Ureaplasma infections in pre-term infants: Recent information regarding the role of Ureaplasma species as neonatal pathogens

성태정 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.12

Although numerous clinical observational studies have been conducted over a period of over 30 years, the clinical significance of Ureaplasma infection is still under debate. The Ureaplasma speices. is a commensal in the female genital tract and considered to have of low virulence;however, Ureaplasma colonization has been associated with infertility,stillbirth, preterm delivery, histologic chorioamnionitis, and neonatal morbidities, including congenital pneumonia, meningitis, bronchopulmonary dysplasia, and perinatal death. Recently, Ureaplasma was subdivided into 2 separate species and 14 serovars. Ureaplasma parvum is known as biovar 1 and contains serovars 1, 3, 6, and 14, and Ureaplasma urealyticum (biovar 2) contains the remaining serovars (2, 4,5, and 7-13). The existence of differences in pathogenicities of these 14serovars and 2 biovars is controversial. Although macrolides are the only antimicrobial agents currently available for use in neonatal ureaplasmal infections, in the current clinical field, it is difficult to make decisions regarding which antibiotics should be used. Future investigations involving large, multicenter, randomized, controlled studies are needed before proper recommendations can be made for clinical practice.

Disorders in Hemostasis

성태정 대한신생아학회 2011 Neonatal medicine Vol.18 No.1

Neonatal bleeding is a common problem encountered in nursery rooms or neonatal incentive care units, especially among premature infants. Furthermore, owing to recent remarkable improvement of neonatology, survival rates of preterm neonates have increased; hence, neonatal bleeding cannot be emphasized enough. Since the total blood volume of neonates is small, bleeding can be one of the causes of morbidities and mortalities. Therefore, rapid diagnosis and immediate therapy is urgently needed. The patient’s medical history including a familial history of a bleeding disorder or of a previously affected infant who suffered from bleeding along with maternal and neonatal drugs can provide important diagnostic clues. Presence of bleeding with or without petechiae and ecchymoses in a healthy term or late preterm infant with thrombocytopenia but normal prothrombin time and activated partial thromboplastin time strongly suggests a congenital bleeding disorder. For a sick infant who is bleeding from multiple sites,an acquired disorder such as disseminated intravascular coagulation is suspected. Intracranial hemorrhage in term or late preterm infants without a history of birth trauma is highly suggestive of coagulation disorders. The purpose of this review is to summarize recent advances in diagnostic methods is as well as basic concepts of neonatal hemostatic disorders. First, an outline of background information will be presented followed by a discussion of primary and secondary hemostatic disorders as well as inherited and acquired disorders.

신생아에서 흡입 일산화질소 치료의 임상적 적응증

성태정 대한신생아학회 2015 Neonatal medicine Vol.22 No.2

Nitric oxide (NO) is a colorless, odorless gas that acts as a potent pulmonary vasodilator. When administered via inhalation, NO rapidly diffuses across the alveolarcapillary membrane and binds to hemoglobin, and thus has little effect on the systemic circulation. NO was approved by the United States Food and Drug Administration (US FDA) for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in 1999. Neonatal hypoxic respiratory failure may be caused by persistent pulmonary hypertension of the newborn and other diseases such as meconium aspiration syndrome, sepsis, birth asphyxia, and respiratory distress syndrome that contribute to pulmonary arterial hypertension. Inhaled NO is the only approved treatment in term and late preterm (>34 weeks) neonates with hypoxic respiratory failure associated with pulmonary hypertension, and it reduces the need for extracorporeal membrane oxygenation. The present article will review the clinical indications for US FDA-approved inhaled NO therapy according to evidence-based clinical studies.

Congenital Acute Myeloid Leukemia with t(8;16) and t(17;19) Double Translocation: Case Presentation and Literature Review

성태정,이대형,김순기,전용훈 대한의학회 2010 Journal of Korean medical science Vol.25 No.6

Congenital leukemia is uncommon and excluding transient myeloproliferation associated with Down syndrome, makes up approximately 1% of childhood leukemias. A newborn boy was born with multiple subcutaneous nodules and large purpuric papules. Skin biopsy revealed proliferation of atypical hematologic cells in the dermis. Bone marrow morphology was consistent with acute myeloid leukemia (M5)and cytogenetic studies revealed t(8;16) and t(17;19) double translocation. Although prognosis of congenital leukemia is known to be dismal, recent reports showed spontaneous remissions. With the fear of chemotherapy-related toxicity, to treat or not to treat may be a dilemma both to parents and pediatricians. We report our experience and review the literature.

Small bowel obstruction caused byan anomalous congenital band in an infant

성태정,조지웅 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.2

저자들은 발열과 식욕저하를 주소로 패혈증 의증으로 전원 된 27일된 신생아에서 구토와 혈변 등은 없었으나, 입원 당시 복부팽만과 단순복부촬영에서 보인 소장 확장소견으로 개복술을 실시한 결과 선천성 밴드에 의해 내탈장된 소장이 압박되어 유발된 장폐색증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Ureaplasma urealyticum or Ureaplasma parvum:what’s the difference?

성태정 대한소아청소년과학회 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.11

청소년에서 유용한 비만의 선별검사와 비만도, BMI 및 혈청지질과의 관계

성태정,김달현,홍영진,손병관,장경자,박준영,김순기,Sung, Tae Jung,Kim, Dal Hyun,Hong, Young Jin,Son, Byong Kwan,Chang, Kyung Ja,Park, Jun Young,Kim, Soon Ki 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.3

목 적 : 소아 및 청소년 비만은 매년 증가되고 있는 추세이다. 소아와 청소년기라는 특성을 고려할 때 비만을 진단하는 기준 중, 어떤 기준을 적용하는 것이 비만아 선별검사에 좀더 유용한가에 대해 알아보고, 이렇게 선별된 비만아에서 비만과 관련된 여러 심혈관계 성인병 발생 위험 인자 중 조기에 예측 가능한 인자를 알아내어, 어떠한 인자가 추적관찰에 유용한지 알아보았다. 방 법 : 2001년 7월부터 11월까지 한국건강관리 협회와 인천광역시 교육청 주관으로 비만도 20% 이상인 중 고등학생 2,814명(남 : 녀=2,011 : 803)을 대상으로 하여 체중, 신장, 신체측정, 혈청지질(총 콜레스테롤, 혈청지질, HDL 콜레스테롤, LDL 콜레스테롤)을 측정하였다. 결 과 : 비만도 20% 이상인 중고생에서 BMI 95 백분위수 이상은 86.6%였으며, 체지방 기준에 의한 비만은 93.2%, 피하지방 두께에 의한 비만은 45.6%였다. BMI에 따른 비만아 중 고콜레스테롤혈증은 남아 21.0%, 여아 21.4%를 보였고, 비만도에 따라 나눈 남아 20.7%, 여아는 19.2%로 BMI와 큰 차이를 보이지 않았다. BMI에 따라 판정된 비만아를 세분하여 제 I도 과체중(고위험군, group I), 제 II도 과체중(비만, group II), 제 III도 과체중(과비만, group III)으로 나누어 보면, 남아에서는 고중성지방의 빈도가 group I에서는 15.0%, group II에서는 23.2%, group III은 34.5%로 비만할수록 더욱 증가하였고, 여아에서는 group I에서는 11.8%, group II는 20.7%, group III은 28.2%였다. 비만도에 의하면 남아에서 경도비만은 17.2%, 중증도 비만은 29.2%, 고도비만은 39.7%였고, 여아에서는 10.0%, 19.5%, 29.8%였다. 결 론 : 본 연구에서는 청소년기의 비만시 혈청지질 검사를 BMI만으로 하였을 경우 10.0-17.0%의 누락을 보였으므로 BMI 기준에 의한 혈중 지질의 측정은 한계가 있었다. 또한, 비만할수록 높아지는 고지혈증의 빈도는 비만도에 의한 것이 BMI보다 더 잘 반영하였다. 따라서 성인병 선별검사는 비만도에 의한 것이 좀더 누락율을 줄일 수 있을 것으로 사료된다. 심혈관 질환발생 위험 예측인자로는 남녀 모두 비만할수록 중성지방이 증가하여 중성지방이 관련 있는 것으로 나타났다. Purpose : Every year, there is a remarkable increase in the prevalence of children with excess body fat. The aim of this study is to find a useful screening method in assessing adolescent, obesity and to specify the predictable risk factors that are related to adult cardiovascular disease according to BMI and obesity index. Methods : From July to November in 2001, a total of 2,814(male : female=2,011 : 803) mid to high school students who were in the obesity range according to obesity index(>20%) were evaluated according to height, weight, body mass index(BMI), obesity index, and serum lipid levels. Results : Among the obese students over 20% by obesity index, 86.6% were over the range of 95 percentile by BMI. Among students defined as obese by BMI, 21.0% of males and 21.4% of females students had hypercholesterolemia; by obesity index, the ratio was 20.7% male and 19.0% female. The frequency of hypertriglyceremia in male students was 15.0% in group I(overweight group, 85P<BMI<95P), 23.2% in group II(obese, 95P<BMI<97P) and 34.5% in group III(extreme obese, BMI>97p); in female students 11.8%, 20.7% and 28.2% respectively. Conclusion : In this study, using BMI alone to test the serum lipid level in adolescent obesity had a limit of 10.0-17.0% omission. Therefore using obesity index as a screening method to find the adult cardiovascular disease would rather reduce the omission rate. The risk factor of cardiovascular disease according to BMI was the increasing level of triglyceride in both male and female students. We think that using the obesity index has more rationale rather than BMI in assessing lipid profiles.

미숙아에서 발견된 부분형 DiGeorge 증후군 1례

성태정,고은영,김달현,오지은,권영세,임대현,손병관,Sung, Tae Jung,Ko, Eun Young,Kim, Dal Hyon,Oh, Ji Eun,Kwon, Young Se,Lim, Dae Hyun,Son, Byong Kwan 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.3

저자들은 미숙아에서 청색증과 무호흡증으로 입원 치료 하던 중 저칼슘혈증으로 인한 경련이 나타난 환아에게서 흉부 X선 사진과 MRI상 흉선을 관찰할 수 없으면서 T 세포수의 감소와 부갑상선 홀몬수치 감소를 나타내고 소악증, 어구, 부리모양의 코 등의 안면 기형과 합지증, 코 역류증, 폐쇄성 수면 무호흡증, 구개 범인두 부전증 등의 증상을 보이며 염색체 22q11 극소결실이 FISH검사에서 확진된 부분형 DiGeorge 증후군 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. We experienced a case of partial DiGeorge syndrome in a $35^{+5}$ week premature female infant presented with micrognathia, fish-shaped mouth, beaked nose, nasal regurgitation, obstructive sleep apnea, velopharyngeal insufficiency and late onset hypocalcemic seizures. The chromosome 22q11 microdeletion was found by the FISH method. The lab findings showed serum calcium level of 4.4 mg/dL, ionized calcium level of 0.49 mg/dL, phosphorous level of 7.5 mg/dL, magnesium level of 1.3 mg/dL and PTH-RIA level of <1 pq/mL. Initial treatment was done with 10% calcium gluconate infusion and magnesium sulfate followed by oral calcium gluconate and low phosphorousformula milk feeding. The serum calcium level was normalized in 6 days. Nasal regurgitation, desaturation with obstructive sleep apnea continued. T-cell functions & numbers(CD 3, CD 4, CD 8)were decreased but Ig G/A/M levels were normal. No visible signs of thymus shadow were seen in either chest X-ray & chest MRI. Electrocardiography and echocardiography showed normal heart. Kidney ultrasonographby showed right side mild hydronephrosis. Neurosonography was normal but EEG showed electrical partial seizure. Hearing assessment by BERA showed mild to moderate hearing impairment. Velopharyngoplasty is scheduled for further treatment. A brief review of literature was made.

출생 전 염증반응과 미숙아 주요 합병증과의 관계: 최신지견을 중심으로

성태정 ( Tae Jung Sung ) 대한주산의학회 2013 Perinatology Vol.24 No.3

Infant who is less than a gestational age of 37 weeks, called premature baby, is born earlier and hence all organs are immature. Nowadays several studies showed that long-term outcomes of premature babies were dependent on the postnatal conditions or level of NICU care. However, there is growing body of evidence implicating infection during the prenatal periods as important contributors to the risk of adverse outcome in this high-risk population. Postnatal inflammations are characterized by the presence of marked release of inflammatory mediators; elevated proinflammatory cytokine levels (IL-1, IL-6, IL-8, TNF-α), C-reactive protein, myeloperoxidase, intercellular adhesion molecule-1, matrix metalloproteinase are reported in preterm infants with prenatal inflammation. Moreover, premature-associated morbidities such as bronchopulmonary dysplasia, periventricular leukomalacia, nectrotizing enterocolitis, sepsis, and retinopathy of pretmaturity are more often in that condition. In the future, studies should be continued on intrauterine inflammation together with postnatal inflammation and strategies to reduce the rates of infection with possible drugs in these vulnerable infants are needed.

신생아 호흡 곤란증 치료의 최신지견

성태정 ( Tae Jung Sung ) 대한주산의학회 2014 Perinatology Vol.25 No.2

Respiratory distress syndrome (RDS) is a syndrome caused by pulmonary insufficiency especially in premature infants. It is due to lack of alveolar surfactant along with structural immaturity of the lung. Although recent advances in the management of RDS, it is still a major cause of morbidity and mortality in premature infants. Surfactant replacement therapy is crucial in the management of RDS. Exogenous lung surfactant can be either natural or synthetic. Natural surfactant is extracted from animal sources such as bovine or porcine. Synthetic surfactant is manufactured from compounds that mimic natural surfactant properties. Until recently, natural surfactant extracts would seem to be the more desirable choice. Two basic strategies for surfactant replacement have emerged: prophylactic or preventive treatment, in which surfactant is administered at the time of birth or shortly thereafter to infants who are at high risk for developing RDS from surfactant deficiency; and rescue or therapeutic treatment, in which surfactant is administered after the initiation of mechanical ventilation in infants with clinically confirmed RDS. At least 100 mg/kg of phospholipid is required, but there are pharmacokinetic and clinical data suggesting that 200 mg/kg has a better clinical outcome. Recent recommended method is ‘INSURE’ (Intubate-SURfactant-Extubation) technique. After installation of pulmonary surfactant, reducing the high peak and fluctuations in oxygen saturation are important since these are associated with an increased incidence of retinopathy of prematurity. Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia.