Respiratory syncytial virus-associated seizures in Korean children, 2011-2016

Cha, Teahyen,Choi, Young Jin,Oh, Jae-Won,Kim, Chang-Ryul,Park, Dong Woo,Seol, In Joon,Moon, Jin-Hwa The Korean Pediatric Society 2019 Clinical and Experimental Pediatrics (CEP) Vol.62 No.4

Purpose: Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. Methods: We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. Results: During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: $20.8{\pm}16.6months$) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. Conclusion: Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.

Comparison of Respiratory Outcome between the Surfactant without Endotracheal Tube Intubation and the Intubation-Surfactant-Extubation Techniques in Extremely Low Gestational Age Neonates with Respiratory Distress Syndrome

( Teahyen Cha ),( Jiyoon Jeong ),( Byong Sop Lee ),( Ellen Ai-rhan Kim ),( Ki-soo Kim ),( Euiseok Jung ) 대한주산의학회 2021 Perinatology Vol.32 No.3

Objective: The aim of this study was to determine whether there were differences in respiratory outcomes of extremely low gestational age neonates according to the surfactant without endotracheal tube intubation (SURE) technique or the intubation-surfactant-extubation (INSURE) technique in treating respiratory distress syndrome. Methods: Preterm infants less than 28 weeks of gestational age between January 2015 and December 2020 were retrospectively reviewed. Demographic and outcome variables, the respiratory outcomes including incidence of bronchopulmonary dysplasia (BPD) and pulmonary acuity score (PAS) were compared between the infants who received SURE and INSURE. Results: A total of 53 infants (SURE, 18; INSURE, 35) were analyzed. There were differences between SURE and INSURE groups in birth weight (919.5 g vs. 815.6 g, P=0.037) and Apgar score (1 minute: 6 vs. 5, P=0.037; 5 minutes: 8 vs. 7, P=0.016). Positive pressure ventilation rate at delivery room, continuous positive airway pressure failure rate, the second dose of surfactant administration, the duration of invasive and/or noninvasive respiratory support, and the incidence of BPD were not significantly different between the two groups. The PAS at 7 days of life (DOL) was lower than at birth in SURE group (P=0.048). However, there were no differences between PAS at birth and at postmenstrual age 36 weeks. Conclusion: Respiratory outcomes including incidence of BPD were not different between the SURE and INSURE groups. Nevertheless, PAS at 7 DOL decreased after the SURE technique.

Prenatal Factors Influencing Long-Term Neurodevelopmental Outcomes

( Teahyen Cha ),( Soon Min Lee ) 대한주산의학회 2023 Perinatology Vol.34 No.4

The developing brain in utero is highly vulnerable to maternal and environmental influences. As a mediator of maternal and environmental signals to the fetus, epigenetic processes within the placenta are particularly powerful such that alterations of placental gene expression, downstream function, and signaling during fetal development have the potential for dramatic changes in developmental programming. This influence of intrauterine experiences has been progressively extended from the modification of fetal brain to the susceptibility to develop neurodevelopmental disorders in childhood, as well as in adulthood. In this review, we describe maternal factors such as obesity, smoking, alcohol drinking, stress, and nutrition that moderate the impact on adverse neurodevelopment conditions. And, we also have depicted maternal disease that could result poor childhood neurodevelopment. Lastly, we describe evidence linking adverse environmental variation such as pollutant, heavy metal, air pollution during the fetal period and long-term neuro-developmental changes in brain structure and function. detrimental effects in the offspring. A comprehensive understanding and accurate knowledge of prenatal factors that can influence neurodevelopmental disorders are invaluable for clinicians in providing informed guidance during pregnancy and newborn care counseling. This, in turn, contributes to improved outcomes for children and families, promoting lifelong health and disease prevention for the child.

Risk Factors for Nephrocalcinosis in Very Low Birth Weight Infants

( Sang Eun Han ),( Teahyen Cha ),( Jinsup Kim ),( Ja Hye Kim ),( Chang Ryul Kim ),( Hyun Kyung Park ),( Hyun Ju Lee ) 대한주산의학회 2019 Perinatology Vol.30 No.1

Objective: The objective was to identify risk factors for nephrocalcinosis in very low birth weight (VLBW) infants. Methods: Prospective study has done between 2014 and 2017. The study included 81 VLBW infants in the neonatal intensive care unit (NICU). Renal ultrasonography was performed at four weeks and 3 months. Baseline characteristics, complications and medication during NICU admission were collected. 25-(OH)-vitamin D, calcium, phosphorous, alkaline phosphatase, urine calcium to creatinine ratio were serially measured. Results: The incidence of nephrocalcinosis was 16.9%. On univariate analysis, gestational age, lower birth weight, maternal pregnancy-induced hypertension, neonatal sepsis, and frequency of vancomycin and caffeine citrate treatment were significantly associated with nephrocalcinosis. In addition, preterm infants with nephrocalcinosis had lower cord blood 25-(OH)-vitamin D and serum calcium levels and higher serum alkaline phosphatase levels at 2 weeks of life. Multivariate analysis showed that gestational age (P=0.042), birth weight (P=0.019), sepsis (P=0.046), small for gestational age (P=0.015), and maternal pregnancy-induced hypertension (P=0.024) were significant risk factors for nephrocalcinosis. Conclusion: This study suggests that neonatal sepsis and maternal pregnancy-induced hypertension, in addition to gestational age and birth weight are important perinatal risk factors for nephrocalcinosis.

Response to Inhaled Nitric Oxide and Clinical Outcome in Very Low Birth Weight Infants with Early Pulmonary Hypertension

Jae-Young Cho,Byong Sop Lee,Moon Yeon Oh,Teahyen Cha,Jiyoon Jeong,Euiseok Jung,Ai-Rhan Kim,Ki-Soo Kim 대한신생아학회 2020 Neonatal medicine Vol.27 No.3

Purpose: To determine the efficacy of inhaled nitric oxide (iNO) in very low birth weight (VLBW) infants with early pulmonary hypertension (PH). Methods: We reviewed the medical records of 22 preterm infants who were born <30 weeks of gestational age with birth weight <1,500 g, diagnosed with early PH, and treated with iNO within the first 72 hours after birth. Responders were defined by a reduction in FiO2 >20% and/or oxygenation index (OI) >20% from the baseline values at 1 hour after beginning iNO therapy. Cardiorespiratory support indices including OI, oxygen saturation index, and vasoactive-inotropic score (VIS) were serially obtained for 96 hours following iNO therapy. Results: The mean gestational age of the patients was 26.1±2.0 weeks and the mean birth weight was 842±298 g. The mean OI at the start of iNO was 63.8±61.0. Improvement in oxygenation indicated by prompt decrease in FiO2 and OI from the baseline values were observed 1 hour after beginning iNO therapy and lasted up to 96 hours. After iNO therapy, VIS increased until 24 hours and decreased thereafter. At 1 hour after iNO, 16 patients (73%) were classified as responders and six (27%) as nonresponders. Compared with nonresponders, responders did not demonstrate the beneficial effect of iNO in terms of short-term survival and neonatal complications. The 1-year mortality rate did not differ between responders (56%) and nonresponders (67%). Conclusion: Although iNO treatment immediately improved oxygenation in most VLBW infants with early severe PH, the long-term mortality rate was high. A largescale study is needed to determine whether the initial response to iNO can predict patients’ survival.

Association of Maternal Diabetes with Neonatal Outcomes of Very Low Birth Weight Infants

( Jee In Song ),( Euiseok Jung ),( Moonyeon Oh ),( Jiyoon Jeong ),( Teahyen Cha ),( Seunghyun Ko ),( Byong Sop Lee ),( Ellen Ai-rhan Kim ),( Ki-soo Kim ) 대한주산의학회 2021 Perinatology Vol.32 No.4

Objective: Women with diabetes mellitus (DM) are at high risk for preterm delivery. However, reported findings on the effects of maternal diabetes on the outcome of very low birth weight infants (VLBWIs) are inconsistent. This study compared the mortality and morbidity among VLBWIs born to women with and without DM. Methods: In this retrospective cohort study, we included data on VLBWI without congenital malformations born between April 2013 and September 2020. Neonatal outcomes according to maternal diabetes, type of diabetes, and maternal insulin treatment were compared using multivariate logistic analysis. Results: Of 756 infants, 61 were born to women with DM. Of these 61 mothers, 55 had gestational DM, while 6 had pregestational DM. After adjusting for confounders, it was observed that VLBWI born to women with diabetes were less likely to develop sepsis. The risk of grade 3 or 4 intraventricular hemorrhage (IVH) was higher in the insulin-requiring DM group. There was no significant difference in the mortality of VLBWI under any maternal condition. Conclusion: Maternal diabetes lowers the prevalence of sepsis in VLBWI, which is particularly augmented in the insulin-requiring DM group. However, maternal insulin treatment increases the incidence of severe IVH in VLBWI.