• Clinical and Experimental Pediatrics
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• v.58 no.9
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• pp.347-353
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• 2015

Purpose: The purpose of this study was to evaluate the efficacy and safety of Montelukast sodium in the prevention of bronchopulmonarydysplasia (BPD). Methods: The Interventional study was designed as a multicenter, prospective, and randomized trial, with open labeled and parallel-experimental groups, 66 infants were enrolled and allocated to either the case group (n=30) or the control group (n=36) based on gestational age (GA). Infants in the case group were given Montelukast sodium (Singulair) based on their body weight (BW). Zero week was defined as the start time of the study. Results: The incidence of moderate to severe BPD was not different between the groups (case group: 13 of 30 [43.3%] vs. control group: 19 of 36 [52.8%], P=0.912). Additionally, secondary outcomes such as ventilation index, mean airway pressure and resort to systemic steroids were not significantly different. There were no serious adverse drug reactions in either group, and furthermore the rate of occurrence of mild drug related-events were not significantly different (case group: 10 of 42 [23.8%] vs. control group: 6 of 48 (15.8%), P=0.414). Conclusion: Montelukast was not effective in reducing moderate or severe BPD. There were no significant adverse drug events associated with Montelukast treatment.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.209-212
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• 2007

Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder of early infancy, and is characterized by periorificial dermatitis, alopecia, and intractable diarrhea. Serum zinc levels are usually low in untreated patients and the oral administration of zinc sulfate can clear skin lesions and other symptoms. Although premature and cow's milk-fed infants are at particular risk of developing AE, there have been a few reports about AE in term and breast-fed infants. We report a case of transient AE in a 4-month-old breast-fed infant. This patient suffered from diarrhea and dermatitis for more than a month. Her skin lesions were erythematous, scaly, crusted, psoriasiform, eczematous, with an eruption at the chin, and a periorificial disposition with involvement of the flexural areas of lower extremities. Her serum zinc level was almost normal at $129{\mu}g/dL$ (reference range: $60-121{\mu}g/dL$), but the zinc level in her hair was low: 8 mg percent (reference range: 10-21 mg percent). Skin biopsy findings were consistent with AE. Seven days after zinc supplementation, the skin lesions and diarrhea improved. The authors recommend that a clinical trial of zinc supplementation be considered in cases where there are suspicious of AE, even when the serum zinc level is normal.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.19-23
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• 2003

Necrotizing Enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002, and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease: one of who had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<$5.0{\times}10^9/L$), seven had thrombocytopenia (<$100{\times}10^9/L$), and three severe thrombocytopenia (<$50{\times}10^9/L$). Laparotomy was required in 10 of the 13 patients. Indications for operation in the acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operations for intestinal stricture and fistula. There were no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count ($50{\times}10^9/L$) (p<0.05). Congenital heart disease and Rota viral infection are associated with NEC in term infants and thrombocytopenia and leucopoenia may be surgical indications.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.39-48
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• 1990

Congenital duodenal obstruction in the newborn infant may be due to a variety of causes. Duodenal obstruction often presents with bilious vomiting and upper abdominal distention. Diagnosis is usually established on plain x-ray of the abdomen by the classic finding of the double-bubble. In the period July 1986 to June 1990, 16 patients with congenital duodenal obstruction were operated and the following results were obtained. 1. Sixteen patients were comprised of 11 males and 5 females, the ratio of male and female was 2.2:1. 2. Thirteen patients(81%) had been admitted to our hospital during one month of life. 3. Congenital duodenal obstruction was in 16 cases; malrotation in eight(50%), annular pancreas in six(38%), type 1 atresia in one(6%), and wind-sock anomaly in one(6%). 4. There were two premature patients and six patients of small for gestational age. 5. Overall, bilious vomiting, occurring in three fourths, was the single most frequent presenting complaint. 6. Polyhydramnios occurred in two of the patients. 7. Diagnosis was possible with clinical symptom and simple abdomen. 8. The operative procedures performed were ; duodenoduodenostomy in five, duodenojejunostomy in two, excision of wind-sock membrane in one, and Ladd's procedure in eight. 9. A total of ten asociated congenital anomalies were found in six patients. 10. Postoperative complications occurred in five cases(31%).

• Clinical and Experimental Pediatrics
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• v.64 no.9
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• pp.480-488
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• 2021

Background: An adequate large-scale pediatric cohort based on nationwide administrative data is lacking in Korea. Purpose: This study established the National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008) based on data from a nationwide population-based health screening program and data on healthcare utilization for children. Methods: The NICKs-2008 study consisted of the Korean National Health Insurance System (NHIS) and the National Health Screening Program for Infants and Children (NHSPIC) databases comprising children born in 2008 (n=469,248) and 2009 (n=448,459) in the Republic of Korea. The NHIS database contains data on age, sex, residential area, income, healthcare utilization (International Classification of Diseases10 codes, procedure codes, and drug classification codes), and healthcare providers. The NHSPIC consists of 7 screening rounds. These screening sessions comprised physical examination, developmental screening (rounds 2-7), a general health questionnaire, and age-specific anticipatory guidance. Results: During the 10-year follow-up, 2,718 children (0.3%) died, including more boys than girls (hazard ratio, 1.145; P<0.001). A total of 848,048 children participated in at least 1 of the 7 rounds of the NHSPIC, while 96,046 participated in all 7 screening programs. A total of 823 infants (0.1%) weighed less than 1,000 g, 3,177 (0.4%) weighed 1,000-1,499 g, 37,166 (4.4%) weighed 1,500-2,499 g, 773,081 (91.4%) weighed 2,500-4,000 g, and 32,016 (5.1%) weighed over 4,000 g. There were 23,404 premature babies (5.5%) in 2008 compared to 23,368 (5.6%) in 2009. The developmental screening test indicated appropriate development in 95%-98% of children, follow-up requirements for 1%-4% of children, and recommendations for further evaluation for 1% of children. Conclusion: The NICKs-2008, which integrates data from the NHIS and NHSPIC databases, can be used to analyze disease onset prior to hospitalization based on information such as lifestyle, eating habits, and risk factors.

• Neonatal Medicine
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• v.25 no.4
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• pp.161-169
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• 2018

Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.149-159
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• 2021

Purpose: Antibiotic exposure during pregnancy may affect the fetus and newborn in many ways. This study investigated the impact of prenatal antibiotic exposure duration on neonatal outcomes in very preterm (VP) or very low birth weight (VLBW) infants. Methods: From September 2015 to December 2020, preterm infants with gestational age less than 32 weeks or with a BW less than 1,500 g who were admitted to the neonatal intensive care unit, and their mothers were enrolled. Prenatal antibiotic exposure was defined as antibiotics received by mothers before delivery, and the patients were categorized into the non-antibiotic group, short-duration (SD; ≤7 days) group, or long-duration (LD; >7 days) groups. Results: A total of 93 of 145 infants were exposed to prenatal antibiotics, among which 35 (37.6%) were in the SD group and 58 (62.4%) were in the LD group. Infants in the LD group had a significantly higher birth weight-for-gestational-age (BW/GA) Z-score than those in the non-antibiotic group, even after the adjustment for confounding factors (beta, 0.258; standard error, 0.149; P<0.001). Multivariate logistic regression analysis showed that prolonged prenatal antibiotic exposure was independently associated with death (adjusted odds ratio [aOR], 8.926; 95% confidence interval [CI], 1.482-53.775) and composite outcomes of death, necrotizing enterocolitis (NEC), and late-onset sepsis (LOS) (aOR, 2.375; 95% CI, 1.027-5.492). Conclusions: Prolonged prenatal antibiotic exposure could increase the BW/GA Z-score and the risk of death and composite outcomes of death, NEC, and LOS in VP or VLBW infants.

• 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.

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

• Neonatal Medicine
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• v.17 no.2
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• pp.239-244
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• 2010

Purpose: To evaluate two different heel lancet device in terms of pain response and success of the procedure in the preterm infants undergoing heel puncture. Methods: 100 preterm infants undergoing capillary blood gas analysis or capillary bilirubin monitoring underwent heel puncture, were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. Primary outcome measures included the Premature Infants Pain Profile (PIPP) score, total duration of procedure, number of heel puncture and number of bruise. The pain response was evaluated using PIPP score and the effectiveness was evaluated using three criteria: total duration of blood sampling, number of puncture, bruising of the heel or ankle. Statistical analysis was performed using the SPSS ver. 13.0 program. Difference between the groups were analysed with t test (continuous variables) and the Chi square test or Fisher test (categorical variables). Results: The mean PIPP score was 4.91 for the automatic lancet group compared with 5.84 for the conventional manual lancet group (P=0.0255).The number of pain scores above 7 during blood collection did not differ between two groups (P=0.2167). The procedure took less time to perform in the automatic lancet group (mean, 30.69 seconds) than in the conventional lancet group (mean, 48.92 seconds) (P<0.0001). Conclusion: This study demonstrated that the automatic lancet device causes less pain and a shorter procedure time than the conventional manual lancet in preterm infants undergoing heel puncture. On the basis of these results the automatic lancet device is very useful method for blood collection in preterm infants by heel puncture.