• Neonatal Medicine
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• v.17 no.2
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• pp.161-167
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• 2010

Acute kidney injury (AKI), formerly referred to as acute renal failure (ARF) is defined as the sudden impairment of kidney function (estimated from the glomerular filtration rate [GFR]) that results in the lack of excretion of waste products. More than 30 definitions of AKI exist in the literature, most of which are based on serum creatinine. Lack of a uniform and multidimensional AKI definition has led to failure to recognize significant renal injury, delays in treatment, and inability to generalize single-study results. The RIFLE criteria were developed to standardize the diagnosis of ARF and in the process the term AKI has been proposed to encompass the entire spectrum of the syndrome from minor changes in renal function to requirement for renal replacement therapy. Large prospective studies are needed to test definitions and to better understand risk factors, incidence, independent outcomes, and mechanisms that lead to poor short- and long-term outcomes. Early biomarkers of AKI need to be explored in critically ill neonates.

• Neonatal Medicine
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• v.15 no.2
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• pp.113-118
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• 2008

Clinical trials in neonates of different gestational age, birth weight, postnatal age and general health status are needed to assure safe and optimal evidence-based-therapy to this special population. Pharmacodynamic maturation must be considered in grouping the neonates for clinical trials. Informed consent from the parents, protection of the neonates participating in the clinical trials, adherence to good clinical practice guidelines, and designation of short term and long term outcomes must be taken into consideration from the beginning of the trials. Collaboration between centers will be helpful in overcoming the problem with small patient size. Many of these challenges are surmountable and an well-designed clinical trial will improve the mortality and morbidity in these very small children.

• Neonatal Medicine
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• v.15 no.2
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• pp.190-195
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• 2008

Cholelithiasis is rarely recognized in children, especially in infants. Hemolytic disorders, long-term total parenteral nutrition (TPN), congenital anomalies of the biliary tree leading to stasis of bile flow, congenital IgA-deficiency, furosemide treatment, and prolonged fasting have been reported as predisposing factors for cholelithiasis in childhood. Hemolytic disease of the newborn due to anti-E has rarely been reported as a risk factor for cholelithiasis. We report a case of gallbladder stones in a neonate associated with anti-E antibody hemolytic disease.

• Neonatal Medicine
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• v.18 no.1
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• pp.23-33
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• 2011

The etiology of thrombosis is multifactorial and involves the interaction of inherited and acquired risk factors. Many neonatal thromboembolic disorders are iatrogenic and their incidence is likely to increase as advancements are made in neonatal care. Among pediatric populations, neonates have the highest risk for thrombosis secondary to the unique developmental hemostatic system, inherited prothrombotic disorders, and perinatal clinical conditions. Central venous and arterial catheters present the greatest risk for developing thromboembolisms in neonates. Both venous and arterial thromboses have been reported in a variety of anatomic locations. Prompt identification and appropriate management of thromboembolisms is critical for avoiding life-threatening complications. To date, few data are currently available regarding the contribution of inherited and acquired prothrombotic disorders in the pathogenesis of neonatal thromboembolism. In particular, a lack of information about neonatal thromboembolism in Korea has inhibited the development of appropriate guidelines for diagnosing thromboembolisms in neonates. An overview of the current knowledge about the role of inherited and acquired risk factors for neonatal thromboembolism in the West and a detailed description of common neonatal thromboembolic diseases is reviewed.

• Neonatal Medicine
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• v.18 no.1
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• pp.6-13
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• 2011

All newborn infants with clinically significant bleeding should be evaluated for a hemostatic deficit. Medical history should include the following data: familial bleeding disorders, maternal illness and medication, age of bleeding onset, and prophylactic administration of vitamin K. The first essential step for evaluating bleeding neonates is determining whether the baby is sick or well. The physician should also evaluate the extent of the bleeding, features of bleeding lesions, and other abnormal findings from the physical examination. Skeletal anomalies may provide diagnostic clues. Depending on the clinical features and results of screening tests, other tests including coagulation factors may be useful for determining the diagnosis. All laboratory results must be considered in the context of age-related reference values. The platelet function analyzer provides a promising alternative to bleeding time. Fibrin degradation products and D-dimers are used for screening and specially testing fibrinolytic activity, respectively. The Apt test may help to rule out factors derived from maternal blood. Radiologic imaging studies are important because asymptomatic intracranial hemorrhages are common in neonates.

• Neonatal Medicine
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• v.18 no.1
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• pp.1-5
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• 2011

Coagulation involves the regulated sequence of proteolytic activation of a series of proteins to achieve appropriate and timely hemostasis in an injured vessel. In the non-pathological state, the inciting event involves exposure of circulating factor VIIa to extravascularly expressed tissue factor, which brings into motion the series of steps which results in cell based model of coagulation. In the new concepts of coagulation system, initiation, amplification and propagation steps are involved to converse of fibrinogen to fibrin. The precisely synchronized cascade of events is counter-balanced by a system of anticoagulant mechanisms. Developmental hemostasis refers to the age-related changes in the coagulation system that are most marked during neonate and childhood. An understanding of these changes in crucial to the accurate diagnosis of hemostatic abnormalities in neonate and children. This review aims to elucidate the main events within the coagulation cascade as it is currently understood to operate in vivo, and also a short review of the anticoagulants as they relate to this model. Also this paper describes the common pitfalls observed in the clinical data related to the coagulation system in neonate to children.

• Neonatal Medicine
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• v.16 no.2
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• pp.131-136
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• 2009

Preterm infants are frequently discharged from the hospital with growth retardation. Given the potentially lifelong effects of growth impairmnet during a critical time of development, considerable effort should be focused on improving growth after discharge. Growth monitoring must be based on regular measurements of weight, length, and head circumference to identify those preterm infants with poor growth that may need additional nutritional support. Although prior studies vary in design and the intervention used, the evidence supports the use of fortified formulas in formula-fed preterm infants after discharge. The situation for infants fed human milk is much less clear, it seems prudent to concentrate our efforts on the encouragement of breast-feeding in this population. Catch up growth may have many benefits, and may lead to improved development. However, its long-term metabolic consequences are currently unclear. Understanding the optimal means of providing nutrition after discharge is an ongoing process.

• Neonatal Medicine
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• v.15 no.1
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• pp.94-99
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• 2008

Although neonatal hypoglycemia is a common metabolic abnormality in newborn infants, brain injuries resulting from isolated neonatal hypoglycemia are rare. Many infants who are hypoglycemic do not exhibit clinical manifestations, while other infants are symptomatic and at risk for permanent brain damage. There is no disagreement that hypoglycemia can cause neonatal encephalopathy and result in permanent brain injury. Occipital brain injury associated with neonatal hypoglycemia can result in long-term disability, epilepsy, and visual impairment. Infants should receive ongoing developmental and visual surveillance for lateonset epilepsy, and visual or cognitive impairment. We report two cases of newborn infants with abnormal visual evoked potentials (VEP) caused by neonatal hypoglycemic encephalopathy.

• Neonatal Medicine
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• v.28 no.1
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• pp.48-52
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• 2021

Aplasia cutis congenita (ACC) is a rare congenital disorder characterized by skin defects involving the epidermis, dermis, subcutaneous tissue, bone, and sometimes dura. It commonly affects the scalp in approximately 70% of cases, but the neck, trunk, and the extremities can also be affected. ACC can occur either as an isolated condition or associated with other anomalies and congenital syndromes, and it can be acquired either genetically or sporadically. Morbidity and mortality are associated with the defects of skull bone, dura, and other multiple anomalies. We herein report the case of a female infant, with a large scalp defect accompanied by a skull defect noted at birth, who developed mental retardation in the preschool years.

• Neonatal Medicine
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• v.28 no.2
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• pp.72-76
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• 2021

Ectopic pancreas is defined as an abnormally located pancreatic tissue not sufficiently connected with the normal pancreas, which rarely occurs in neonates. To our knowledge, only a few cases of ectopic pancreas have been reported in newborns in South Korea. We report a case of ectopic pancreas as the cause of intussusception and jejunal atresia in a newborn. This clinical association is extremely rare, and this is the first report in South Korea.