미숙아 무호흡에 있어서 theophylline 투여가 신기능에 미치는 영향

김수영,김행미,최병호,이건수 慶北大學校 醫科大學 1998 慶北醫大雜誌 Vol.39 No.1

미숙아와 저출생 체중아의 분만에서 Nested PCR을 이용한 Chlamydia trachomatis 감염의 진단

노재호,이혜경,김한진,민용식,박경배,박준수,김영창,조성란 대한소아과학회 2001 小兒科 Vol.44 No.8

단일 환아에서만 미숙아망막병증이 발생한 쌍둥이 간의 관련인자 비교 분석

임재완(Jae Wan Lim),유재호(Jae Ho Yoo),이승욱(Seung Uk Lee),이상준(Sang Joon Lee),남기엽(Ki Yup Nam) 대한안과학회 2016 대한안과학회지 Vol.57 No.10

목적: 쌍둥이 미숙아 중에서 한 환아에게만 미숙아망막병증이 발생한 쌍을 비교하여 미숙아망막병증과 관련된 인자를 알아내고자 하였다. 대상과 방법: 고신대학교 복음병원에서 미숙아로 태어난 쌍둥이들 중 한 환아만 미숙아망막병증(1단계 이상)으로 진단 받은 13쌍 26명을 대상으로 의무기록을 후향적으로 분석하였다. 미숙아망막병증 유무에 따라 쌍둥이를 ‘미숙아망막병증군’과 ‘미숙아망막병증이 없는 군’으로 나누었다. 태어날 당시의 임신나이, 성별, 몸무게, 아프가점수, 시행된 치료, 혈액검사 결과, 신생아 황달, 패혈증, 호흡곤란 증후군, 기관지폐 형성이상, 동맥관개존증, 신생아괴사성장염 등 신생아 합병증 여부 등을 비교 분석하였다. 결과: 출생 시 시행된 다양한 처치들과 미숙아망막병증 발생과 연관이 있는 것으로 알려져 있는 출생 후 합병증들에 대해서 분석하였으나 두 군 간 유의한 차이는 없었다. 혈액 검사상에서는 혈소판이 미숙아망막병증군에서 191 (±46) ×103/μL, 미숙아망막병증이 없는 군에서 240 (±77) ×103/μL로 나타나 미숙아망막병증군에서 유의하게 낮았고(p=0.046) 아스파라진산 아미노전이효소는 미숙아 망막병증군에서 36 (±26.6) IU/L, 미숙아망막병증이 없는 군에서 22 (±5.9) IU/L로 미숙아망막병증 군에서 유의하게 높은 것으로 확인되었다(p=0.019). 결론: 한 환아에게만 미숙아 망막병증이 발생한 쌍둥이들을 대상으로 한 이번 연구에서 혈소판 수치와 아스파라진산 아미노전이효소가 미숙아망막병증의 발생과 관련이 있는 인자로 확인되었다. 선별 검사 시에 고려해야 할 인자로 생각되나 임상적으로 적용하기 위해서는 추후 더 많은 환아를 대상으로 한 전향적인 연구가 필요할 것으로 사료된다. <대한안과학회지 2016;57(10):1592-1597> Purpose: To analyze related factors of retinopathy of prematurity by comparing between premature twins in which retinopathy developed on one twin. Methods: A retrospective survey consisting of 13 premature twins in which retinopathy of prematurity (stage 1 or more) developed on one twin was performed. All twins were born in Kosin University Gospel Hospital. The twins were separated into two groups according to whether they had retinopathy of prematurity: the retinopathy of prematurity (ROP) group and non-ROP group. The twins’ gestational age, weight, sex, Apgar score, treatments, blood tests, and neonatal complications were investigated. Results: There were no significant differences between the twins except platelet count and aspartate aminotransferase. Platelet count was 191 (±46) ⅹ103/μL in the ROP group and 240 (±77) ⅹ103/μL in the non-ROP group, a significant difference (p = 0.046). Aspartate aminotransferase was 36 (±26.6) IU/L in the ROP group and 22 (±5.9) IU/L in the non-ROP group, a significant difference (p = 0.019). Conclusions: In conclusion, we found platelet count and aspartate aminotransferase to be significant factors related to development of retinopathy of prematurity. It is thought that these factors should be considered when screening for ROP, although a larger prospective study is be needed before the results can be applied in clinical practice. J Korean Ophthalmol Soc 2016;57(10):1592-1597

1형 미숙아망막병증의 치료로서 일차 유리체강내 라니비주맙 주입술의 효과

정규철(Gyu Chul Chung),문성혁(Sung-Hyuk Moon) 대한안과학회 2017 대한안과학회지 Vol.58 No.9

Purpose: To evaluate the effectiveness and safety of primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity. Methods: Retrospective analysis of the medical records of patients diagnosed with retinopathy of prematurity and treated with intravitreal ranibizumab injection from January 1, 2013 to January 1, 2016 was performed. We complied with the standards for ‘prethresold, type 1’ established by the Early Treatment of Retinopathy of Prematurity study for intravitreal ranibizumab injection. The follow-up period after injection was at least 9 months. Patients who received additional treatment such as laser photocoagulation or intravitreal injection without reactivation of retinopathy of prematurity were excluded. Results: A total of 21 patients (39 eyes) were included in this study. Nine (16 eyes) were male and 12 (23 eyes) were female. The average duration between treatment decision and intravitreal ranibizumab injection was 2.1 ± 1.5 days. Complete regression of the plus sign occurred 18.2 ± 9.1days after injection. One eye with reactivation was treated with panretinal laser photocoagulation while four other eyes with reactivation were treated with intravitreal bevacizumab injection. There were 87.1% (34/39) eyes that underwent primary intravitreal ranibizumab injection with stable results without any reactivation. There were no systemic complications related to intravitreal ranibizumab injection. Conclusions: Primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity showed good efficacy and safety. However, thorough evaluation is needed after primary intravitreal ranibizumab injection due to the potential for reactivation. Long-term monitoring is needed after intravitreal ranibizumab injection. J Korean Ophthalmol Soc 2017;58(9):1080-1086

Comparison between Caffeine and Theophylline Therapy for Apnea of Prematurity

Kumi Jeong,Ho Sung Kim,Eun Song Song,Young Youn Choi 대한신생아학회 2015 Neonatal medicine Vol.22 No.1

Purpose: Methylxanthines are commonly used to treat apnea of prematurity. Recent studies have reported that caffeine therapy reduces the rate of bronchopulmonary dysplasia (BPD) and improves the rate of survival in preterm infant without neurodevelopmentaldisabilities. This study was performed to compare the effects on apnea episodes, adverse effects and morbidity between the caffeine and theophylline groups. Methods: A retrospective study was performed in 143 infants born at less than 33 weeks of gestation and treated with caffeine (n=54) or theophylline (n=89) from 2011 to 2012. The baseline characteristics of mothers and their infants were examined. The number of apnea events before and after treatment, the duration of respiratory support, and the rate of re-intubation were compared. Furthermore, adverse effects, clinical course, and morbidities such as BPD and periventricular leukomalacia were compared before discharge. Results: There were no significant differences in the baseline characteristics. Theophyllineand caffeine appeared to have similar short-term therapeutic advantages on apnea of prematurity in mean apnea rate after first two weeks of treatment. However, there were no statistically significant differences in the duration of respiratorysupport, rate of re-intubation, clinical course, and morbidity between the two groups. Adverse effects, indicated by feeding intolerance were lower in the caffeine group. Conclusion: Caffeine was as effective as theophylline in the short-term for reducing apnea in preterm babies and was better tolerated and was easier to administer. A prospective randomized study is needed to confirm the effect of caffeine on the lone-term neurodevelopmentaloutcome in prematurity.

Linguistic Skills and Working Memory in Monolingual and Bilingual Children Born Prematurely: Preliminary Data

Roxanne Mariette Belanger,Chantal Mayer-Crittenden,Michelle Brouillette 한국언어재활사협회 2017 Clinical Archives of Communication Disorders Vol.2 No.3

Determining the effects of prematurity on language development is a complex phenomenon. This is especially true when one considers that many children live in multilingual and multicultural environments. When preparing for an evaluation, speech-language pathologists must use assessment tools that allow them to objectively determine the communication abilities of their client; the selection of assessment tools is a critical step in this evaluation process. However, in Official Minority Language Communities (OMLC), this process is made more difficult by the lack of standardized assessment tools and regional norms. At present, no study has examined the linguistic competencies of bilingual children born prematurely and taken into consideration the implication of residing in a minority language community. Using a formal evaluation battery comprised of French and English language tests, this study examined the linguistic knowledge, linguistic processing and working memory of three groups of premature children having average non-verbal language skills: monolingual children speaking English (ENG) (n=5, X=6.6 years; SD=1.1), bilingual children whose dominant language was French (FD) (n=5, X=9.3 years; SD=0.99), and bilingual children whose dominant language was English (ED) (n=3, X=8.1 years; SD=1.5). Results showed that regardless of language dominance, birth weight and degree of prematurity, participants’ scores fell within the average range on simple language tasks, or tasks measuring linguistic knowledge. However, most children experienced difficulties with complex language tasks measuring linguistic processing, as well as working memory. More bilinguals then monolinguals were identified as having a PLI. Also, of those identified, only one participant was identified as having language delays in the preschool period, demonstrating that the difficulties observed in this study developed at a later stage. Long-term follow-up is necessary in order to determine if these weaknesses are maintained, or if they impact academic success.

Risk Factors for Retinopathy of Prematurity Requiring Laser Treatment in Preterm Infants Born Before 28 Weeks of Gestation

Ju Young Kim,Yung Zu Park,Min Jeong Seok,Songyi Song,Tae-Jung Sung 대한신생아학회 2019 Neonatal medicine Vol.26 No.2

Purpose: To investigate the risk factors for retinopathy of prematurity (ROP) requiring laser treatment in preterm infants born before a gestational age (GA) of 28 weeks. Methods: This was a single-institution retrospective case-control study of high-risk preterm infants (GA ≤28 weeks) with ROP who were, born between January 2008 and December 2016. Patients who underwent laser treatment for severe ROP were enrolled. Infants in the control group were matched to preterm infants with a similar GA and mild ROP who, did not require laser treatment. Various prenatal and postnatal risk factors were compared between the two groups. Results: One hundred and twenty-two infants were included in this study (61 cases and 61 controls). The average birth weight was similar between the two groups (895.2±172.9 g vs. 938.5±168.0 g, P=0.164). There was no significant difference in the duration of invasive ventilation; however, the duration of noninvasive mechanical ventilation was significantly longer in patients (with ROP) who underwent laser treatment (P=0.036). The proportion of infants at a postnatal age of 28 days who were receiving oxygen treatment was significantly higher (60/61 [98.4%] vs. 51/61 [83.6%], P=0.004) in the severe ROP group. However, the rates of oxygen treatment for infants with a GA of 36 weeks were not significantly different (59%, for both groups). Other prematurity-associated morbidities were similar between the two groups. Conclusion: Altogether, a judicious reduction of oxygen therapy might reduce the incidence of laser treatment. Early diagnosis and treatment through periodic ophthalmologic examination are necessary in preterm infants receiving oxygen treatment at 28 days after birth.

단일기관에서 미숙아 폐출혈에서의 유전자재조합 활성화 제 7인자 사용 경험

박혜진,최은진 대한소아혈액종양학회 2016 Clinical Pediatric Hematology-Oncology Vol.23 No.1

Background: Pulmonary hemorrhage in prematurity is a life-threatening complication and associated with a high mortality. Recombinant activated factor VII (rFVIIa) has been reported as hemostatic treatment in sick neonates with refractory bleeding events in many studies. We evaluated the efficacy and safety of rFVIIa in prematurity with pulmonary hemorrhage in our institution. Methods: From the prematurities who were treated with rFVIIa to pulmonary hemorrhage from January 2010 to December 2015, we retrospectively analyzed the results of rFVIIa. Results: Of the 29 prematurities who were treated with rFVIIa for pulmonary hemorrhage, fifteen were male and fourteen were female. The median gestational age was 27 1/7 weeks (range, 22 1/7-34 1/7 weeks) and median birth weight was 870 g (range, 470-2,070 g). One to eight doses of rFVIIa (median dose 115.6 g/kg/dose) were administered, with 16 (55%) patients receiving a single dose. Hemostatic effect was achieved in 21 (72.4%) cases, but 6 of 21 patients died of unrelated cause, and overall mortality was 14 of 29 (48.3%). Thrombotic adverse event was not observed in any of our patients. Conclusion: Although the number of patients included in this study was small and the fact that this was a retrospective non-randomized control study, rFVIIa could be considered as a therapeutic option for pulmonary hemorrhage in prematurity.

미숙아 빈혈에서 Recombinant Human Erythropoietin의 투여용량에 따른 효과

이상락,김대훈,김천수,박근수,김명성 啓明大學校 醫科大學 1996 계명의대학술지 Vol.15 No.4

Anemia of prematurity is a major problem in caring of preterm babies, and up to recent days transfusion is a routine therapy for this disease. Transfusion causes various complications such as blood-borne viral infections, graft-versus-host reaction, hyperkalemia. Recently, the use of recombinant human erythropoietin(rHuEPP) is an alternative therapy for anemia of prematurity, but optimal dosage of rHuEPO is not uncertain. So, we conducted this study to determine the optimal dosage of rHuEPO in reducing postnatal transfusion and to assess the safety of rHuEPO in prematurity. Four groups of healthy premature infants of less than 34 weeks' gestation with birth weight less than 1.6kg were treated without rHuEPO(control group, n=6) or with rHuEPO:Epo-600 group(n=10) received 600 U/kg/week;Epo-900group(n=10), 900 U/kg/week; Epo-1,200 group(n=10), 1,200 U/kg/week, who were admitted to the Neonatal intensive care unit, Dong-San Medical Center, Keimyung University during the period of 2 years from Jan. 1994 to Dec. 1995. All rHuEPO-treated infants were given iron supplements, and all infants received folic acid and vitamin E supplements. The following results were obtained. 1) The mean birth weight, gestational age, age of therapy onset, initial hemoglobin and reticulocyte count showed similar distribution in all groups. 2) The reticulocyte count was significantly higher in Epo-1,200 group at 1 week, and all rHuEPO groups at 4 weeks after therapy than that of control group(P<0.05). 3) The mean serum iron level was lower in EPO-treated g개up than that of control group after therapy, but statistically not significant. The mean serum ferritin level was significantly lower in Epo-1,200 group than that of control group(P<0.05) 4) The blood erythropoietin level was similar in all groups during therapy. 5) Phlebotomy volume was similar in all groups, but high-does group(Epo-900, Epo-1,200) received significantly less transfusions than control and Epo-600 group(P<0.05). 6) Any side effects related rHuEPO therapy were not observed in all treated group. In conclusion, higher dosage(more than 900 U/kg/week) of rHuEPO therapy is safe and effective in reducing the need for blood transfusion.

미숙아 대사성 골 질환

남궁란,이순민,은호선,박민수,박국인,이철 대한신생아학회 2013 Neonatal medicine Vol.20 No.3

Preterm infants are at significant risk of reduced bone mineral content and subsequent bone disease, variably termed osteopenia of prematurity or neonatal rickets. The prevalence varies depending on gestation, occurs up to 30% of Korean extremely low birth weight infants (ELBW). The etiology is multifactoreal: inadequate nutrient intake, prolonged parenteral nutrition, chronic co-morbidities and immobilization. In Korean ELBW infants, rickets of prematurity was significantly increased by 18times with severe parenteral nutrition associated cholestasis, and by 3 times with moderate/severe bronchopulmonary dysplasia. Prolonged hospitalization with ventilator care could lead to lack of physical activity and muscle contraction against resistance in preterm infants, which may increase bone resorption and demineralization,resulting in osteopenia. Low serum P and high alkaline phosphatase (ALP)are suggestive of metabolic bone disease. In Korean ELBW infants, increased serum ALP (>495 IU) at the age of 5 weeks has a 81% of sensitivity and 87% of specificity for radiographic rickets. An early nutritional intervention can reduce both the prevalence and the severity of osteopenia. Provision of adequate nutrition including energy, protein and minerals, and passive physical exercise during first weeks of life may prevent abnormal bone remodeling activity in preterm infants. Early detection by vigorous monitoring of bone homeostasis and prompt treatment of osteopenia are warranted in these high-risk infants. This review is to focus on the recent advances in the understanding of bone metabolism in preterm infants and on the therapeutic approach to prevent and to treat metabolic bone disease of prematurity.