1
|
Park MW, Shin HI, Bang MS, Kim DK, Shin SH, Kim EK, Lee ES, Shin HI, Lee WH. Reduction in limb-movement complexity at term-equivalent age is associated with motor developmental delay in very-preterm or very-low-birth-weight infants. Sci Rep 2024; 14:8432. [PMID: 38600352 PMCID: PMC11006919 DOI: 10.1038/s41598-024-59125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
Reduced complexity during the writhing period can be crucial in the spontaneous movements of high-risk infants for neurologic impairment. This study aimed to verify the association between quantified complexity of upper and lower-limb movements at term-equivalent age and motor development in very-preterm or very-low-birth-weight infants. Video images of spontaneous movements at term-equivalent age were collected from very-preterm or very-low-birth-weight infants. A pretrained pose-estimation model and sample entropy (SE) quantified the complexity of the upper- and lower-limb movements. Motor development was evaluated at 9 months of corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. The SE measures were compared between infants with and without motor developmental delay (MDD). Among 90 infants, 11 exhibited MDD. SE measures at most of the upper and lower limbs were significantly reduced in infants with MDD compared to those without MDD (p < 0.05). Composite scores in the motor domain showed significant positive correlations with SE measures at most upper and lower limbs (p < 0.05). The results show that limb-movement complexity at term-equivalent age is reduced in infants with MDD at 9 months of corrected age. SE of limb movements can be a potentially useful kinematic parameter to detect high-risk infants for MDD.
Collapse
Affiliation(s)
- Myung Woo Park
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Choi HJ, Shin BS, Shin SH, Kim EK, Kim HS. Critical period of oxygen supplementation and invasive ventilation: implications for severe retinopathy of prematurity. Ital J Pediatr 2024; 50:58. [PMID: 38561824 PMCID: PMC10985977 DOI: 10.1186/s13052-024-01629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Several studies have identified graded oxygen saturation targets to prevent retinopathy of prematurity (ROP), a serious complication in preterm infants. We aimed to analyze the critical period of oxygen supplementation and/or invasive ventilation associated with severe ROP. METHODS This retrospective case-control study included neonates with a gestational age (GA) < 29 weeks. Participants were divided into two groups: treated retinopathy and untreated/no retinopathy. Time-weighted average FiO2 (TWAFiO2) and weekly invasive ventilation were compared between groups by postnatal age (PNA) and postmenstrual age (PMA). The association of treated retinopathy with TWAFiO2 and invasive ventilation was analyzed. RESULTS Data from 287 neonates were analyzed; 98 were treated for ROP and had lower GAs (25.5 vs. 27.4 weeks, p < 0.01) and lower birthweights (747.6 vs. 1014 g, p < 0.001) than those with untreated/no ROP. TWAFiO2 was higher from PMA 26-34 weeks, except for PMA 31 weeks in treated ROP, and higher in the first nine weeks of life in treated ROP. On multiple logistic regression, TWAFiO2 and invasive ventilation were associated with ROP treatment during the first seven weeks PNA. Invasive ventilation was associated with ROP treatment from PMA 26-31 weeks; no association was found for TWAFiO2 and PMA. CONCLUSIONS Amount of oxygen supplementation and/or invasive ventilation during the first 7 weeks of life or up to 31 weeks PMA was associated with development of severe ROP. This period might be candidate timing for strict oxygen supplementation strategies in preterm infants, while concerns of mortality with low oxygen supplementation should be further explored.
Collapse
Affiliation(s)
- Ho Jung Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Baek Sup Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Kim YJ, Shin SH, Kim EK, Kim HS. Short term effect of intravenous treprostinil in term and preterm infants with pulmonary hypertension. BMC Pediatr 2024; 24:83. [PMID: 38281939 PMCID: PMC10823739 DOI: 10.1186/s12887-023-04501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a life-threatening condition in newborns. We aimed to assess the clinical and echocardiographic responses of term and preterm infants to treprostinil. METHODS This retrospective study included newborns diagnosed with PH and treated with treprostinil as additional therapy after inhaled nitric oxide administration in the neonatal intensive care unit of a tertiary center. Term and preterm infants were compared in terms of echocardiographic findings and clinical findings 4 weeks after treprostinil treatment. RESULTS During the study period, 11 term and 18 preterm infants were diagnosed with PH and received treprostinil. There were no differences in the echocardiographic findings of interventricular septal deviation, direction of shunt, and ratio of estimated pulmonary artery pressure over systolic blood pressure. Congenital diaphragmatic hernia was the most common condition occurring upon PH diagnosis among term infants, while severe bronchopulmonary dysplasia was the most common in preterm infants. Improvements in echocardiographic findings were more pronounced in term infants than in preterm infants (100% vs. 55.6%, P = 0.012). The inhaled nitric oxide dose was gradually tapered for term infants and was lower than that for preterm infants at 1, 2, and 3 weeks after treprostinil. CONCLUSION Intravenous treprostinil could be an adjuvant therapy option for term and preterm infants with PH, especially for those who cannot receive oral medication. The efficacy and safety of treprostinil in this population with PH should be investigated further.
Collapse
Affiliation(s)
- Yoo-Jin Kim
- Department of Pediatrics, Chung-buk National University Hospital, Cheongju-si, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| |
Collapse
|
4
|
Joo MW, Ko T, Kim MS, Lee YS, Shin SH, Chung YG, Lee HK. Development and Validation of a Convolutional Neural Network Model to Predict a Pathologic Fracture in the Proximal Femur Using Abdomen and Pelvis CT Images of Patients With Advanced Cancer. Clin Orthop Relat Res 2023; 481:2247-2256. [PMID: 37615504 PMCID: PMC10566917 DOI: 10.1097/corr.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Improvement in survival in patients with advanced cancer is accompanied by an increased probability of bone metastasis and related pathologic fractures (especially in the proximal femur). The few systems proposed and used to diagnose impending fractures owing to metastasis and to ultimately prevent future fractures have practical limitations; thus, novel screening tools are essential. A CT scan of the abdomen and pelvis is a standard modality for staging and follow-up in patients with cancer, and radiologic assessments of the proximal femur are possible with CT-based digitally reconstructed radiographs. Deep-learning models, such as convolutional neural networks (CNNs), may be able to predict pathologic fractures from digitally reconstructed radiographs, but to our knowledge, they have not been tested for this application. QUESTIONS/PURPOSES (1) How accurate is a CNN model for predicting a pathologic fracture in a proximal femur with metastasis using digitally reconstructed radiographs of the abdomen and pelvis CT images in patients with advanced cancer? (2) Do CNN models perform better than clinicians with varying backgrounds and experience levels in predicting a pathologic fracture on abdomen and pelvis CT images without any knowledge of the patients' histories, except for metastasis in the proximal femur? METHODS A total of 392 patients received radiation treatment of the proximal femur at three hospitals from January 2011 to December 2021. The patients had 2945 CT scans of the abdomen and pelvis for systemic evaluation and follow-up in relation to their primary cancer. In 33% of the CT scans (974), it was impossible to identify whether a pathologic fracture developed within 3 months after each CT image was acquired, and these were excluded. Finally, 1971 cases with a mean age of 59 ± 12 years were included in this study. Pathologic fractures developed within 3 months after CT in 3% (60 of 1971) of cases. A total of 47% (936 of 1971) were women. Sixty cases had an established pathologic fracture within 3 months after each CT scan, and another group of 1911 cases had no established pathologic fracture within 3 months after CT scan. The mean age of the cases in the former and latter groups was 64 ± 11 years and 59 ± 12 years, respectively, and 32% (19 of 60) and 53% (1016 of 1911) of cases, respectively, were female. Digitally reconstructed radiographs were generated with perspective projections of three-dimensional CT volumes onto two-dimensional planes. Then, 1557 images from one hospital were used for a training set. To verify that the deep-learning models could consistently operate even in hospitals with a different medical environment, 414 images from other hospitals were used for external validation. The number of images in the groups with and without a pathologic fracture within 3 months after each CT scan increased from 1911 to 22,932 and from 60 to 720, respectively, using data augmentation methods that are known to be an effective way to boost the performance of deep-learning models. Three CNNs (VGG16, ResNet50, and DenseNet121) were fine-tuned using digitally reconstructed radiographs. For performance measures, the area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, precision, and F1 score were determined. The area under the receiver operating characteristic curve was used to evaluate three CNN models mainly, and the optimal accuracy, sensitivity, and specificity were calculated using the Youden J statistic. Accuracy refers to the proportion of fractures in the groups with and without a pathologic fracture within 3 months after each CT scan that were accurately predicted by the CNN model. Sensitivity and specificity represent the proportion of accurately predicted fractures among those with and without a pathologic fracture within 3 months after each CT scan, respectively. Precision is a measure of how few false-positives the model produces. The F1 score is a harmonic mean of sensitivity and precision, which have a tradeoff relationship. Gradient-weighted class activation mapping images were created to check whether the CNN model correctly focused on potential pathologic fracture regions. The CNN model with the best performance was compared with the performance of clinicians. RESULTS DenseNet121 showed the best performance in identifying pathologic fractures; the area under the receiver operating characteristic curve for DenseNet121 was larger than those for VGG16 (0.77 ± 0.07 [95% CI 0.75 to 0.79] versus 0.71 ± 0.08 [95% CI 0.69 to 0.73]; p = 0.001) and ResNet50 (0.77 ± 0.07 [95% CI 0.75 to 0.79] versus 0.72 ± 0.09 [95% CI 0.69 to 0.74]; p = 0.001). Specifically, DenseNet121 scored the highest in sensitivity (0.22 ± 0.07 [95% CI 0.20 to 0.24]), precision (0.72 ± 0.19 [95% CI 0.67 to 0.77]), and F1 score (0.34 ± 0.10 [95% CI 0.31 to 0.37]), and it focused accurately on the region with the expected pathologic fracture. Further, DenseNet121 was less likely than clinicians to mispredict cases in which there was no pathologic fracture than cases in which there was a fracture; the performance of DenseNet121 was better than clinician performance in terms of specificity (0.98 ± 0.01 [95% CI 0.98 to 0.99] versus 0.86 ± 0.09 [95% CI 0.81 to 0.91]; p = 0.01), precision (0.72 ± 0.19 [95% CI 0.67 to 0.77] versus 0.11 ± 0.10 [95% CI 0.05 to 0.17]; p = 0.0001), and F1 score (0.34 ± 0.10 [95% CI 0.31 to 0.37] versus 0.17 ± 0.15 [95% CI 0.08 to 0.26]; p = 0.0001). CONCLUSION CNN models may be able to accurately predict impending pathologic fractures from digitally reconstructed radiographs of the abdomen and pelvis CT images that clinicians may not anticipate; this can assist medical, radiation, and orthopaedic oncologists clinically. To achieve better performance, ensemble-learning models using knowledge of the patients' histories should be developed and validated. The code for our model is publicly available online at https://github.com/taehoonko/CNN_path_fx_prediction . LEVEL OF EVIDENCE Level III, diagnostic study.
Collapse
Affiliation(s)
- Min Wook Joo
- Department of Orthopedic Surgery, St. Vincent’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Taehoon Ko
- Department of Medical Informatics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Min Seob Kim
- The City Hall Station St. Mary’s Psychiatric Clinic, Seoul, Republic of Korea
| | - Yong-Suk Lee
- Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Kwon Lee
- Department of Orthopedic Surgery, St. Vincent’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
5
|
Shin SH, Lee KS, Koo KC, Cho KS, Hong CH, Chung BH, Ryoo HS, Ryu JH, Kim YB, Yang SO, Lee JK, Jung TY, Yoo JW. Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate. World J Urol 2023; 41:3065-3074. [PMID: 37787942 PMCID: PMC10632267 DOI: 10.1007/s00345-023-04628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Despite advances in technology, such as advent of laser enucleation and minimally invasive surgical therapies, transurethral resection of the prostate (TURP) remains the most widely performed surgical technique for benign prostatic hyperplasia (BPH). We evaluated resection volume (RV)-derived parameters and analyzed the effect of RV on post-TURP outcomes. METHODS This observational study used data from patients who underwent TURP at two institutions between January 2011 and December 2021 Data from patients with previous BPH surgical treatment, incomplete data, and underlying disease affecting voiding function were excluded. The collected data included age, prostate-specific antigen, transrectal ultrasound (TRUS)- and uroflowmetry-derived parameters, RV, perioperative laboratory values, perioperative International Prostatic Symptom Score (IPSS), follow-up period, retreatment requirements and interval between the first TURP and retreatment. RESULTS In 268 patients without prior BPH medication, there were no differences in prostate volume (PV), transitional zone volume (TZV), or RV according to IPSS. A total of 60 patients started retreatment, including medical or surgical treatment, within the follow-up period. There was a significant difference in RV/PV between the groups without and with retreatment respectively (0.56 and 0.37; p = 0.008). However, preoperative TRUS- and uroflowmetry-derived parameters did not differ between the two groups. Multiple linear regression analysis showed that RV (p = 0.003) and RV/TZV (p = 0.006) were significantly associated with differences in perioperative IPSS. In the multivariate logistic regression analysis, only RV/PV was correlated with retreatment (p = 0.010). CONCLUSION Maximal TURP leads to improved postoperative outcomes and reduced retreatment rate, it may gradually become a requirement rather than an option.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Hong
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Ryoo
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Seung Ok Yang
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jeong Kee Lee
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jeong Woo Yoo
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea.
| |
Collapse
|
6
|
Shin BS, Shin SH, Park SG, Kim EK, Kim HS. Factors associated with acute kidney injury among preterm infants administered vancomycin: a retrospective cohort study. BMC Pediatr 2023; 23:296. [PMID: 37328836 PMCID: PMC10273740 DOI: 10.1186/s12887-023-04085-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 05/19/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Vancomycin (VCM) is a widely used antibiotic for the treatment of gram-positive microorganisms, with some nephrotoxic effects. Recent studies have suggested that piperacillin-tazobactam (TZP) aggravates VCM-induced nephrotoxicity in adults and adolescents. However, there is a lack of research investigating these effects in the newborn population. Therefore, this study investigates whether the concomitant use of TZP with VCM use increases the risk of acute kidney injury (AKI) and to explore the factors associated with AKI in preterm infants treated with VCM. METHODS This retrospective study included preterm infants with birth weight < 1,500 g in a single tertiary center who were born between 2018 and 2021 and received VCM for a minimum of 3 days. AKI was defined as an increase in serum creatinine (SCr) of at least 0.3 mg/dL and an increase in SCr of at least 1.5 times baseline during and up to 1 week after discontinuation of VCM. The study population was categorized as those with or without concomitant use of TZP. Data on perinatal and postnatal factors associated with AKI were collected and analyzed. RESULTS Of the 70 infants, 17 died before 7 postnatal days or antecedent AKI and were excluded, while among the remaining participants, 25 received VCM with TZP (VCM + TZP) and 28 VCM without TZP (VCM-TZP). Gestational age (GA) at birth (26.4 ± 2.8 weeks vs. 26.5 ± 2.6 weeks, p = 0.859) and birthweight (750.4 ± 232.2 g vs. 838.1 ± 268.7 g, p = 0.212) were comparable between the two groups. There were no significant differences in the incidence of AKI between groups. Multivariate analysis showed that GA (adjusted OR: 0.58, 95% CI: 0.35-0.98, p = 0.042), patent ductus arteriosus (PDA) (adjusted OR: 5.23, 95% CI: 0.67-41.05, p = 0.115), and necrotizing enterocolitis (NEC) (adjusted OR: 37.65, 95% CI: 3.08-459.96, p = 0.005) were associated with AKI in the study population. CONCLUSIONS In very low birthweight infants, concomitant use of TZP did not increase the risk of AKI during VCM administration. Instead, a lower GA, and NEC were associated with AKI in this population.
Collapse
Affiliation(s)
- Baek Sup Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Seul Gi Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| |
Collapse
|
7
|
Song IG, Shin SH, Cho YM, Lim Y. Survival of children with trisomy 18 associated with the presence of congenital heart disease and intervention in the Republic of Korea. BMC Pediatr 2023; 23:252. [PMID: 37210512 DOI: 10.1186/s12887-023-04056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Trisomy 18 syndrome (T18) is the second most common autosomal trisomy and has a high risk of fetal loss and stillbirth. Aggressive surgical treatments for the respiratory, cardiac, or digestive systems of patients with T18 were previously futile, while the results of recent studies are controversial. Over the past decade, there have been approximately 300,000 to 400,000 births annually in the Republic of Korea; however, there have been no nationwide studies on T18. This nationwide retrospective cohort study aimed to determine the prevalence of T18 in Korea and its prognosis according to the presence of congenital heart disease and relevant interventions. METHODS This study utilized NHIS-registered data between 2008 and 2017. A child was defined as having T18 if the ICD-10 revision code Q91.0-3 was reported. Subgroup analysis was performed for children with congenital heart diseases, and survival rates were compared based on the history of cardiac surgical or catheter interventions. The primary outcomes in this study were the survival rate during the first hospitalization period and the 1-year survival rate. RESULTS Of the children born between 2008 and 2017, 193 were diagnosed with T18. Of these, 86 died, with a median survival of 127 days. The 1-year survival rate for children with T18 was 63.2%. The survival rate in the first admission of children with T18 who did and did not have congenital heart disease was 58.3% and 94.1%, respectively. Children with heart disease who underwent surgical or catheter intervention had a longer survival time than those who did not. CONCLUSIONS We suggest these data could be used in ante- and postnatal counseling. Ethical concerns about the prolonged survival of children with T18 remain; however, the potential benefits of interventions for congenital heart disease in this population need further study.
Collapse
Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yoon-Min Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, South Korea
| | - Youna Lim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| |
Collapse
|
8
|
Lim SY, Shin SH, Yang HJ, Park SG, Kim EK, Kim HS, Jun JK. Neonatal and developmental outcomes of very preterm twins according to the chorionicity and weight discordance. Sci Rep 2023; 13:6784. [PMID: 37100892 PMCID: PMC10133444 DOI: 10.1038/s41598-023-33428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
Perinatal outcomes of twin pregnancies are determined by several factors, such as gestational age (GA), chorionicity, and discordance at birth. This retrospective study aimed to investigate the association of chorionicity and discordance with neonatal and neurodevelopmental outcomes in preterm twin infants from uncomplicated pregnancy. Data of very preterm twin infants who were both live-born between 2014 and 2019 on the chorionicity of the twin, diagnosis of the twin-to-twin syndrome (TTTS), weight discordance at birth, and neonatal and neurodevelopmental outcomes at 24 months of corrected age (CA) were collected. Of the 204 twin infants analyzed, 136 were dichorionic (DC) and 68 were monochorionic (MC), including 15 pairs with TTTS. After adjusting for GA, brain injury, including severe intraventricular hemorrhage and periventricular leukomalacia, was mostly found in the MC with TTTS group, with a higher incidence of cerebral palsy and motor delay at CA 24 months. After excluding TTTS, multivariable analysis showed no association between chorionicity and neonatal and developmental outcomes, whereas small infants among co-twins (adjusted odds ratio (aOR) 3.33, 95% confidence interval 1.03-10.74) and greater discordance (%) of weight at birth (aOR 1.04, 1.00-1.07) were associated with neurodevelopmental impairment. Monochorionicity might not determine adverse outcomes among very preterm twins from uncomplicated pregnancy.
Collapse
Affiliation(s)
- Soo Yeon Lim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea.
| | - Hyo Ju Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seul Gi Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
Kim YJ, Kim EK, Cheon JE, Song H, Bang MS, Shin HI, Shin SH, Kim HS. Impact of Cerebellar Injury on Neurodevelopmental Outcomes in Preterm Infants With Cerebral Palsy. Am J Phys Med Rehabil 2023; 102:340-346. [PMID: 36075880 DOI: 10.1097/phm.0000000000002099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to analyze brain imaging findings and neurodevelopmental outcomes of preterm infants diagnosed with cerebral palsy. DESIGN Brain magnetic resonance imaging of preterm infants born between 23 and 32 wks' gestation and diagnosed with cerebral palsy at 2 yrs of corrected age were evaluated. Brain lesions were categorized as periventricular leukomalacia, intraventricular hemorrhage, and cerebellar hemorrhage and graded by the severity. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, at 18-24 mos corrected age, and the Korean Ages and Stages Questionnaire at 18 and 24 mos of corrected age. RESULTS Cerebral palsy was found in 38 children (6.1%) among 618 survivors. Cerebellar injury of high-grade cerebellar hemorrhage and/or atrophy accounted for 25%. Among patients with supratentorial lesions, those having cerebellar injury showed significantly lower scores on each Korean Ages and Stages Questionnaire domain except gross motor than patients without cerebellar injury. They also revealed a high proportion of patients below the cutoff value of Korean Ages and Stages Questionnaire in language, fine motor, and problem-solving domains ( P < 0.05) and lower Bayley Scales of Infant and Toddler Development, Third Edition, language composite scores ( P = 0.038). CONCLUSIONS Poor neurodevelopmental outcomes other than motor function were associated with cerebellar injury. Evaluation of the cerebellum may help predict functional outcomes of patients with cerebral palsy.
Collapse
Affiliation(s)
- Yoo Jinie Kim
- From the Division of Neonatology, Department of Pediatrics, Konkuk University Medical Center, Seoul, South Korea (YJK); Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea (YJK, E-KK, SHS, H-SK); Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea (EK-K, SHS, H-SK); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J-EC); Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (HS); and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea (MSB, H-IS)
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Lee ES, Kim EK, Shin SH, Jung YH, Song IG, Kim YJ, Kim HY, Choi YH, Moon KC, Kim B. Efficacy and safety of mucous fistula refeeding in preterm infants: an exploratory randomized controlled trial. BMC Pediatr 2023; 23:137. [PMID: 36991415 PMCID: PMC10053085 DOI: 10.1186/s12887-023-03950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND This study aimed to evaluate whether mucous fistula refeeding (MFR) is safe and beneficial for the growth and intestinal adaptation of preterm infants with enterostomies. METHODS This exploratory randomized controlled trial enrolled infants born before 35 weeks' gestation with enterostomy. If the stomal output was ≥ 40 mL/kg/day, infants were assigned to the high-output MFR group and received MFR. If the stoma output was < 40 mL/kg/day, infants were randomized to the normal-output MFR group or the control group. Growth, serum citrulline levels, and bowel diameter in loopograms were compared. The safety of MFR was evaluated. RESULTS Twenty infants were included. The growth rate increased considerably, and the colon diameter was significantly larger after MFR. However, the citrulline levels did not significantly differ between the normal-output MFR and the control group. One case of bowel perforation occurred during the manual reduction for stoma prolapse. Although the association with MFR was unclear, two cases of culture-proven sepsis during MFR were noted. CONCLUSIONS MFR benefits the growth and intestinal adaptation of preterm infants with enterostomy and can be safely implemented with a standardized protocol. However, infectious complications need to be investigated further. TRIAL REGISTRATION clinicaltrials.gov NCT02812095, retrospectively registered on June 6, 2016.
Collapse
Affiliation(s)
- Eun Sun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Gyu Song
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Pediatrics, Korea University Medical Centre, Guro Hospital, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyun Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Young-Hun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Bohyun Kim
- Department of Pathology, Seoul National University Children's Hospital, Seoul, Republic of Korea
| |
Collapse
|
11
|
Kim SY, Kim EK, Song H, Cheon JE, Kim BN, Kim HS, Shin SH. Association of Brain Microstructure and Functional Connectivity With Cognitive Outcomes and Postnatal Growth Among Early School-Aged Children Born With Extremely Low Birth Weight. JAMA Netw Open 2023; 6:e230198. [PMID: 36862414 PMCID: PMC9982697 DOI: 10.1001/jamanetworkopen.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
IMPORTANCE Postnatal growth may be associated with longitudinal brain development in children born preterm. OBJECTIVE To compare brain microstructure and functional connectivity strength with cognitive outcomes in association with postnatal growth among early school-aged children born preterm with extremely low birth weight. DESIGN, SETTING, AND PARTICIPANTS This single-center cohort study prospectively enrolled 38 children 6 to 8 years of age born preterm with extremely low birth weight: 21 with postnatal growth failure (PGF) and 17 without PGF. Children were enrolled, past records were retrospectively reviewed, and imaging data and cognitive assessments occurred from April 29, 2013, through February 14, 2017. Image processing and statistical analyses were conducted through November 2021. EXPOSURE Postnatal growth failure in the early neonatal period. MAIN OUTCOMES AND MEASURES Diffusion tensor images and resting-state functional magnetic resonance images were analyzed. Cognitive skills were tested using the Wechsler Intelligence Scale; executive function was assessed based on a composite score calculated from the synthetic composite of the Children's Color Trails Test, STROOP Color and Word Test, and Wisconsin Card Sorting Test; attention function was evaluated using the Advanced Test of Attention (ATA); and the Hollingshead Four Factor Index of Social Status-Child was estimated. RESULTS Twenty-one children born preterm with PGF (14 girls [66.7%]), 17 children born preterm without PGF (6 girls [35.3%]), and 44 children born full term (24 girls [54.5%]) were recruited. Attention function was less favorable in children with PGF than those without PGF (mean [SD] ATA score: children with PGF, 63.5 [9.4]; children without PGF, 55.7 [8.0]; P = .008). Significantly lower mean (SD) fractional anisotropy in the forceps major of the corpus callosum (0.498 [0.067] vs 0.558 [0.044] vs 0.570 [0.038]) and higher mean (SD) mean diffusivity in the left superior longitudinal fasciculus-parietal bundle (8.312 [0.318] vs 7.902 [0.455] vs 8.083 [0.393]; originally calculated as millimeter squared per second and rescaled 10 000 times as mean diffusivity × 10 000) were seen among children with PGF compared with children without PGF and controls, respectively. Decreased resting-state functional connectivity strength was observed in the children with PGF. The mean diffusivity of the forceps major of the corpus callosum significantly correlated with the attention measures (r = 0.225; P = .047). Functional connectivity strength between the left superior lateral occipital cortex and both superior parietal lobules correlated with cognitive outcomes of intelligence (right superior parietal lobule, r = 0.262; P = .02; and left superior parietal lobule, r = 0.286; P = .01) and executive function (right superior parietal lobule, r = 0.367; P = .002; and left superior parietal lobule, r = 0.324; P = .007). The ATA score was positively correlated with functional connectivity strength between the precuneus and anterior division of the cingulate gyrus (r = 0.225; P = .048); however, it was negatively correlated with functional connectivity strength between the posterior cingulate gyrus and both superior parietal lobules (the right superior parietal lobule [r = -0.269; P = .02] and the left superior parietal lobule [r = -0.338; P = .002]). CONCLUSIONS AND RELEVANCE This cohort study suggests that the forceps major of the corpus callosum and the superior parietal lobule were vulnerable regions in preterm infants. Preterm birth and suboptimal postnatal growth could have negative associations with brain maturation, including altered microstructure and functional connectivity. Postnatal growth may be associated with differences in long-term neurodevelopment among children born preterm.
Collapse
Affiliation(s)
- Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Huijin Song
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
12
|
Hwang JK, Shin SH, Kim EK, Kim SH, Kim HS. Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes. Front Pediatr 2023; 11:1108925. [PMID: 36873629 PMCID: PMC9977292 DOI: 10.3389/fped.2023.1108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The definition of bronchopulmonary dysplasia (BPD) has been evolved recently from definition by the National Institute of Child Health and Human Development in 2001 (NICHD 2001) to the definition reported in 2018 (NICHD 2018) and that proposed by Jensen et al. in 2019 (NICHD 2019). The definition was developed based on the evolution of non-invasive respiratory support and to achieve better prediction of later outcomes. Our objective was to evaluate the association between different definitions of BPD and occurrence of pulmonary hypertension (PHN) and long term outcomes. METHODS This retrospective study enrolled preterm infants born at < 32 weeks of gestation between 2014 and 2018. The association between re-hospitalization owing to a respiratory illness until a corrected age (CA) of 24 months, neurodevelopmental impairment (NDI) at a CA of 18-24 months, and PHN at a postmenstrual age (PMA) of 36 weeks was evaluated, with the severity of BPD defined based on these three definitions. RESULTS Among 354 infants, the gestational age and birth weight were the lowest in severe BPD based on the NICHD 2019 definition. In total, 14.1% of the study population experienced NDI and 19.0% were re-hospitalized owing to a respiratory illness. At a PMA of 36 weeks, PHN was identified in 9.2% of infants with any BPD. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was the highest for Grade 3 BPD of the NICHD 2019 criteria (5.72, 95% confidence interval [CI]: 1.37-23.92), while the adjusted OR of Grade 3 BPD was 4.96 (95% CI: 1.73-14.23) in the NICHD 2018 definition. Moreover, no association of the severity of BPD was found in the NICHD 2001 definition. The adjusted ORs for NDI (12.09, 95% CI: 2.52-58.05) and PHN (40.37, 95% CI: 5.15-316.34) were also the highest for Grade 3 of the NICHD 2019 criteria. CONCLUSION Based on recently suggested criteria by the NICHD in 2019, BPD severity is associated with long-term outcomes and PHN at a PMA of 36 weeks in preterm infants.
Collapse
Affiliation(s)
- Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seh Hyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
Heo JS, Kim EK, Kim SY, Song IG, Yoon YM, Cho H, Lee ES, Shin SH, Oh BM, Shin HI, Kim HS. Response to: 'Comment on 'Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial' by Heo et al' by Harding et al. Arch Dis Child Fetal Neonatal Ed 2023; 108:93-94. [PMID: 35063948 DOI: 10.1136/archdischild-2021-323580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Ju Sun Heo
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Korea University Anam Hospital, Seoul, The Republic of Korea
| | - Ee-Kyung Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Sae Yun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Catholic University of Korea Yeouido Saint Mary's Hospital, Seoul, The Republic of Korea
| | - In Gyu Song
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Korea University Guro Hospital, Seoul, The Republic of Korea
| | - Young Mi Yoon
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Jeju National University Hospital, Jeju, The Republic of Korea
| | - Hannah Cho
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Korea University Anam Hospital, Seoul, The Republic of Korea
| | - Eun Sun Lee
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Paediatrics, Chung-Ang University Hospital, Seoul, The Republic of Korea
| | - Seung Han Shin
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, The Republic of Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, The Republic of Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, The Republic of Korea
| | - Han-Suk Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea
| |
Collapse
|
14
|
Kim SH, Shin SH, Yang HJ, Park SG, Lim SY, Choi YH, Kim EK, Kim HS. Neurodevelopmental outcomes and volumetric analysis of brain in preterm infants with isolated cerebellar hemorrhage. Front Neurol 2022; 13:1073703. [DOI: 10.3389/fneur.2022.1073703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundCerebellar hemorrhage (CBH) is a major form of cerebellar injury in preterm infants. We aimed to investigate the risk factors and neurodevelopmental outcomes of isolated CBH and performed volumetric analysis at term-equivalent age.MethodsThis single-centered nested case-control study included 26 preterm infants with isolated CBH and 52 infants without isolated CBH and any significant supratentorial injury.ResultsIsolated CBH was associated with PCO2 fluctuation within 72 h after birth (adjusted odds ratio 1.007, 95% confidence interval 1.000–1.014). The composite score in the motor domain of the Bayley Scales of Infant and Toddler Development at 24 month of corrected age was lower in the punctate isolated CBH group than that in the control group (85.3 vs. 94.5, P = 0.023). Preterm infants with isolated CBH had smaller cerebellum and pons at term-equivalent age compared to the control group. Isolated CBH with adverse neurodevelopment had a smaller ventral diencephalon and midbrain compared to isolated CBH without adverse neurodevelopmental outcomes.ConclusionsIn preterm infants, isolated CBH with punctate lesions were associated with abnormal motor development at 24 months of corrected age. Isolated CBH accompanied by a smaller ventral diencephalon and midbrain at term equivalent had adverse neurodevelopmental outcomes.
Collapse
|
15
|
Craig AJ, Shin SH, Cho JB, Balijapelly S, Kelly JC, Stoyko SS, Choudhury A, Jang JI, Aitken JA. Crystal structure, electronic structure, and optical properties of the novel Li 4CdGe 2S 7, a wide-bandgap quaternary sulfide with a polar structure derived from lonsdaleite. Acta Crystallogr C Struct Chem 2022; 78:470-480. [DOI: 10.1107/s2053229622008014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
The novel quaternary thiogermanate Li4CdGe2S7 (tetralithium cadmium digermanium heptasulfide) was discovered from a solid-state reaction at 750 °C. Single-crystal X-ray diffraction data were collected and used to solve and refine the structure. Li4CdGe2S7 is a member of the small, but growing, class of I4–II–IV2–VI7 diamond-like materials. The compound adopts the Cu5Si2S7 structure type, which is a derivative of lonsdaleite. Crystallizing in the polar space group Cc, Li4CdGe2S7 contains 14 crystallographically unique ions, all residing on general positions. Like all diamond-like structures, the compound is built of corner-sharing tetrahedral units that create a relatively dense three-dimensional assembly. The title compound is the major phase of the reaction product, as evidenced by powder X-ray diffraction and optical diffuse reflectance spectroscopy. While the compound exhibits a second-harmonic generation (SHG) response comparable to that of the AgGaS2 (AGS) reference material in the IR region, its laser-induced damage threshold (LIDT) is over an order of magnitude greater than AGS for λ = 1.064 µm and τ = 30 ps. Bond valence sums, global instability index, minimum bounding ellipsoid (MBE) analysis, and electronic structure calculations using density functional theory (DFT) were used to further evaluate the crystal structure and electronic structure of the compound and provide a comparison with the analogous I2–II–IV–VI4 diamond-like compound Li2CdGeS4. Li4CdGe2S7 appears to be a better IR nonlinear optical (NLO) candidate than Li2CdGeS4 and one of the most promising contenders to date. The exceptional LIDT is likely due, at least in part, to the wider optical bandgap of ∼3.6 eV.
Collapse
|
16
|
Hong KT, Shin SH, Choi YH, Kim EK, Kim HS. Case Series of Isolated Deep Gray Matter Injuries in Preterm Infants. Neonatal Med 2022. [DOI: 10.5385/nm.2022.29.3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Hypoxic-ischemic encephalopathy in neonates is an important cause of brain damage that leads to severe neurological sequelae or death. Brain injury patterns on magnetic resonance imaging (MRI) scans are used to predict neurodevelopmental outcome severity. This case series describes the clinical manifestations and neurologic outcomes of four preterm infants with isolated deep gray matter injuries. Basal ganglia and thalamic lesions were noted without white matter and cerebral cortex lesion on brain MRI. All patients were preterm infants born at less than 33 weeks’ gestation and required resuscitation in the delivery room. All had seizures during the neonatal period requiring anti-seizure medications. Severe neurologic disability was identified in three patients using neurodevelopmental assessment tools. Another patient has not been evaluated with assessment tools yet as he was 2 months’ corrected age, but he was supported by home ventilation via a tracheostomy due to insufficient self-respiration. This case series demonstrates that isolated deep gray matter injuries in preterm infants could predict severe neurodevelopmental outcomes.
Collapse
|
17
|
Lee SH, Shin SH, Ko JM, Kim B, Oh HS, Kim MJ, Park SG, Kim EK, Kim HS. A Korean Child with Schaaf-Yang Syndrome Presented with Hearing Impairment: A Case Report. Neonatal Med 2022. [DOI: 10.5385/nm.2022.29.3.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Schaaf-Yang syndrome (SYS) is a rare genomic imprinting disorder caused by truncating mutations in the paternally derived MAGE family member L2 (<i>MAGEL2</i>) allele. It is also responsible for Prader-Willi syndrome, characterized by neonatal hypotonia, developmental delay, intellectual disability, respiratory distress in early infancy, and arthrogryposis. More than 250 individuals with approximately 57 different molecular variants have been reported since 2013, but the phenotype-genotype association in SYS is not yet fully understood. Here, we describe the case of a Korean patient diagnosed with SYS harboring a mutation in the paternal allele of <i>MAGEL2</i>: c.2895G>A, resulting in a protein change of p.Trp965*. The patient’s phenotype included respiratory distress, arthrogryposis, hypotonia, and feeding difficulty in the early neonatal period. Mild renal dysfunction and hearing impairment were observed during infancy.
Collapse
|
18
|
Kim YJ, Shin SH, Park HW, Kim EK, Kim HS. Risk factors of early pulmonary hypertension and its clinical outcomes in preterm infants: a systematic review and meta-analysis. Sci Rep 2022; 12:14186. [PMID: 35986155 PMCID: PMC9391329 DOI: 10.1038/s41598-022-18345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this meta-analysis was to determine the incidence and risk factors of early pulmonary hypertension (PHT) in preterm infants and evaluate the association of early PHT with morbidities such as bronchopulmonary dysplasia (BPD), late PHT, and in-hospital mortality. We searched the PubMed (1980–2021), Embase (1968–2021), CINAHL (2002–2021), Cochrane library (1989–2021), and KoreaMed (1993–2021). Observational studies on the association between early PHT diagnosed within the first 2 weeks after birth and its clinical outcomes in preterm infants born before 37 weeks of gestation or with very low birth weight (< 1500 g) were included. Two authors independently extracted the data and assessed the quality of each study using a modified Newcastle–Ottawa Scale. We performed meta-analysis using Comprehensive Meta-Analysis version 3.3. A total of 1496 potentially relevant studies were found, of which 8 studies (7 cohort studies and 1 case–control study) met the inclusion criteria comprising 1435 preterm infants. The event rate of early PHT was 24% (95% confidence interval [CI] 0.174–0.310). The primary outcome of our study was moderate to severe BPD at 36 weeks postmenstrual age, and it was associated with early PHT (6 studies; odds ratio [OR] 1.682; 95% CI 1.262–2.241; P < 0.001; heterogeneity: I2 = 0%; P = 0.492). Preterm infants with early PHT had higher OR of in-hospital mortality (6 studies; OR 2.372; 95% CI 1.595–3.528; P < 0.001; heterogeneity: I2 = 0%; P = 0.811) and developing late PHT diagnosed after 4 weeks of life (4 studies; OR 2.877; 95% CI 1.732–4.777; P < 0.001; heterogeneity: I2 = 0%; P = 0.648). Infants with oligohydramnios (4 studies; OR 2.134; 95% CI 1.379–3.303; P = 0.001) and those who were small-for-gestational-age (5 studies; OR 1.831; 95% CI 1.160–2.890; P = 0.009) had an elevated risk of developing early PHT. This study showed that early PHT is significantly associated with mortality and morbidities, such as BPD and late PHT. Preterm infants with a history of oligohydramnios and born small-for-gestational-age are at higher risk for developing early PHT; however, high-quality studies that control for confounders are necessary.
Collapse
|
19
|
Shin SH, Shin SH, Kim SH, Song IG, Jung YH, Kim EK, Kim HS. Noninvasive Neurally Adjusted Ventilation in Postextubation Stabilization of Preterm Infants: A Randomized Controlled Study. J Pediatr 2022; 247:53-59.e1. [PMID: 35460702 DOI: 10.1016/j.jpeds.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the effects of noninvasive neurally adjusted ventilatory assist (NIV-NAVA) to nasal continuous positive airway pressure (NCPAP) in achieving successful extubation in preterm infants. STUDY DESIGN This prospective, single-center, randomized controlled trial enrolled preterm infants born at <30 weeks of gestation who received invasive ventilation. Participants were assigned at random to either NIV-NAVA or NCPAP after their first extubation from invasive ventilation. The primary outcome of the study was extubation failure within 72 hours of extubation. Electrical activity of the diaphragm (Edi) values were collected before extubation and at 1, 4, 12, and 24 hours after extubation. RESULTS A total of 78 infants were enrolled, including 35 infants in the NIV-NAVA group and 35 infants in the NCPAP group. Extubation failure within 72 hours of extubation was higher in the NCPAP group than in the NIV-NAVA group (28.6% vs 8.6%; P = .031). The duration of respiratory support and incidence of severe bronchopulmonary dysplasia were similar in the 2 groups. Peak and swing Edi values were comparable before and at 1 hour after extubation, but values at 4, 12, and 24 hours after extubation were lower in the NIV-NAVA group compared with the NCPAP group. CONCLUSIONS In the present trial, NIV-NAVA was more effective than NCPAP in preventing extubation failure in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov: NCT02590757.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung Hyun Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seh Hyun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - In Gyu Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| |
Collapse
|
20
|
Rhee SJ, Shin SH, Oh J, Jung YH, Choi CW, Kim HS, Yu KS. Population pharmacokinetic analysis of sildenafil in term and preterm infants with pulmonary arterial hypertension. Sci Rep 2022; 12:7393. [PMID: 35513541 PMCID: PMC9072418 DOI: 10.1038/s41598-022-11038-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Abstract
Sildenafil is widely used off-label in pediatric patients with pulmonary arterial hypertension (PAH). This study was conducted to characterize the pharmacokinetics (PK) of sildenafil in term and preterm neonates with PAH, by developing a population PK model, and to suggest appropriate doses to achieve clinically effective concentrations. A population PK modelling analysis was performed using sildenafil and its metabolite N-desmethyl sildenafil (DMS) concentration data from 19 neonates with PAH, whose gestational ages ranged 24–41 weeks. They received sildenafil orally at a dose of 0.5–0.75 mg/kg, four times a day. To investigate the appropriate sildenafil dose, simulations were conducted according to body weight which was significant covariate for sildenafil clearance. A one-compartment model with first-order absorption adequately described the PKs of sildenafil and DMS. Sildenafil clearance was expected to increase rapidly with increasing body weight. In the simulation, sildenafil doses > 1 mg/kg was required to achieve and maintain target concentrations of sildenafil and to expect timely clinical effects in term and preterm infants. These results could be utilized for the safer and more effective use of sildenafil in term and preterm infants.
Collapse
Affiliation(s)
- Su-Jin Rhee
- Department of Pharmacy, Wonkwang University College of Pharmacy, Iksan, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Heo JS, Kim EK, Kim SY, Song IG, Yoon YM, Cho H, Lee ES, Shin SH, Oh BM, Shin HI, Kim HS. Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2022; 107:166-173. [PMID: 34281934 DOI: 10.1136/archdischild-2021-321945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants. DESIGN Blinded, parallel group, randomised controlled trial (1:1:1). SETTING Neonatal intensive care unit of a South Korean tertiary hospital. PARTICIPANTS Preterm infants born at <32 weeks of gestation who achieved full tube feeding. INTERVENTIONS Two sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day). PRIMARY OUTCOME Time from start to independent oral feeding (IOF). RESULTS Analyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: -0.49; 95% CI: -0.86 to -0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants' actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST. CONCLUSIONS In very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02508571).
Collapse
Affiliation(s)
- Ju Sun Heo
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Ee-Kyung Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sae Yun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Catholic University of Korea Yeouido Saint Mary's Hospital, Seoul, Korea (the Republic of)
| | - In Gyu Song
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Korea University Guro Hospital, Seoul, Korea (the Republic of)
| | - Young Mi Yoon
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Jeju National University Hospital, Jeju, Korea (the Republic of)
| | - Hannah Cho
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Eun Sun Lee
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Paediatrics, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
| | - Seung Han Shin
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea (the Republic of).,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Han-Suk Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
22
|
Shin HI, Shin HI, Bang MS, Kim DK, Shin SH, Kim EK, Kim YJ, Lee ES, Park SG, Ji HM, Lee WH. Deep learning-based quantitative analyses of spontaneous movements and their association with early neurological development in preterm infants. Sci Rep 2022; 12:3138. [PMID: 35210507 PMCID: PMC8873498 DOI: 10.1038/s41598-022-07139-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/11/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to develop quantitative assessments of spontaneous movements in high-risk preterm infants based on a deep learning algorithm. Video images of spontaneous movements were recorded in very preterm infants at the term-equivalent age. The Hammersmith Infant Neurological Examination (HINE) was performed in infants at 4 months of corrected age. Joint positional data were extracted using a pretrained pose-estimation model. Complexity and similarity indices of joint angle and angular velocity in terms of sample entropy and Pearson correlation coefficient were compared between the infants with HINE < 60 and ≥ 60. Video images of spontaneous movements were recorded in 65 preterm infants at term-equivalent age. Complexity indices of joint angles and angular velocities differed between the infants with HINE < 60 and ≥ 60 and correlated positively with HINE scores in most of the joints at the upper and lower extremities (p < 0.05). Similarity indices between each joint angle or joint angular velocity did not differ between the two groups in most of the joints at the upper and lower extremities. Quantitative assessments of spontaneous movements in preterm infants are feasible using a deep learning algorithm and sample entropy. The results indicated that complexity indices of joint movements at both the upper and lower extremities can be potential candidates for detecting developmental outcomes in preterm infants.
Collapse
Affiliation(s)
- Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Eun Sun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Seul Gi Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Min Ji
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
23
|
Piozzi GN, Kim JS, Choo JM, Shin SH, Kim JS, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH. Da Vinci SP robotic approach to colorectal surgery: two specific indications and short-term results. Tech Coloproctol 2022; 26:461-470. [PMID: 35182278 DOI: 10.1007/s10151-022-02597-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Da Vinci® Single Port (dvSP) was recently developed. Its application in colorectal surgery is under investigation. The aim of this study was to explore the safety and feasibility of dvSP for intersphincteric (dvSP-ISR), right colectomy (dvSP-RC), and transverse colectomy (dvSP-TC). Surgical indication and short-term results were analyzed. METHODS All consecutive patients from a prospective database of patients who underwent dvSP-ISR, dvSP-RC, and dvSP-TC at Korea University Anam Hospital from November 2020 to December 2021, were analyzed. Perioperative, pathological, and oncological short-term outcomes were analyzed. RESULTS A total of 7 dvSP-ISR, 5 dvSP-RC, and 1 dvSP-TC were performed. Median age was 56.0 (55.0-61.0) years for the dvSP-ISR and 54.0 (44.7-63.5) years for the dvSP-RC/TC. Median body mass index was 22.8 (17.1-24.8) kg/m2 for the dvSP-ISR and 23.6 (20.8-26.9) kg/m2 for the dvSP-RC/TC. All dvSP-ISR patients received neoadjuvant long-course chemoradiotherapy, including one patient with squamocellular carcinoma who was treated with 5-fluorouracil (5-FU)/mitomycin. All other patients, excluding one dvSP-RC patient with Crohn's disease, had an adenocarcinoma. Median operation time was 280 (240-370) minutes for the dvSP-ISR and 220 (201-270) minutes for the dvSP-RC/TC. Estimated blood loss was insignificant. No intraoperative complications or conversions to multiport/open surgery was reported. Median post-operative stay was 7.0 (6.0-10.0) days for the dvSP-ISR and 5.0 (4.0-6.7) days for the dvSP-RC/TC. Quality of mesorectum was complete for six patients, and nearly complete for one. Median number of retrieved lymph nodes were 21 (17-25) for the dvSP-ISR and 28 (24-49) for the dvSP-RC/TC. Proximal and distal resection margins were tumor free. Four patients experienced post-operative complications not related to the platform which were: ileus, voiding dysfunction, infected pelvic hematoma, and wound infection. Median follow-up was 9 (6-11) months and 11 (7-17) months for the dvSP-ISR and dvSP-RC/TC, respectively. Two patients had systemic recurrence; all others were tumor free. CONCLUSIONS The dvSP platform is safe and feasible for intersphincteric resection with right lower quadrant access, and right/transverse colectomy with suprapubic access. Further studies are needed to evaluate benefit differences compared to multiport robotic platform.
Collapse
Affiliation(s)
- G N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J M Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Shin
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - T-H Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S-J Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-M Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| |
Collapse
|
24
|
Song IG, Kim HS, Cho YM, Lim YN, Moon DS, Shin SH, Kim EK, Park J, Shin JE, Han J, Eun HS. Association between birth weight and neurodevelopmental disorders assessed using the Korean National Health Insurance Service claims data. Sci Rep 2022; 12:2080. [PMID: 35136157 PMCID: PMC8827104 DOI: 10.1038/s41598-022-06094-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/11/2022] [Indexed: 01/23/2023] Open
Abstract
The risk of neurodevelopmental disorders in low birth weight (LBW) infants has gained recognition but remains debatable. We investigated the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-aged children according to their birth weight. We conducted a retrospective cohort study using the Korean National Health Insurance claims data of 2,143,652 children who were born between 2008 and 2012. Gestational age of infants was not available; thus, outcomes were not adjusted with it. Not only infants with birth weights of < 1.5 kg, but also 2.0–2.4 kg and 1.5–1.9 kg were associated with having ADHD; odds ratio (OR), 1.41 (95% confidence interval [CI] 1.33–1.50), and 1.49 (95% CI 1.33–1.66), respectively. The OR in infants with birth weights of 2.0–2.4 kg and 1.5–1.9 kg was 1.91 (95% CI 1.79–2.05) and 3.25 (95% CI 2.95–3.59), respectively, indicating increased odds of having ASD. Subgroup analysis for children without perinatal diseases showed similar results. In this national cohort, infants with birth weights of < 2.5 kg were associated with ADHD and ASD, regardless of perinatal history. Children born with LBW need detailed clinical follow-up.
Collapse
Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea.
| | - Yoon-Min Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, South Korea
| | - You-Na Lim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Duk-Soo Moon
- Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea
| | - Joonsik Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Han
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Seon Eun
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
25
|
Bae SP, Kim EK, Yun J, Yoon YM, Shin SH, Park SY. Retinopathy of Prematurity Requiring Treatment Is Closely Related to Head Growth during Neonatal Intensive Care Unit Hospitalization in Very Low Birth Weight Infants. Neonatology 2022; 119:176-183. [PMID: 35139511 DOI: 10.1159/000519714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is caused by prenatal sensitization and postnatal insults to the immature retina. This process can be associated with the postnatal growth of preterm infants. We investigated whether ROP requiring treatment was associated with the postnatal growth failure of very low birth weight (VLBW) infants. METHOD From a cohort of VLBW infants (birth weight <1,500 g) registered in the Korean Neonatal Network from January 2013 to December 2017, 3,133 infants with gestational age (GA) between 24 and 28 weeks were included in the study. Postnatal growth failure was defined when the change in each anthropometric z-score between birth and discharge was <10th percentile of the total population. Propensity score matching (PSM) at 1:1 was performed to match the distribution of GA and postnatal morbidities between infants with and without ROP requiring treatment. Prenatal factors and ROP were analyzed by conditional logistic regression. RESULTS Of 3,133 enrolled infants, 624 (19.9%) were diagnosed with ROP requiring treatment. After PSM, ROP requiring treatment was associated with postnatal growth failure assessed by head circumference (adjusted odds ratio [aOR] 1.91, 95% confidence interval [CI] 1.18-3.09), but not weight (aOR 1.45, 95% CI 0.97-2.17) and length (aOR 1.21, 95% CI 0.81-1.82). CONCLUSION ROP requiring treatment was associated with poor head circumference growth, not with weight and length. Our findings suggest that ROP requiring treatment and poor head growth during NICU hospitalization are fundamentally related.
Collapse
Affiliation(s)
- Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jungha Yun
- Department of Pediatrics, CHA University School of Medicine, CHA Ilsan Medical Center, Goyang-si, Republic of Korea
| | - Young Mi Yoon
- Department of Pediatrics, Jeju University School of Medicine, Jeju National University Hospital, Jeju-si, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Su Yeon Park
- Department of Data Innovation, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| |
Collapse
|
26
|
Lee HK, Lim JG, Park JS, Shin SH, Kwon SK, Suh DI. An infant with subglottic cysts presenting as abruptly-progressed stridor and respiratory distress 2 months after extubation. Allergy Asthma Respir Dis 2022. [DOI: 10.4168/aard.2022.10.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ha Kyung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Gyu Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Shin SH, Shin JS, Kim EK, Kim HS. Capillary partial pressure of carbon dioxide for predicting rehospitalization in preterm infants under noninvasive respiratory support with severe bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3863-3869. [PMID: 34547833 DOI: 10.1002/ppul.25672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The severity of bronchopulmonary dysplasia (BPD) is an important predictor of prognosis in preterm infants. However, the severity of BPD was determined mainly by the degree of oxygen supplementation and mode of respiratory support. OBJECTIVES This retrospective study aimed to examine the role of partial pressure of carbon dioxide (pCO2 ) in predicting rehospitalization among preterm infants with severe BPD without invasive ventilation at 36 weeks' postmenstrual age (PMA). METHODS We assessed preterm infants aged <32 gestational weeks with severe BPD who were receiving noninvasive respiratory support at 36 weeks' PMA. Patients were compared after stratifying them according to the history of rehospitalization owing to respiratory infection before a corrected age (CA) of 1 year and pCO2 measured by capillary blood gas analysis at 36 weeks' PMA. RESULTS Among 54 infants who had severe BPD with noninvasive respiratory support at 36 weeks' PMA, 16 (29.6%) experienced rehospitalization due to respiratory problems. At 36 weeks' PMA, the amount of oxygen supplementation (0.30 vs. 0.28, p = 0.021) and pCO2 (62.1 vs. 53.6 mmHg, p = 0.006) were higher in the rehospitalization group than in the no rehospitalization group. Multivariate logistic analysis findings indicated that pCO2 ≥ 57.4 mmHg was the only factor associated with rehospitalization (adjusted odds ratio: 8.017, 95% confidence interval 1.239-51.859). CONCLUSION High pCO2 during noninvasive respiratory support at 36 weeks' PMA in severe BPD was associated with rehospitalization. Consideration of the degree of impairment in ventilatory capacity may improve the prediction of later respiratory outcomes in infants with BPD.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Jae-Suk Shin
- Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| |
Collapse
|
28
|
Lee JY, Shin HJ, Bae HJ, Jo YH, Cho YS, Shin SH, Kim EK, Kim HS. Effect of selenium-free parenteral nutrition on serum selenium of neonates and infants maintained on long-term parenteral nutrition. JPEN J Parenter Enteral Nutr 2021; 46:1045-1053. [PMID: 34665472 DOI: 10.1002/jpen.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk of selenium deficiency increases for infants receiving long-term parenteral nutrition (PN). This study analyzed selenium deficiency in neonates and infants requiring long-term PN and evaluated the effect of intravenous (IV) selenium provision. METHODS This study was a retrospective study of neonates and infants who were admitted to a neonatal intensive care unit from January 2010 to December 2019, received PN for ≥2 weeks, and had their serum selenium concentration measured. Patients were divided into two groups, depending on their serum selenium concentration, a deficient group (n = 55) and a nondeficient group (n = 47). RESULTS Of the study participants, 53.9% (55 of 102) were deficient in selenium. No difference in demographic and clinical characteristics existed except bronchopulmonary dysplasia. A subgroup analysis was performed for patients (n = 29). The average dose of IV selenium administered to patients was 2.7 ± 1.0 mcg/kg/day. The average initial serum selenium concentration was 36.5 ± 18.0 mcg/L, and the serum concentration significantly increased to 52.5 ± 19.1 mcg/L after IV selenium administration (P < .001). The correlation between the average IV selenium dose and the change in serum selenium concentrations was statistically significant (r = .423; P = .022). CONCLUSION Selenium deficiency is common in neonates and infants receiving long-term PN. Serum selenium concentration increased proportionally as the IV selenium dose increased. Therefore, it is recommended to supply a proper dose of IV selenium depending on the degree of selenium deficiency.
Collapse
Affiliation(s)
- Ji Young Lee
- Department of Pharmacy, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Jung Shin
- Department of Pharmacy, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hye Jung Bae
- Department of Pharmacy, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Yun Hee Jo
- Department of Pharmacy, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Jongno-gu, Seoul, Republic of Korea
| |
Collapse
|
29
|
Song U, Ryu YH, Hong K, Shim SY, Park S, Lee JS, Ju YS, Shin SH, Lee S. Severe protein C deficiency in a newborn caused by a homozygous pathogenic variant in the PROC gene: a case report. BMC Pediatr 2021; 21:453. [PMID: 34654403 PMCID: PMC8520241 DOI: 10.1186/s12887-021-02923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Severe protein C deficiency is a rare and inherited cause of thrombophilia in neonates. Protein C acts as an anticoagulant, and its deficiency results in vascular thrombosis. Herein, we report a case of protein C deficiency with a homozygous pathogenic variant in a term neonate, with good outcomes after proper treatment. Case presentation A four-day-old male newborn was transferred to the Seoul National University Hospital on account of dark red to black skin lesions. He was born full-term with an average birth weight without perinatal problems. There were no abnormal findings in the prenatal tests, including intrauterine sonography. The first skin lesion was observed on his right toes and rapidly progressed to proximal areas, such as the lower legs, left arm, and buttock. Under the impression of thromboembolism or vasculitis, we performed a coagulopathy workup, which revealed a high D-dimer level of 23.05 μg/ml. A skin biopsy showed fibrin clots in most capillaries, and his protein C activity level was below 10%, from which we diagnosed protein C deficiency. On postnatal day 6, he experienced an apnea event with desaturation and an abnormal right pupillary light reflex. Brain computed tomography showed multifocal patchy intracranial hemorrhage and intraventricular hemorrhage with an old ischemic lesion. Ophthalmic examination revealed bilateral retinal traction detachments with retinal folds. Protein C concentrate replacement therapy was added to previous treatments including steroids, prostaglandin E1, and anticoagulation. After replacement therapy, there were no new skin lesions, and the previous lesions recovered with scarring. Although there were no new brain hemorrhagic infarctions, there was ongoing ischemic tissue loss, which required further rehabilitation. Ophthalmic surgical interventions were performed to treat the bilateral retinal traction detachments with retinal folds. Molecular analysis revealed a homozygous pathogenic variant in the PROC gene. Conclusion Severe protein C deficiency can manifest as a fatal coagulopathy in any organ. Early diagnosis and proper treatment, including protein C concentrate replacement, may improve outcomes without serious sequelae.
Collapse
Affiliation(s)
- Uisook Song
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Hye Ryu
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kiteak Hong
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - So-Yeon Shim
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | | | - Young Seok Ju
- GENOME INSIGHT Inc., Daejeon, Republic of Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
30
|
Kim ES, Kim EK, Kim SY, Song IG, Jung YH, Shin SH, Kim HS, Kim JI, Kim BN, Shin MS. Cognitive and Behavioral Outcomes of School-aged Children Born Extremely Preterm: a Korean Single-center Study with Long-term Follow-up. J Korean Med Sci 2021; 36:e260. [PMID: 34636503 PMCID: PMC8506418 DOI: 10.3346/jkms.2021.36.e260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND School-aged children born very preterm have been suggested to have worse cognitive and behavioral outcomes than children born full-term. Executive function (EF) is a higher level of cognitive function related to academic achievement. The present study aimed to evaluate the cognitive (including EF) and behavioral outcomes of Korean children born extremely preterm (EP) and to analyze any biological or socioeconomic risk factors for poor cognitive outcomes in this population. METHODS A total of 71 infants weighing < 1,000 g at birth or born before 30 weeks of gestation (EP group) who were admitted to the neonatal intensive care unit from 2008 to 2009 were included in this study and compared with 40 term-birth controls. The Korean Wechsler Intelligence Scale for Children-Fourth Edition, Advanced Test of Attention (ATA), Stroop test, Children's Color Trails Test (CCTT), and Wisconsin Card Sorting Test (WCST) were used. Additionally, the Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) were completed. Perinatal and demographic data were collected and analyzed. RESULTS The mean full-scale intelligence quotient (FSIQ) score in the EP group was significantly lower than that of the term control group (89.1 ± 18.3 vs. 107.1 ± 12.7; P < 0.001). In the EP group, 26 (37%) children had an FSIQ score below 85, compared to only one child (3%) in the control group. Furthermore, the EP group showed significantly worse EF test results (ATA, Stroop test, CCTT, WCST). Except for the higher social immaturity subscore in the EP group, the K-CBCL and K-ARS scores were not different between the two groups. EP children who received laser treatment for retinopathy of prematurity (ROP) had an 8.8-fold increased risk of a low FSIQ score, and a 1-point increase in the discharge weight Z-score decreased the risk of a low FSIQ score by approximately half in this EP cohort. CONCLUSION This is the first Korean study to investigate the cognitive and behavioral outcomes of school-aged children born EP. In the study cohort, EP children exhibited significantly lower FSIQ scores and EF than their full-term peers, and 37% of them had cognitive problems. Nonetheless, except for social immaturity, the behavioral problems were not different in EP children. Severe ROP and low discharge weight Z-score were identified as independent risk factors for low FSIQ score after adjusting for birth weight.
Collapse
Affiliation(s)
- Eun Sun Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea.
| | - Sae Yun Kim
- Department of Pediatrics, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Gyu Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Han Shin
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | | | - Bung Nyun Kim
- Department of Psychiatry and Behavioural Science, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Sup Shin
- Department of Psychiatry and Behavioural Science, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
31
|
Yun J, Jung YH, Shin SH, Song IG, Lee YA, Shin CH, Kim EK, Kim HS. Impact of very preterm birth and post-discharge growth on cardiometabolic outcomes at school age: a retrospective cohort study. BMC Pediatr 2021; 21:373. [PMID: 34465300 PMCID: PMC8406828 DOI: 10.1186/s12887-021-02851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/31/2021] [Indexed: 11/29/2022] Open
Abstract
Background Adverse metabolic outcomes later in life have been reported among children or young adults who were born as preterm infants. This study was conducted to examine the impact of very preterm/very low birth weight (VP/VLBW) birth and subsequent growth after hospital discharge on cardiometabolic outcomes such as insulin resistance, fasting glucose, and systolic and diastolic blood pressure (BP) among children at 6–8 years of age. Methods This retrospective cohort study included children aged 6–8 years and compared those who were born at < 32 weeks of gestation or weighing < 1,500 g at birth (n = 60) with those born at term (n = 110). Body size, fat mass, BP, glucose, insulin, leptin, adiponectin, and lipid profiles were measured. Weight-for-age z-score changes between discharge and early school-age period were also calculated, and factors associated with BP, fasting glucose, and insulin resistance were analyzed. Results Children who were born VP/VLBW had significantly lower fat masses, higher systolic BP and diastolic BP, and significantly higher values of fasting glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), compared to children born at term. VP/VLBW was correlated with HOMA-IR and BPs after adjusting for various factors, including fat mass index and weight-for-age z-score changes. Weight-for-age z-score changes were associated with HOMA-IR, but not with BPs. Conclusions Although children aged 6–8 years who were born VP/VLBW showed significantly lower weight and fat mass, they had significantly higher BPs, fasting glucose, HOMA-IR, and leptin levels. The associations of VP/VLBW with cardiometabolic factors were independent of fat mass and weight gain velocity. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02851-5.
Collapse
Affiliation(s)
- Jungha Yun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Present address: Department of Pediatrics, CHA Ilsan Medical Center, Goyang-si, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Present address: Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - In Gyu Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Present address: Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| |
Collapse
|
32
|
Park SJ, Han HS, Shin SH, Yoo KH, Li K, Kim BJ, Seo SJ, Park KY. Adverse skin reactions due to use of face masks: a prospective survey during the COVID-19 pandemic in Korea. J Eur Acad Dermatol Venereol 2021; 35:e628-e630. [PMID: 34131961 PMCID: PMC8447351 DOI: 10.1111/jdv.17447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S J Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S H Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Lee ES, Kim EK, Shin SH, Choi YH, Jung YH, Kim SY, Koh JW, Choi EK, Cheon JE, Kim HS. Factors associated with neurodevelopment in preterm infants with systematic inflammation. BMC Pediatr 2021; 21:114. [PMID: 33685414 PMCID: PMC7938564 DOI: 10.1186/s12887-021-02583-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. We aimed to investigate whether preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Methods This prospective cohort study enrolled infants born before 30 weeks of gestation or with birth weight < 1250 g. Infants were grouped according to the presence of systemic inflammation: Control (no inflammation, n = 49), I (systemic inflammation, n = 45). Blood and cerebrospinal fluid samples for markers of brain injury and inflammation were collected and amplitude-integrated electroencephalography (aEEG) was performed within 4 h of septic workup. We evaluated aEEG at 35 weeks postmenstrual age (PMA), head circumference at 36 weeks PMA, and brain MRI at discharge. The Bayley Scales of Infant and Toddler Development III (Bayley-III) was performed at a corrected age (CA) of 18 months. Results The I group had more white matter injuries (2 vs. 26.7%, Control vs. I, respectively) at the time of discharge, lower brain functional maturation (9.5 vs. 8), and smaller head size (z-score − 1.45 vs. -2.12) at near-term age and poorer neurodevelopment at a CA of 18 months than the control (p < 0.05). Among the I group, the proportion of immature neutrophils (I/T ratios) and IL-1 beta levels in the CSF were associated with aEEG measures at the day of symptom onset (D0). Seizure spike on aEEG at D0 was significantly correlated with motor and social-emotional domains of Bayley-III (p < 0.05). The I/T ratio and CRP and TNF-α levels of blood at D0, white matter injury on MRI at discharge, head circumference and seizure spikes on aEEG at near-term age were associated with Bayley-III scores at a CA of 18 months. Conclusions Systemic inflammation induced by clinical infection and NEC are associated with neurodevelopmental impairment in preterm infants. The seizure spike on aEEG, elevated I/T ratio, CRP, and plasma TNF-alpha during inflammatory episodes are associated with poor neurodevelopment.
Collapse
Affiliation(s)
- Eun Sun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young-Hun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul, South Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University, Seoul, South Korea
| | - Ji Won Koh
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Eui Kyung Choi
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Children's Hospital, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| |
Collapse
|
34
|
Kim SH, Kim YJ, Shin SH, Cho H, Shin SH, Kim EK, Kim HS, Hong S, Lee SM. Antenatal magnesium sulfate and intestinal morbidities in preterm infants with extremely low gestational age. Pediatr Neonatol 2021; 62:202-207. [PMID: 33495105 DOI: 10.1016/j.pedneo.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that antenatal magnesium sulfate use is associated with favorable neurodevelopmental outcomes in preterm infants. However, there are concerns regarding the effects of antenatal magnesium sulfate on neonates, especially regarding gastrointestinal morbidities. This study aims to explore the effects of antenatal magnesium sulfate on intestinal morbidities requiring surgery in preterm infants. METHODS This was a retrospective cohort study of 181 preterm infants who were born at less than 28 weeks of gestational age. Subjects were categorized as infants exposed to antenatal magnesium sulfate and those not exposed to antenatal magnesium sulfate. RESULTS Antenatal magnesium sulfate was associated with a decreased risk of surgical conditions of the intestine (OR 0.393, 95% CI 0.170-0.905). The multivariate analysis showed that the duration of antenatal magnesium sulfate use was associated with surgical conditions of the intestine (adjusted OR 0.766, 95% CI 0.589-0.997). In the <26 weeks of gestational age subgroup, the use of antenatal magnesium sulfate was significantly associated with decreased intestinal morbidities requiring surgery (adjusted OR 0.234, 95% CI 0.060-0.922). CONCLUSION Antenatal magnesium sulfate use appears to have a protective effect on intestinal morbidities requiring surgery in preterm infants in a duration-dependent manner. Association of antenatal magnesium sulfate use and decreased intestinal morbidities requiring surgery was more distinct in preterm infants <26 weeks of gestational age.
Collapse
Affiliation(s)
- Seh Hyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung Hyun Shin
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hannah Cho
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea.
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| |
Collapse
|
35
|
Kim YJ, Shin SH, Cho H, Shin SH, Kim SH, Song IG, Kim EK, Kim HS. Extrauterine growth restriction in extremely preterm infants based on the Intergrowth-21st Project Preterm Postnatal Follow-up Study growth charts and the Fenton growth charts. Eur J Pediatr 2021; 180:817-824. [PMID: 32909099 PMCID: PMC7480632 DOI: 10.1007/s00431-020-03796-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
Growth charts are essential for monitoring the postnatal growth of preterm infants. The preterm postnatal follow-up study (PPFS) of the Intergrowth-21st Project provides new growth standards based on a longitudinal study. This study was conducted to investigate the prevalence of extrautrine growth restriction (EUGR) and the associated factors of EUGR in preterm infants, using the PPFS charts and the Fenton charts. Data of 1,356 infants with gestational age (GA) less than 28 weeks from the Korean Neonatal Network were analysed. The prevalence of small for gestational age (SGA) of weight and length was higher with the Intergrowth charts than with the Fenton charts. EUGR in weight and length was more prevalent when using the Fenton charts. Multivariate analysis showed that low GA, high birthweight z score, male, treated patent ductus arteriosus (PDA), necrotizing enterocolitis, intraventricular haemorrhage and duration of parenteral nutrition (PN) were associated with EUGR in weight by the Intergrowth charts. High birthweight z score, treated PDA and PN duration were associated with EUGR defined by the Fenton charts.Conclusion: Compared to the Fenton charts, SGA was more defined and EUGR was less prevalent in extremely low gestational infants, while EUGR defined by the Intergrowth charts categorized infants with adverse clinical courses more elaborately. What is Known: • Preterm infants are at risk of postnatal growth restriction (PGR), although optimal postnatal growth is important for the long-term outcomes. • Growth charts are essential tools to monitor the postnatal growth of preterm infants. What is New: • PGR of weight and length were less defined with the Intergrowth charts than the Fenton charts. • PGR defined by the Intergrowth preterm postnatal follow-up study (PPFS) chart categorized preterm infants with morbidities more elaborately than the Fenton charts.
Collapse
Affiliation(s)
- Yoo-jin Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Seung Han Shin
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Paediatrics, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769 South Korea
| | - Hannah Cho
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung Hyun Shin
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seh Hyun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - In Gyu Song
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Yoon YM, Bae SP, Kim YJ, Kwak JG, Kim WH, Song MK, Shin SH, Kim EK, Kim HS. New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease. Clin Exp Pediatr 2020; 63:395-401. [PMID: 32668824 PMCID: PMC7568950 DOI: 10.3345/cep.2019.01522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high. PURPOSE We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center. METHODS This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016. RESULTS A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7-36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53-4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7-36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53-4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival. CONCLUSION For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.
Collapse
Affiliation(s)
- Young Mi Yoon
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Yoon-Joo Kim
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| |
Collapse
|
37
|
Min J, Cho MH, Bae SP, Shin SH, Ha IS, Cheong HI, Kang HG. A Premature Baby with Severe Oligohydramnios and Hypotension: a Case Report of Renal Tubular Dysgenesis. J Korean Med Sci 2020; 35:e283. [PMID: 32808512 PMCID: PMC7431287 DOI: 10.3346/jkms.2020.35.e283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
Abstract
Renal tubular dysgenesis (RTD) is a rare fatal disorder in which there is poor development of proximal tubules, leading to oligohydramnios and the Potter sequences. RTD occurs secondary to renin-angiotensin system (RAS) blockade during the early stages of fetal development or due to autosomal recessive mutation of genes in the RAS pathway. A boy born at 33+1 weeks due to cord prolapse was found to be anuric and hypotensive. Pregnancy was complicated by severe oligohydramnios from gestational age 28+4 weeks. Abdominal sonography revealed diffuse globular enlargement of both kidneys with increased cortical parenchymal echogenicity. Infantogram showed a narrow thoracic cage and skull X-ray showed large fontanelles and wide sutures suggestive of ossification delay. Basal plasma renin activity was markedly elevated and angiotensin-converting enzyme was undetectable. Despite adequate use of medications, peritoneal dialysis, and respiratory support, he did not recover and expired on the 23rd day of life. At first, autosomal recessive polycystic kidney disease was suspected, but severe oligohydramnios along with refractory hypotension, anuria, skull ossification delay and high renin levels made RTD suspicious. ACE gene analysis revealed compound heterozygous pathogenic variations of c.1454.dupC in exon 9 and c.2141dupA in exon 14, confirming RTD. Based on our findings, we propose that, although rare, RTD should be suspected in patients with severe oligohydramnios and refractory hypotension.
Collapse
Affiliation(s)
- Jeesu Min
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Wide River Institute of Immunology, Seoul National University, Seoul, Korea.
| |
Collapse
|
38
|
Han SJ, Lee SM, Oh S, Hong S, Oh JW, Shin SH, Park CW, Park JS, Jun JK. Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence. J Perinat Med 2020; 48:/j/jpme.ahead-of-print/jpm-2019-0437/jpm-2019-0437.xml. [PMID: 32229695 DOI: 10.1515/jpm-2019-0437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022]
Abstract
Background In monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS. Methods The study population consisted of monochorionic twin pregnancies with preterm birth (24-37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups. Results During the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups. Conclusion The spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.
Collapse
Affiliation(s)
- Soo Jin Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jeong Won Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
39
|
Byun J, Han JW, Youn JK, Yang HB, Shin SH, Kim EK, Kim HY, Jung SE. Risk factors of meconium-related ileus in very low birth weight infants: patients-control study. Sci Rep 2020; 10:4674. [PMID: 32170203 PMCID: PMC7070079 DOI: 10.1038/s41598-020-60016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/06/2020] [Indexed: 01/07/2023] Open
Abstract
Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions.
Collapse
Affiliation(s)
- Jeik Byun
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
40
|
Kim YI, Song KB, Lee YJ, Park KM, Hwang DW, Lee JH, Shin SH, Kwon JW, Ro JS, Kim SC. Management of isolated recurrence after surgery for pancreatic adenocarcinoma. Br J Surg 2019; 106:898-909. [PMID: 31162655 DOI: 10.1002/bjs.11144] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/10/2018] [Accepted: 01/25/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. METHODS Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. RESULTS Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83·6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27·2 per cent), distant multifocal in 251 (18·6 per cent), distant isolated in 188 (14·0 per cent), locoregional plus distant in 153 (11·4 per cent) and peritoneal seeding in 388 (28·8 per cent). Of the 1346 patients with recurrence, 197 (14·6 per cent) had isolated recurrence; of these, 48 (24·4 per cent of all isolated recurrences; 3·6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14·7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23·5 versus 12·0 months; P = 0·014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33·3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28·0 versus 12·0 months, P = 0·010) and lung (median 36·5 versus 9·5 months; P = 0·010) than in those who did not undergo resection. CONCLUSION Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.
Collapse
Affiliation(s)
- Y I Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - K B Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - Y-J Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - K-M Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - D W Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J H Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S H Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J W Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J-S Ro
- Clinical Preventive Medicine Centre, Seoul National University Bundang Hospital, Bundang-gu, South Korea
| | - S C Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| |
Collapse
|
41
|
Yi YG, Oh BM, Shin SH, Shin JY, Kim EK, Shin HI. Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis. BMC Pediatr 2019; 19:440. [PMID: 31722705 PMCID: PMC6854670 DOI: 10.1186/s12887-019-1811-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023] Open
Abstract
Background Stress signals during sucking activity such as nasal flaring, head turning, and extraneous movements of the body have been attributed to incoordination of sucking, swallowing, and respiration (SSR) in premature infants. However, the association of uncoordinated sucking pattern with developmental outcomes has not yet been investigated. The aim of this study was to investigate whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the developmental outcomes at 8–12 and 18–24 months of age (corrected for prematurity). Methods We retrospectively reviewed the medical records and video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) of premature infants and divided them into two groups based on the presence or absence of incoordination. The Bayley-III cognition composite scores of the incoordination-positive and incoordination-negative group were compared at 8–12 and 18–24 months of age. Results Seventy premature infants exhibited a disorganized sucking pattern according to the NOMAS. The average Bayley-III cognition composite scores at 8–12 months of age were 92.5 ± 15.6 and 103.0 ± 11.3 for the incoordination-positive (n = 22) and incoordination-negative groups (n = 48), respectively (p = 0.002). The average Bayley-III cognition composite scores at 18–24 months were 90.0 ± 17.9 and 100.7 ± 11.5 for the incoordination-positive (n = 21) and incoordination-negative groups (n = 46), respectively (p = 0.005). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with cognitive development at 18–24 months of age. Conclusions Uncoordinated sucking pattern in premature infants was independently associated with a higher risk of abnormal developmental outcome in the cognitive domain of the Bayley-III at both 8–12 and 18–24 months. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of SSR that results in stress signals on the NOMAS is observed before 40 weeks postmenstrual age.
Collapse
Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung Han Shin
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jin Yong Shin
- Division of Occupational Therapy, Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ee-Kyung Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
42
|
Byun J, Kim HY, Jung SE, Yang HB, Kim EK, Shin SH, Kim HS. Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis. J Korean Med Sci 2019; 34:e222. [PMID: 31496138 PMCID: PMC6732259 DOI: 10.3346/jkms.2019.34.e222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improvements in perinatal intensive care have improved survival of extremely-low-birth-weight (ELBW) neonates, although the risk of acute abdomen has increased. The differential diagnosis resulting in abdominal surgery can be categorized into necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), meconium-related ileus (MRI), and meconium non-related ileus (MNRI). The purpose of this study was to review our experience with abdominal surgery for ELBW neonates, and to evaluate characteristics and prognosis according to the differential diagnosis. METHODS Medical records of ELBW neonates treated between 2003 and 2015 were retrospectively reviewed. RESULTS Of 805 ELBW neonates, 65 (8.1%) received abdominal surgery. The numbers of cases by disease category were 29 for NEC, 18 for SIP, 13 for MRI, and 5 for MNRI. Ostoma formation was performed in 61 (93.8%) patients; primary anastomosis without ostoma was performed in 4 (6.2%). All patients without ostoma formation experienced re-perforation of the anastomosis site. Seven patients had 30-day postoperative mortality (6 had NEC). Long-term survival of the surgical and non-surgical groups was not statistically different. NEC was a poor prognostic factor for survival outcome (P = 0.033). CONCLUSION Abdominal surgery for ELBW neonates is feasible. Ostoma formation can lead to reduced complications compared to primary anastomosis.
Collapse
Affiliation(s)
- Jeik Byun
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Sung Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Beom Yang
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ee Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
43
|
Bae HJ, Yoon HW, Kim MJ, Jung AH, Jung SH, Hahn HJ, Jo YH, Cho YS, Kim EK, Shin SH, Song IG, Shin SH. Effects of Early Phosphorus Intake on Respiratory Distress in Extremely Low-Birth-Weight Infants. Neonatal Med 2019. [DOI: 10.5385/nm.2019.26.3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
44
|
Shin SH, Kim EK, Lee KY, Kim HS. TNF-α antagonist attenuates systemic lipopolysaccharide-induced brain white matter injury in neonatal rats. BMC Neurosci 2019; 20:45. [PMID: 31470812 PMCID: PMC6716877 DOI: 10.1186/s12868-019-0529-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background Systemic inflammation is an important risk factor for neurodevelopmental impairments in preterm infants. Premyelinating oligodendrocytes are main building blocks of white matter in preterm infants and vulnerable to oxidative stress and excitotoxic stress. Tumour necrosis factor-α (TNF-α) plays important roles in systemic inflammation and local inflammation leading to apoptosis of premyelinating oligodendrocytes and white matter injury (WMI) in brain tissue. This study was conducted to investigate whether etanercept, a TNF-α antagonist, could attenuate systemic lipopolysaccharide (LPS)-induced WMI in the immature brain. Results We found that intraperitoneal LPS administration caused systemic and local inflammation in brain tissue. Subsequent etanercept treatment significantly attenuated LPS-induced inflammation in brain tissue as well as in systemic circulation. Intraperitoneal LPS also induced microgliosis and astrocytosis in the cingulum and etanercept treatment reduced LPS-induced microgliosis and astrocytosis. Additionally, systemic LPS-induced apoptosis of oligodendrocyte precursor cells was observed, which was lessened by etanercept treatment. The concentration of etanercept in the CSF was higher when it was administrated with LPS than when administrated with a vehicle. Conclusions It appears that etanercept reduce WMI in the neonatal rat brain via attenuation of systemic and local inflammation. This study provides preclinical data suggesting etanercept-mediated modulation of inflammation as a promising approach to reduce WMI caused by sepsis or necrotizing enterocolitis in preterm infants.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea.
| | - Kyung-Yup Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| |
Collapse
|
45
|
Abstract
Background Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants. Methods This retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation. Results There were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO2, were similar between the two groups. SpO2 and pCO2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group (P = 0.041). Conclusions The data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.
Collapse
Affiliation(s)
- Byoung Kook Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea.
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| |
Collapse
|
46
|
Heo YJ, Lee YA, Lee B, Lee YJ, Lim YH, Chung HR, Shin SH, Shin CH, Yang SW. How can the occurrence of delayed elevation of thyroid stimulating hormone in preterm infants born between 35 and 36 weeks gestation be predicted? PLoS One 2019; 14:e0220240. [PMID: 31442229 PMCID: PMC6707626 DOI: 10.1371/journal.pone.0220240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
Abstract
Objective We evaluated frequency and risk factors of delayed TSH elevation (dTSH) and investigated follow-up outcomes in the dTSH group with venous TSH (v-TSH) levels of 6–20 mU/L according to whether late preterm infants born at gestational age (GA) 35–36 weeks had risk factors. Methods The medical records of 810 neonates (414 boys) born at Seoul National University Hospital who had a normal neonatal screening test (NST) and underwent the first repeat venous blood test at 10–21 days post birth were reviewed. Results Seventy-three (9.0%) neonates showed dTSH, defined as a v-TSH level ≥6.0 mU/L, 12 of whom (1.5%) were started on levothyroxine medication. A multivariate-adjusted model indicated that a low birth weight (LBW <2,000 g), a congenital anomaly, and exposure to iodine contrast media (ICM) were significant predictors for dTSH (all p < 0.05). Among these 73 dTSH infants, all 5 infants with TSH levels ≥20 mU/L began levothyroxine medication, and 6 of 16 infants with v-TSH levels of 10–20 mU/L were indicated for levothyroxine, regardless of coexisting risk factors. However, only 1 of 52 infants with v-TSH levels of 6–10 mU/L who had a congenital anomaly was indicated for levothyroxine. All healthy late preterm infants, including LBW and multiple births, with v-TSH levels of 6–10 mU/L exhibited normal thyroid function. Conclusions dTSH was detected in 9.0% and levothyroxine was indicated in 1.5% of infants born at GA 35–36 weeks, particularly those with a LBW, a congenital anomaly, or history of ICM exposure. Either levothyroxine or retesting is indicated for late preterm neonates with TSH levels ≥10 mU/L regardless of risk factors. If healthy preterm neonates show v-TSH levels of 6–10 mU/L, a second repeat test may not be necessary; however, further studies are required to set a threshold for retesting.
Collapse
Affiliation(s)
- You Jung Heo
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Bora Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
47
|
Choi N, Ko JM, Shin SH, Kim EK, Kim HS, Song MK, Choi CW. Phenotypic and Genetic Characteristics of Five Korean Patients with Costello Syndrome. Cytogenet Genome Res 2019; 158:184-191. [PMID: 31394527 DOI: 10.1159/000502045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/27/2022] Open
Abstract
Costello syndrome (CS) is a rare genetic disorder characterized by distinctive facial appearance, cardiopulmonary complications, severe growth retardation, skin and skeletal defects, developmental delay, and tumor predisposition. CS is caused by heterozygous de novo mutations in the proto-oncogene HRAS, which is a component of the RAS/mitogen-activated protein kinase pathway. Herein, we reviewed the phenotypic and genetic features of 5 Korean patients who were genetically diagnosed with CS. Atrial tachycardia and polyhydramnios, which are important prenatal features for CS, were observed in 4 and 5 patients, respectively. The distinctive coarse facial appearances of the patients and presence of deep palmoplantar creases supported the clinical diagnosis of CS, which was confirmed by HRAS sequence analysis. Extremely poor postnatal growth was observed in all 5 patients. Further, all patients exhibited cardiac abnormalities; left ventricular hypertrophy and hypertrophic cardiomyopathy were observed in 3 patients. All 5 patients suffered from airway problems; 3 of them required intubation right after birth, and 2 of them received tracheostomy. One patient with a p.Gly12Ser mutation was diagnosed with retroperitoneal rhabdomyosarcoma alveolar type at the age of 5 years. Consistent with previous reports, both patients with p.Gly12Cys mutations died within the first year of life due to cardiopulmonary failure. Our study summarizes the characteristics of these 5 Korean patients with CS and, along with previous studies, provides clues for genotype-phenotype correlation in patients with CS.
Collapse
|
48
|
Jung YH, Jang J, Kim HS, Shin SH, Choi CW, Kim EK, Kim BI. Correction to: Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants. BMC Pediatr 2019; 19:263. [PMID: 31362718 PMCID: PMC6668141 DOI: 10.1186/s12887-019-1642-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Jinhee Jang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| |
Collapse
|
49
|
Jung YH, Jang J, Kim HS, Shin SH, Choi CW, Kim EK, Kim BI. Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants. BMC Pediatr 2019; 19:121. [PMID: 31014304 PMCID: PMC6480897 DOI: 10.1186/s12887-019-1492-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 11/27/2022] Open
Abstract
Background Despite significant advances in neonatology, bronchopulmonary dysplasia (BPD) remains the most common cause of serious morbidity and mortality in premature infants. The aim of the present study was to determine associations between the respiratory severity score (RSS) with death or BPD in premature infants. Methods This was a retrospective study conducted between January 2010 and December 2014. We enrolled preterm infants with a gestational age of less than 28 weeks who were supported by mechanical ventilation for more than a week during the first 4 weeks of life. We collected the RSS scores on day of life 2, 7, 14, 21 and 28. The correlations between postnatal RSSs and death or severe BPD were analyzed using multivariate logistic regression. Results Of the 138 eligible infants, 66 infants (47.8%) either died or developed severe BPD. The RSS cut-off values for predicting severe BPD or death were 3.0 for postnatal day (PND) 14 with an odds ratio (OR) of 11.265 (p = 0.0006, 95% confidence interval (CI), 2.842 to 44.646), 3.6 for PND 21 with an OR of 15.162 (p = 0.0003, 95% CI, 3.467 to 66.316), and 3.24 for PND 28 with an OR of 10.713 (p = 0.0005, 95% CI, 2.825 to 40.630). Conclusion Strong correlations were observed between the RSSs on PND 14, 21, and 28 and death or subsequent severe BPD. The RSS could provide a simple estimate of severe BPD or death., Further research with a larger study population is necessary to validate the usefulness of the RSS for predicting severe BPD or death. Electronic supplementary material The online version of this article (10.1186/s12887-019-1492-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Jinhee Jang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea
| |
Collapse
|
50
|
Bae HJ, Shin SH, Kim EK, Kim HS, Cho YS, Gwak HS. Effects of cyclic parenteral nutrition on parenteral nutrition-associated cholestasis in newborns. Asia Pac J Clin Nutr 2019; 28:42-48. [PMID: 30896413 DOI: 10.6133/apjcn.201903_28(1).0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Parenteral nutrition (PN) is one of the main nutritional methods used in newborns; however, long-term PN may induce PN-associated cholestasis (PNAC). This study aims to evaluate the effect of cyclic PN in the prevention and improvement of PNAC in newborns requiring long-term PN. METHODS AND STUDY DESIGN A retrospective cohort study was conducted on patients admitted at the Seoul National University Children's Hospital neonatal intensive care unit between October 2010 and September 2015 and referred to the nutrition support team with total parenteral nutrition for more than 14 days. The primary outcome was the incidence of PNAC. The incidence of hypoglycemia, changes in direct bilirubin (DB) concentrations, and length of hospital stay were investigated. RESULTS A total of 124 patients were observed in this study. Among these, 100 patients received continuous PN, whereas 24 patients received both continuous and cyclic PN. PNAC occurred in 31.5% (39/124) of study population. The incidence rates of PNAC were 27.4% during continuous PN period and 20.8% during cyclic PN period. Cyclic PN was an independent factor that significantly decreased PNAC incidence (OR=0.154; 95% CI, 0.045-0.529, p=0.003). DB concentrations significantly decreased (p=0.049) with therapeutic cyclic PN, but remained normal with prophylactic cyclic PN. No significant difference in hypoglycemia incidence and length of hospital stay was observed in both continuous PN and continuous to cyclic PN groups. CONCLUSIONS Cyclic PN could be effective in the prevention and improvement of PNAC and also safe in terms of hypoglycemia in newborns.
Collapse
Affiliation(s)
- Hye Jung Bae
- College of Pharmacy and Division of Life & Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.,Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy and Division of Life & Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.
| |
Collapse
|