신생아 패혈증의 원인 병원체에 대한 조사

박용훈,김경아,신손문,문한구 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1

전국의 신생아 수련 병원에 설문지를 보내어 각 병원의 1997년 1월부터 12월까지 출생한 신생아 중 패혈증으로 진단되고 혈액 배양 검사에서 균이 검출된 경우, 병록지를 통해 후향적 조사를 실시하였고, 37개 병원에서 참여해 34.9%의 응답율을 나타내었으며, 결과는 다음과 같다. 1) 신생아 패혈증의 발생빈도는 평균 0.73%(0~2.95%)였고, 남녀 비는 1.15:1이었다. 2) 신생아 패혈증의 원인균은 candida류를 포함하여 64종의 균이 검출되었다. 가장 흔한 원인균은 S. aureus였고, S. epidermidis, CONS의 순으로 많았다. 3) 조기 신생아 패혈증의 가장 흔한 원인균은 S. aureus였으며 CONS와 S. epidermidis가 그 다음으로 많았다. 후기 신생아 패혈증도 S. aureus가 가장 많이 검출되었고, S. epidermidis, CONS의 순으로 많았다. 4) 신생아 패혈증에 관련된 산모의 위험 인자는 조기 파수가 104명(21.8%)으로 가장 많았고, 그외에 난산, 태아의 빈맥, 융모양막염, 산모감염의 순이었다. 5) 신생아 패혈증과 연관된 국소 감염의 분포는 73명(26.1%)의 환아에서 폐렴이 동반되어 가장 많은 빈도를 보였고, 요로 감염, 뇌막염, 관절염의 순으로 많았다. 6) 신생아의 병원내 감염의 가장 흔한 원인균으로는 S. epidermidis가 가장 많았고, S. aureus, Entero-bacter의 순이었다. 7) 도관과 관련된 신생아 패혈증의 원인균은, S. aureus,가 가장 많았고, S. epidermidis, Enterobacter의 순으로 많았다. Candida는 8례에서 발견되었다. 8) 그람 양성균이 항생제에 대한 반응검사에서 Penicillin이나 oxacillin에 대해 S. aureus, S. epidermidis, CONS 모두 30% 이하의 감수성을 보였다. Vacomycin에 대해서는 S. aureus, CONS, Enterococcus 각각 1례에서 내성을 나타내었다. 9) 그람 음성균의 항생제에 대한 반응검사에서 Gentamicin에 대해서 60% 정도의 감수성을 나타내었고, amikacin에 대해서는 80% 이상의 감수성을 보였다. Piperacillin과 aztreonam에 대해서 Pseudomonas가 100%의 감수성, ticarcillin에 대해서는 Klebsiella가 100%의 감수성을 나타내었다. A nationwide survey was conducted to investigate the annual occurrence rate of neonatal sepsis, maternal risk factors in neonatal sepsis, localized infection in neonates, causative organisms in nosocomial infection and the most common causative organism for neonatal sepsis in Korea. Clinical and bacteriological data were collected from 37 neonatal units to perform retrospective review of the medical records of the newborn infants who were confirmed as having neonatal sepsis and whose blood culture was collected to isolate organisms for one year study period from January to December in 1997. 78,463 neonates were born at 37 hospital in 1997, and 20,869 neonates were admitted to the neonatal units. During this period, 772 episodes of neonatal sepsis were recorded in 517 neonates. The occurrence rate of neonatal sepsis was 0.73%(0∼2.95%). Male to female ratio was 1.15:1, and 303 cases(42.1%) were born prematurely. The main pathogens of early onset of sepsis were S. aureus(20%), S. epidermidis(14.4%) and coagulase negative staphylococcus(14.4%). Gram negative bacilli including Enterobacter spp (7.2%), E. coli(5.1%), Klepstella(4.5%), Pseudomonas(3.7%) and Enterobacter faectum(3.6%) accounted for 24.1% of sepsis. Group B beta-hemolytic streptococcus were isolated only in two cases. Common obstetric factors were PROM(21.1%), difficulty delivery(18.7%), fetal tachycardia(5.3%), chorioamnionitis(4.9%), and maternal fever(4.7%). The main pathogens of late-onset sepsis were S. aureus(22.3%), S. epidermidis(20.4%) and CONS(9.9%). There were 6 cases (1.0%) of Candida sepsis. Frequent focal infections accompanying sepsis were pneumonia(26.1%), urinary tract infection(10.5%), meningitis(8.2%), and arthritis(3.6%). S. epidermidia(22.0%) and s. aureus(21.7%) were also the most common pathogens in 373 nosocomial infection.

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

Kazuhisa Hachisuga,Nobuhiro Hidaka,Yasuyuki Fujita,Kotaro Fukushima,Kiyoko Kat 대한혈액학회 2014 Blood Research Vol.49 No.4

Background We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. Methods Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100×10⁹/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. Results Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). Conclusion Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

Kazuhisa Hachisuga,Nobuhiro Hidaka,Yasuyuki Fujita,Kotaro Fukushima,Kiyoko Kat 대한혈액학회 2014 Blood Research Vol.49 No.4

Background We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. Methods Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100×10⁹/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. Results Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). Conclusion Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

Neonatal seizures: diagnostic updates based on new definition and classification

Kim Eun-Hee,Shin Jeongmin,Lee Byoung Kook 대한소아청소년과학회 2022 Clinical and Experimental Pediatrics (CEP) Vol.65 No.8

Neonatal seizures are the most common neurological symptoms caused by various etiologies in the neonatal period, but their diagnosis and treatment are challenging because their pathophysiology and electroclinical manifestations differ from those of patients in older age groups. Many seizures present as electrographic-only events without clinical signs or as obscure clinical manifestations that are difficult to distinguish from other neonatal behaviors. Accordingly, a new definition and classification of neonatal seizures was recently proposed by the International League Against Epilepsy Task Force on neonatal seizures, highlighting the role of electroencephalography in diagnosing and treating neonatal seizures. Neonatal seizures are defined as electrographic events with sudden, paroxysmal, and abnormal alteration of activity and divided into electroclinical seizures and electrographic-only seizures according to their clinical signs, thus excluding clinical events without an electrographic correlation. Seizure types are described by their predominant clinical features and divided into motor (automatisms, clonic, epileptic spasms, myoclonic, tonic, and sequential), nonmotor (autonomic and behavioral arrest), and unclassified. Although many neonatal seizures are acute reactive events caused by hypoxic-ischemic encephalopathy or vascular insults, structural, genetic, or metabolic etiologies of neonatal-onset epilepsy should also be thoroughly evaluated to determine their appropriate management.

신생아용 미세원주응집카드의 유용성

서수현,김세희,심영숙,이경,송상훈,박경운,송정한,한규섭 대한수혈학회 2010 大韓輸血學會誌 Vol.21 No.1

Background: Blood loss due to laboratory phlebotomy among neonates is correlated with anemia as well as transfusion. In this study, microcolumn agglutination cards for performing ABO & RhD blood typing and direct antiglobulin tests in neonates were evaluated and compared with other established systems. Also, the blood group antibody production rates according to the age were calculated to determine the upper age limit for the new method. Methods: Eighty subjects were tested by using the DianaGel Neonatal cards (Diagnostic Grifols, Barcelona, Spain), and the results were compared with those of the slide methods for ABO and RhD blood typing, and the DiaMed-ID DC-Screening I test (DiaMed, Morat, Switzerland) for direct antiglobulin tests. A total of 546 subjects who were under 12 months old were tested for the ABO back-typing, and 58 subjects with the AB blood type were excluded. Results: The results of the DianaGel Neonatal card were in agreement with those of the conventional methods for all the subjects. Only one subject showed a discrepant result for the DAT between the DianaGel and DiaMed methods. Blood group antibodies were detected in 29 out of 169 (17.2%) one-day-old neonates, in eight out of 34 (23.5%) infants between one and three months of age and in 81 out of 96 (84.4%) infants between six and twelve months of age. Conclusion: The DianaGel Neonatal card showed at least equivalent performance as compared to that of the conventional methods, and it showed advantages for a low blood volume requirement and stronger agglutination grades. The DianaGel card is a suitable alternative for blood typing and DAT in infants under the age of 3 months and who do not necessarily need back-typing of the blood groups due to the low production rate of antibodies. (Korean J Blood Transfus 2010;21:9-15) 배경: 신생아에서의 혈액형검사시 요구되는 혈액량은 신생아의 빈혈 및 수혈과 직접적인 연관이 있다. 본 연구에서는 신생아 용 미세원주응집카드인 DianaGel Neonatal을 이용하여 신생아의 ABO 및 RhD 혈액형검사와 직접글로불린검사를 시행하여 기존의 검사방법과 비교하여 평가하였다. 또한 검사가 의뢰된 시점을 기준으로 생후 12개월 이내의 영유아에서의 혈액형 항체형성률을 알아보고 카드를 검사에 사용할 수 있는 상한연령을 확인하고자 하였다. 방법: 신생아용 미세원주응집카드의 성능을 평가하기 위한 연구는 2007년 1월부터 2008년 11월까지 혈액형 관련 검사가 의뢰된 신생아 80명을 대상으로 DianaGel Neonatal (Diagnostic Grifols, Barcelona, Spain)을 이용하여 ABO 혈구형검사, RhD 혈액형검사 및 직접항글로불린검사의 결과를 기존의 검사법들과 비교 평가하였다. 신생아용 미세원주응집카드의 사용가능연령을 설정하기 위한 ABO 항체형성률 연구를 위하여는 2006년 10월부터 2009년 12월까지 말초혈액 검체로 혈액형 관련 검사가 의뢰된 12개월 미만의 영유아 546명을 대상으로 하여 ABO 혈청형검사를 시행하였으며, 그 중 혈액형이 AB형으로 확인된 58명은 분석에서 제외하였다. 결과: DianaGel Neonatal을 평가한 결과 ABO 혈구형검사 및 Rh 혈액형검사에서는 기존의 방법과 결과 차이가 없었다. 직접항글로불린 검사에서는 1예에서 monospecific IgG 검사 결과가 DiaMed사의 결과와 달랐으나 polyspecific 항글로불린에서는 모두 음성을 보였다. ABO항체형성률은 생후 1일에서 17.2%였으며 생후 1개월부터 3개월 미만의 경우에는 23.5%, 6개월부터 12개월 미만의 경우에는 84.4%로 증가하는 양상을 보였다.결론: 신생아용 미세원주응집카드인 DianaGel Neonatal은 기존의 방법들과 비교할 때 소량의 검체로도 강한 응집강도를 보이는 장점을 가지고 있음을 확인하였으며, 혈청형검사가 반드시 필요하지는 않을 것으로 생각되는 생후 3개월 미만의 영유아에서는 신생아용 미세원주응집카드가 무리 없이 사용될 수 있을 것으로 판단된다.

임상 ; 적절한 산전 관리를 받지 않은 임산부와 신생아의 주산기 합병증

최병민 ( Byung Min Choi ),송영우 ( Young Wooh Song ),신정희 ( Jeong Hee Shin ),윤영선 ( Young Sun Yoon ),정현철 ( Hyun Chul Jeong ),임형은 ( Hyung Eun Yim ),이정화 ( Jung Hwa Lee ),김해중 ( Hai Joong Kim ),홍영숙 ( Young Sook H 대한주산의학회 2010 Perinatology Vol.21 No.4

목적: 산전 관리는 임산부와 신생아의 건강 증진을 위해 중요한 것으로 우리 나라의 사회 경제적 여건이 개선 되면서 대부분의 임부가 산전 관리를 받고 있지만 아직도 경기도 일부 지역에서는 적절한 산전 관리를 받지 않은 임산부와 신생아가 있으나 이들에 대한 국내의 보고는 없는 실정이어서 이들의 주산기 합병증에 대하여 조 사하였다. 방법: 2004년 1월부터 2009년 12월까지 고려대학교 부속 안산 병원 신생아 중환자실 및 신생아실에 입원한 신 생아의 어머니 중 산전 관리를 3회 이하로 받은 임산부를 대상으로 하여 후향적으로 의무 기록을 분석하였다. 대상 임산부는 106명, 대상 신생아는 107명으로 재태 연령이 부정확한 경우는 새로운 발라드 법을 이용하여 재 태 기간을 추정하였다. 이들에 대하여 임산부의 분만력과 주산기 합병증을 조사하였고 신생아의 인구역학적 특징과 주산기 합병증, 선천성 기형 및 사망률을 조사하였으며 본원 의료 사회사업팀에서 연계한 의료 지원에 대 하여 알아보았다. 결과: 대상 임산부는 2004년도에 12명이었고 2005년도에 14명, 2006년도에 9명, 2007년도에 15명, 2008 년도에 28명, 2009년도에 28명으로 최근에 적절히 산전 관리를 받지 못하는 임산부와 신생아가 늘어나고 있는 추세를 보였다. 임산부의 주산기 합병증으로는 조산이 35명(33.0%), 빈혈 20명(22.9%), 조기 양막 파수 15 명(17.2%), 융모양막염 14명(16%), 태반 조기 박리 6명(6.8%), 다발성 질벽 열상 6명(6.8%), 전자간증 4명 (4.5%)이 있었다. 신생아의 주산기 합병증으로 미숙아가 44명(41.1%)이었으며 이중 재태 기간 28주 미만의 미 숙아는 7명(6.5%)이었다. 저체중 출생아는 44명(41.1%)으로 극소 저체중 출생아 17명(15.8%), 초극소 저체중 출생아 7명(6.5%)이었다. 대상 신생아 중 재태 연령 34주 미만의 미숙아 26명에 대하여 같은 기간 동안 적절히 산전 관리를 받았던 임산부에게서 출생한 재태 연령 34주 미만의 미숙아 52명을 대조군으로 설정하여 이들의 주산기 합병증에 대하여 비교한 결과, 적절한 산전 관리를 받았던 임산부에게서 태어난 미숙아에 비해 대상 미 숙아들의 호흡곤란 증후군의 발생이 더 많았고(P =0.044), 부당 경량아가 더 많이 태어났으며(P =0.038), 3단계 이상의 뇌출혈 또한 유의하게 더 많이 발생하였다(P =0.040). 또한 선천성 기형아와 사망아의 비율도 높았으며 특히 전전뇌증(holoprosencephaly)이나 Beare-Stevenson 증후군과 같이 생존율이 매우 낮은 기형아의 출생 도 있었다. 대상 환아 중 37명(34.5%)이 입양 기관으로 이송되었고, 1명은 아동보호시설로 퇴원하였으며, 13명 (12.1%)은 보호자의 경제적 사정으로 보건소, 재단, 교우회, 시청 등에서 진료비 지원을 받았다. 결론: 본 연구에서 적절한 산전 관리를 받지 않는 경우 임산부와 신생아의 주산기 합병증의 이환율이 증가하고 임산부의 사회경제적인 여건으로 인하여 사회적 부담도 발생함을 알 수 있었다. 이들은 대부분 저소득층 및 미 성년자와 같은 소외 계층으로 국가에서 운영하는 보건소의 무료 산전 관리 프로그램의 혜택을 받지 못했고 이를 개선하기 위해 야간 및 주말에도 산전 관리 진료를 운영하는 등의 실질적인 국가 정책의 활성화와 소외 계층 에게 정보를 제공하기 위한 홍보 및 교육 프로그램 개발의 필요성이 절실히 요구된다. Objective: With improvement in the social and economic states of Korea, most of the pregnancies have been appropriately examined but there are a few mothers and newborns who have not received proper prenatal care. The aim of this study was to investigate obstetrical and neonatal complications resulting from inadequate prenatal care. Methods: The medical records of 107 neonates who had received prenatal care lesser than 3 visits and admitted to the neonatal intensive care units of Korea University Ansan Hospital from January 2004 to December 2009 were retrospectively reviewed. Obstetrical complications, neonatal gestational age, birth weight, neonatal complications were analyzed. We compared neonatal complications of the inadequate prenatal care group and those of the adequate prenatal care group lesser than 34 weeks` gestational age neonates. Results: In obstetrical complications, there were twenty women with anemia, fifteen cases with premature rupture of membranes, and fourteen chorioamnionitis. In neonatal complications, there were forth-four premature infants, and forty-four low birth weight infants. Respiratory distress syndrome, small for gestational age, severe intraventricular hemorrhage were more common in the inadequate prenatal care group than the adequate prenatal care group. Thirty-seven infants (34.5%) were sent to the adoption agency. Fifty infants (46.6%) received medical expense support by the social service. Conclusions: Obstetrical and neonatal complications and social burden were increasing when the pregnancies had not received adequate prenatal care. To reduce perinatal complications of mothers and neonates in low socioeconomic classes, practical nation`s policies and social supports for adequate prenatal care should be provided.

Neonatal Late-onset Hypocalcemia: Is There Any Relationship with Maternal Hypovitaminosis D?

Do, Hyun Jeong,Park, Ji Sook,Seo, Ji-Hyun,Lee, Eun Shin,Park, Chan-Hoo,Woo, Hyang-Ok,Youn, Hee-Shang The Korean Society of Pediatric Gastroenterology 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.1

Purpose: Neonatal late-onset hypocalcemia is defined as hypocalcemia developed after postnatal 3 days and associated with hypoparathyroidism, high phosphate diets and vitamin D deficiency. We experienced the increment of neonatal late onset hypocalcemia over 1 year. We tried to evaluate the relationship between late onset hypocalcemia and maternal hypovitaminosis D. Methods: The medical records in the neonates with late-onset hypocalcemia during January 2007 to July 2008 were retrospectively reviewed. Among those patients, 17 paired sera of mothers and neonates had collected. The levels of 25-OH vitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured and were compared with neonate and the mother. Results: The mean gestational age was $38^{+1}$ weeks, and the mean body weight was 2,980 g. The onset time of hypocalcemia was 5.9 days of age. Most of them (88.2%) were feeding with formula and no one was only breast milk feeding. Of the 17 patients, 13 were born in spring or in winter. The median levels of calcium, phosphorus, alkaline phosphatase, iPTH and 25OHD were 7.0 mg/dL, 8.6 mg/dL, 191.0 U/L, 57.2 pg/mL and 24.0 ng/mL in neonates. The levels of 25OHD of 6 neonates were <20 ng/mL. A total of 16 mothers were considered vitamin D-deficient (<20 ng/mL), and vitamin D insufficient (20<25OHD<30 ng/mL). Conclusion: Neonatal late-onset hypocalcemia in our study seems to be influenced by maternal vitamin D deficiency and insufficiency. Sun tanning and vitamin D supplements from winter to spring would be helpful to prevent maternal vitamin D deficiency, one of the causes of neonatal late-onset hypocalcemia.

한국인 신생아 황달과 UGT1A1 유전자의 2056G>C 단일염기다형성에 관한 연구

하상균 외 중앙대학교 의과대학 의학연구소 2006 中央醫大誌 Vol.31 No.1·2·3

The incidence of neonatal hyperbilirubinemia is twice as high in East Asians as in Caucasians. Although it has not been clearly defined, the UDP-glucuronosyltransferase gene (UGT1A1) mutation was found to be a risk factor of neonatal hyperbilirubinemia. We studied whether neonatal hyperbilirubinemia is associated with the 2056G>C (rs8330) polymorphism of the UGT1A1 gene. The genomic DNA was isolated from 80 Korean full term neonates who had greater than a 12 mg/dl level of serum bilirubin with no obvious cause, and also isolated from 164 Korean neonates of the control population. We studied a single nucleotide polymorphism (SNP) of 2056G>C in the untranslated region of the UGT1A1 gene by direct sequencing. Three of the 80 neonates with a serum bilirubin level above 12 mg/dl had homozygous mutations and 10 of the 80 neonates had heterozygous mutation. Thirteen of the 164 neonates of the control group had homozygous mutation and 16 neonates of the control group had heterozygous mutation. The allele frequency of 2056G>C polymorphism of UGT1A1 in the hyperbilirubinemia group was 0.1, which was not significantly different from 0.128 in the control group. In this study, our results indicated that this SNP is not associated to the hyperbilirubinemia in Korean neonates.

단일 신생아중환자실에서 경험한 10년간의 신생아 패혈증의 원인균 및 항생제 감수성 변화

박혜원,구소은,이병섭,김기수,피수영,김애란,임진아 대한신생아학회 2009 Neonatal medicine Vol.16 No.2

Purpose : To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. Methods : We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. Results : Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. Conclusion : The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.

Neonatal Late-onset Hypocalcemia: Is There Any Relationship with Maternal Hypovitaminosis D?

도현정,박지숙,서지현,이은신,박찬후,우향옥,윤희상 대한소아소화기영양학회 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.1

Purpose: Neonatal late-onset hypocalcemia is defined as hypocalcemia developed after postnatal 3 days and associated with hypoparathyroidism, high phosphate diets and vitamin D deficiency. We experienced the increment of neonatal late onset hypocalcemia over 1 year. We tried to evaluate the relationship between late onset hypocalcemia and maternal hypovitaminosis D. Methods: The medical records in the neonates with late-onset hypocalcemia during January 2007 to July 2008 were retrospectively reviewed. Among those patients, 17 paired sera of mothers and neonates had collected. The levels of 25-OH vitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured and were compared with neonate and the mother. Results: The mean gestational age was 38+1 weeks, and the mean body weight was 2,980 g. The onset time of hypocalcemia was 5.9 days of age. Most of them (88.2%) were feeding with formula and no one was only breast milk feeding. Of the 17 patients, 13 were born in spring or in winter. The median levels of calcium, phosphorus, alkaline phosphatase, iPTH and 25OHD were 7.0 mg/dL, 8.6 mg/dL, 191.0 U/L, 57.2 pg/mL and 24.0 ng/mL in neonates. The levels of 25OHD of 6 neonates were <20 ng/mL. A total of 16 mothers were considered vitamin D-deficient (<20 ng/mL), and vitamin D insufficient (20<25OHD<30 ng/mL). Conclusion: Neonatal late-onset hypocalcemia in our study seems to be influenced by maternal vitamin D deficiency and insufficiency. Sun tanning and vitamin D supplements from winter to spring would be helpful to prevent maternal vitamin D deficiency, one of the causes of neonatal late-onset hypocalcemia.