• 제목/요약/키워드: preterm birth

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Management of Persistent Pulmonary Hypertension in Preterm Infants

  • Lee, Byong Sop
    • Neonatal Medicine
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    • 제28권1호
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    • pp.1-6
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    • 2021
  • Persistent pulmonary hypertension of the newborn (PPHN) is a consequence of the failure of a decrease in the elevated pulmonary vascular resistance after birth. Pulmonary vasodilators, including inhaled nitric oxide (iNO), have been the mainstream of targeted therapy for PPHN, but no drugs have been proven to be effective in preterm infants with PPHN. The fetus remains hemodynamically stable despite lower arterial oxygen tension and pulmonary blood flow as compared to full-term newborns. This adaptation is due to the lower oxygen requirement and high oxygen-carrying capacity of fetal circulation. The immature lungs of preterm infants are more vulnerable to reactive oxygen species, and the response of pulmonary vascular dilatation to blood oxygen tension is blunted in preterm infants. Recently, iNO has been reported to be effective in a selected group of preterm infants, such as those with prolonged preterm rupture of membrane-oligohydramnios-pulmonary hypoplasia sequence. PPHN in preterm infants, along with maximum supportive treatment based on fetal physiology and meticulous assessment of cardiovascular function, is in dire need of new treatment guidelines, including optimal dosing strategies for pulmonary vasodilators.

Practice for preterm patent ductus arteriosus; focusing on the hemodynamic significance and the impact on the neonatal outcomes

  • Lee, Jin A
    • Clinical and Experimental Pediatrics
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    • 제62권7호
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    • pp.245-251
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    • 2019
  • Hemodynamically significant preterm patent ductus arteriosus (PDA) affects mortality; comorbidities such as necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia; and adverse long-term neurodevelopmental outcomes in preterm infants, particularly in very low birth weight infants. However, recent studies have indicated that there is no consensus on the causal relationship between PDA and neonatal outcomes, the benefit of PDA treatment, the factors guiding the need for treatment, and optimal treatment strategies. Such uncertainty has resulted in wide variations in practice for treating preterm PDA between units, regions, and nations. Nowadays, there has been a paradigm shift to more conservative treatment for preterm PDA, and suggestions regarding selective management of preterm PDA considering risk factors and hemodynamic significance are increasing. Neonatologist-performed echocardiography and advances in modalities to assess hemodynamic significance such as biologic markers and near-infrared spectroscopy also help improve the efficacy of selective treatment of preterm PDA.

Evaluation of three glucometers for whole blood glucose measurements at the point of care in preterm or low-birth-weight infants

  • Hwang, Joon Ho;Sohn, Yong-Hak;Chang, Seong-Sil;Kim, Seung Yeon
    • Clinical and Experimental Pediatrics
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    • 제58권8호
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    • pp.301-308
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    • 2015
  • Purpose: We evaluated three blood glucose self-monitoring for measuring whole blood glucose levels in preterm and low-birth-weight infants. Methods: Between December 1, 2012 and March 31, 2013, 230 blood samples were collected from 50 newborns, who weighed, ${\leq}2,300g$ or were ${\leq}36$ weeks old, in the the neonatal intensive care unit of Eulji University Hospital. Three blood glucose self-monitoring (A: Precision Pcx, Abbott; B: One-Touch Verio, Johnson & Johnson; C: LifeScan SureStep Flexx, Johnson & Johnson) were used for the blood glucose measurements. The results were compared to those obtained using laboratory equipment (D: Advia chemical analyzer, Siemens Healthcare Diagnostics Inc.). Results: The correlation coefficients between laboratory equipment and the three blood glucose self-monitoring (A, B, and C) were found to be 0.888, 0.884, and 0.900, respectively. For glucose levels ${\leq}60mg/dL$, the correlation coefficients were 0.674, 0.687, and 0.679, respectively. For glucose levels>60 mg/dL, the correlation coefficients were 0.822, 0.819, and 0.839, respectively. All correlation coefficients were statistically significant. And the values from the blood glucose self-monitoring were not significantly different from the value of the laboratory equipment, after correcting for each device's average value (P>0.05). When using laboratory equipment (blood glucose ${\leq}60mg/dL$), each device had a sensitivity of 0.458, 0.604, and 0.688 and a specificity of 0.995, 0.989, and 0.989, respectively. Conclusion: Significant difference is not found between three blood glucose self-monitoring and laboratory equipment. But correlation between the measured values from blood glucose self-monitoring and laboratory equipment is lower in preterm or low-birth-weight infants than adults.

The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery

  • Choi, Han Saem;Lee, Soon Min;Eun, Hoseon;Park, Minsoo;Park, Kook-In;Namgung, Ran
    • Clinical and Experimental Pediatrics
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    • 제61권8호
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    • pp.239-244
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    • 2018
  • Purpose: Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. Methods: The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above $23.0^{\circ}C$, and a check-list was used for feedback. Results: Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <$36.0^{\circ}C$) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from $35.5^{\circ}C$ to $36.0^{\circ}C$. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from $35.4^{\circ}C$ to $35.9^{\circ}C$ and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. Conclusion: Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.

기관 삽관을 시행한 조산아에서 발생한 상악 유전치의 발육이상 : 증례보고 (DEVELOPMENTAL DISTURBANCE OF PRIMARY INCISORS IN PRETERM INFANTS WITH ENDOTRACHEAL INTUBATION : A CASE REPORT)

  • 임소영;김성오;이제호;김익환
    • 대한장애인치과학회지
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    • 제15권1호
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    • pp.89-93
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    • 2019
  • 본 증례 보고는 기관 삽관 경험이 있는 조산아에서 상악 유전치의 발육장애가 나타난 증례이다. 본 증례들에서는 기관 삽관으로 인해 치관 형태 이상, 법랑질 결함, 맹출 지연이 나타났다. 또한 치배의 변위로 인한 맹출 경로 이상, 치근 만곡, 후속 영구치의 비정상적인 치근 형성도 나타났다. 이환 치아에 대해서는 예방적 수복치료 및 관리, 적절한 시기에 발치를 고려해야 한다. 소아치과의사는 삽관 경험이 있는 조산아에서 나타날 수 있는 상황에 대해 이해하고, 적절한 개입을 통해 구강 건강 증진을 도모해야 한다.

뇌성마비아의 임상적 양상 (Clinical Features of Children with Cerebral Palsy)

  • 김선영;김재현;김찬문
    • 대한물리치료과학회지
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    • 제5권3호
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    • pp.651-658
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    • 1998
  • Cerebral palsy is a neurodevelopmental impairment caused by a nonprogressive defect or lesion in single or multiple locations in the immature brain. The defect or lesion can occur in utero or during or shortly after birth and produces sensory-motor impairment that are usually evident in early infancy. The causes of cerebral palsy are not completely understood, certain prenatal, perinatal, and postnatal factors have been associated with cerebral palsy. This study was analysed the clinical features of 50 children with cerebral palsy (29 males and 21 females) in National Rehabilitation Hospital from March 17 to June 27, 1998. The time of initial visit was over than 12 months in 74%, and their cheif complains were delayed developments (78%). The preterm infants were 40% and the infants with low birth weight were 36%. The maternal age at childbirth was over than 30 years old in 52%. The most common type of cerebral palsy was spastic (54%), mixed (22%), athetosis and hypotonia (10% each), ataxia (4%). The cerebral palsy with preterm infants and low birth weight were more likely to have spastic type (P=0.002, P=0.023 each). The most preterm infants were born between 30 and 35 years old of maternal age, and there were statistical significance in difference (P=0.031).

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Augmentation of respiratory muscle activities in preterm infants with feeding desaturation

  • Kwon, Dong Rak;Park, Gi Young;Jeong, Ji Eun;Kim, Woo Taek;Lee, Eun Joo
    • Clinical and Experimental Pediatrics
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    • 제61권3호
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    • pp.78-83
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    • 2018
  • Purpose: Frequent desaturation due to immature incoordination of suck-swallow-breathing in preterm infants can influence multiple organs such as the heart, lungs, and brain, which can then affect growth and development. Most notably in preterm infants, feeding desaturation may even affect pulmonary function during gavage feeding. Because respiratory muscle activities may reflect the work required during respiration, we evaluated the differences in these activities between full-term and preterm infants with feeding desaturation, and investigated the correlations with clinical variables. Methods: Nineteen preterm infants with feeding desaturation (group 1) and 19 age-matched full-term infants (group 2) were evaluated. Oromotor function was evaluated using video recording. The root-mean-square (RMS) envelope of the electromyography signal was calculated to quantify the activities of muscles involved in respiration. The differences in RMS between both groups and the correlation with clinical variables including gestational age (GA), birth weight (BW), and Apgar scores (AS) at 1 and 5 minutes after birth were evaluated. Results: The RMS values of the diaphragm (RMS-D) and rectus abdominis (RMS-R) were significantly greater in group 1 compared to group 2, and the 1- and 5-min AS were significantly lower in group 1 compared to group 2. RMS-D and RMS-R were inversely correlated with GA, BW, 1- and 5-min AS in all infants. Conclusion: This study showed that respiratory muscle activities were augmented during feeding in preterm infants compared to full-term infants. Additionally, respiratory muscle activities were inversely correlated with all clinical variables.

미숙아를 출산한 산모의 임신 중 혈압과 혈액지표 조사 (A Survey on Blood Pressure and Hematic Parameters During Pregnancy by Women of Premature Delivery)

  • 이승림;장유경
    • 대한지역사회영양학회지
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    • 제13권6호
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    • pp.903-911
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    • 2008
  • The purpose of this study is to provide basic data for preventing preterm delivery in the aspects of blood pressure and hematic parameters. The blood pressure, hematic parameters, relationship between hematic parameters and nutritional intakes and pregnancy outcomes were compared between a preterm delivery group and a normal term delivery group. The results obtained are summarized as follows. Diastolic blood pressure was statistically higher in the preterm delivery group. White blood cells (p < 0.005) and alanine amino transferase (p < 0.05) of 3rd trimester in pregnancy were statistically higher in the preterm delivery group. Alkaline phosphatase (p < 0.0001) and lactate dehydrogenase (p < 0.05) were statistically lower in the preterm delivery group. Inverse relationships between niacin, vitamin B6 and zinc intakes and bilirubin (p < 0.05) were shown. Vitamin A intakes (p < 0.05) were significantly negatively correlated with blood protein, but zinc intakes (p < 0.05) were significantly positively correlated with blood protein. Vitamin B6 intakes (p < 0.05) were significantly negatively correlated with blood albumin. Calcium intakes (p < 0.005) and iron intakes (p < 0.05) were significantly positively correlated with blood lactate dehydrogenase. Also, vitamin A intakes (p < 0.05) were significantly positively correlated with blood glucose. Normal spontaneous vaginal delivery (p < 0.005) was statistically lower in the preterm delivery group. Birth weight (p < 0.0001) and birth length (p < 0.005) of the neonates were all statistically lower in the preterm delivery group.

미숙아에 대한 감각자극 효과에 관한 메타분석 (Meta-analysis on the Effects of Sensory Stimulation of Preterm Infants)

  • 김은주
    • Child Health Nursing Research
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    • 제9권2호
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    • pp.131-139
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    • 2003
  • Purpose: This study was meta-analysis study that it was to analyze the effect of sensory stimulation on preterm infants. Method: The sample of this study is 18 researches of selected by criteria. The conclusion of study was that sensory stimulation of preterm infants is effective. Result: Most large effect size was Katz(1991)'s study(d=1.96), small effect size was Caine(1991), s(d=0.37). Especially multimodal sensory stimulation(d=1.2) was more effective than unimodal sensory stimulation(0.53). Also behavioral variable of preterm infans was most sensitivity indicator. Conclusion: According to the result, the study on sensory stimulation should be research according to the gestational age and birth weight of preterm infants. In addition, the feasible sensory intervention should be develop.

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Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit

  • Hay, William W. Jr.
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제21권4호
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    • pp.234-247
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    • 2018
  • The goal of nutrition of the preterm infant is to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.