used for prevention and treatment of patent ductus arteriosus as an alternative drug of indomethacin in very premature infants. We aimed to determine the effect of prophylactic ibuprofen on patent ductus arteriosus and clinical outcomes in preterm infants less than 1,250 g. Methods: A retrospective review of 39 preterm infants who were admitted to our neonatal intensive care unit from November 2009 to July 2010 was performed. Patients were divided into a prophylactic group (n=13) and a matched historical control group (n=26), where prophylactic ibuprofen were administrated within 24 hours after birth. The rate of ductal closure, side-effects of drug treatment and clinical outcomes were compared between two groups. Results: Comparison of the prophylactic and control groups revealed no significant differences in the rate of ductal closure (69.2% vs 77.7%, P=0.825) and surgical ligation (23.1% vs 30.8%, P=0.719). Occurrence of bowel perforation was more frequent in the prophylactic group than the control group, but was not significant (30.8% vs 11.5%, P=0.194). The frequency of intraventricular hemorrhage (grade${\geq}$3) and other outcomes did not differ between the groups. Conclusion: Ibuprofen prophylaxis in preterm infants did not decrease the rate of ductal closure, the need for surgical ligation and the incidence of intraventricular hemorrhage. Further studies are needed to investigate the beneficial effect and associated adverse events attributed to ibuprofen prophylaxis.

• Neonatal Medicine
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• v.25 no.3
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• pp.118-125
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• 2018

Purpose: The pre-pregnancy body mass index (BMI) is associated with adverse neonatal outcomes. However, studies on very low birth weight (VLBW) infants are rare. This study aimed to investigate the effect of maternal pre-pregnancy BMI on VLBW infants. Methods: This retrospective study evaluated singleton VLBW infants born at the CHA Gangnam Medical Center from 2006 to 2016. The neonates were classified into three groups according to the maternal pre-pregnancy BMI: underweight (<$18.5kg/m^2$), normal weight (${\geq}18.5$ to <$23kg/m^2$), and overweight or obese (${\geq}23kg/m^2$). Clinical characteristics and morbidities of mothers and infants were analyzed. Results: A total of 181 infants belonging to underweight (16.6%), normal weight (58.6%), and overweight or obese (24.8%) groups were enrolled. The pre-pregnancy BMI had a significant negative correlation with gestational age (r=-0.198, P=0.001) and a significant positive correlation with the z-score of the birth weight (r=0.078, P=0.001) and body length (r=0.067, P=0.008). The number of extremely preterm infants was significantly higher in the overweight or obese group. The proportion of risk of small for gestational age infants was higher in the underweight group (adjusted odds ratio [OR], 2.958; 95% confidence interval [CI], 1.113 to 7.864), whereas that of infants with severe retinopathy of prematurity was higher in the overweight or obese group (adjusted OR, 9.546; 95% CI, 1.230 to 74.109). Conclusion: In our population of VLBW infants, the pre-pregnancy BMI was associated with gestational age, intrauterine growth, and adverse neonatal outcomes. Therefore, proper weight control before pregnancy is important.

• Clinical and Experimental Pediatrics
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• v.63 no.8
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• pp.284-290
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• 2020

Korea currently has the world's lowest birth rate but a rapidly inreasing number of preterm infants. The Korean Neonatal Network (KNN), launched by the Korean Society of Neonatology under the support of Korea Centers for Disease Control, has collected population-based data for very low birth weight infants (VLBWIs) born in Korea since 2013. In terms of the short-term outcomes of VLBWIs born from 2013 to 2016 registered in the KNN, the survival rate of all VLBWIs was 86%. Respiratory distress syndrome and bronchopulmonary dysplasia were observed in 78% and 30% of all VLBWIs, respectively. Necrotizing enterocolitis occurred in 7%, while 8% of the VLBWIs needed therapy for retinopathy of prematurity in the neonatal intensive care unit (NICU). Sepsis occurred in 21% during their NICU stay. Intraventricular hemorrhage (grade ≥III) was diagnosed in 10%. In terms of the long-term outcomes for VLBWIs born from 2013 to 2014 registered in the KNN, the post-discharge mortality rate was approximately 1.2%-1.5%, mainly owing to their underlying illness. Nearly half of the VLBWIs were readmitted to the hospital at least once in their first 1-2 years of life, mostly as a result of respiratory diseases. The overall prevalence of cerebral palsy was 6.2%-6.6% in Korea. Bilateral blindness was reported in 0.2%-0.3% of VLBWIs, while bilateral hearing loss was found in 0.8%-1.9%. Since its establishment, the KNN has published annual reports and papers that facilitate the improvement of VLBWI outcome and the formulation of essential healthcare policies in Korea.