Review of Meconium Aspiration Syndrome

( Myo-jing Kim ) 대한주산의학회 2024 Perinatology Vol.35 No.1

Meconium aspiration syndrome (MAS) is defined as respiratory distress in newborn infants born through meconium-stained amniotic fluid whose symptoms cannot be otherwise explained. MAS is characterized by hypoxemia, hypercapnia and acidosis that continues to be associated with significant morbidities and mortality. Worldwide, the incidence has declined due to improved obstetric and perinatal care. The pathophysiological mechanism of MAS include perinatal hypoxia, acute airway obstruction, pulmonary and systemic inflammation, surfactant inactivation and persistent pulmonary hypertension of the newborn (PPHN). Respiratory and hemodynamic supports are main therapies for MAS. Early identification and appropriate management of PPHN is important as it associates with significant mortality and morbidities. This review suggests a comprehensive overview of the epidemiology, diagnosis, management, prognosis and prevention of MAS.

Enteral nutrition for optimal growth in preterm infants

Myo-Jing Kim 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.12

Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant’s weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters.

Utility of neonatal early-onset sepsis calculator in risk-based group B Streptococcus screening approach

Myo Jing Kim 대한소아청소년과학회 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.10

Enteral nutrition for optimal growth in preterm infants

Kim, Myo-Jing The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.12

Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters.

유전자 검사로 확진된 색소 실조증

김묘징 ( Myo Jing Kim ),이기열 ( Ki Yeol Lee ),기창석 ( Chang Seok Ki ),송기훈 ( Ki Hoon Song ),김영훈 ( Young Hun Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.2

Incontinentia pigmenti (IP) is a rare X-linked dominant, multisystem genodermatosis that affects ectoderm-derived structures. Its cutaneous manifestations are usually subdivided into the vesicular, verrucous, hyperpigmented, and hypopigmented or atrophic stages. IP can also affect other ectoderm-derived structures, such as, hair, nails, teeth, eyes, and the central nervous and musculoskeletal systems. About 80% of IP patients have genomic deletions of exons 4∼10 of the NEMO (NF-κB-Essential MOdulator) gene, also known as the IKKy (gamma-subunit of the inhibitor κB kinase), which is essential for the activation of the NF-κB pathway. The female infant presented in this case report was born to healthy non-consanguineous parents and showed vesiculopustular eruptions with a NEMO gene rearrangement. No IP case has been previously reported to be related to a NEMO gene mutation in South Korea. In other words, this is the first report to confirm the relation between IP and mutation of the NEMO gene in Koreans. (Korean J Dermatol 2011; 49(2):164∼168)

낭성 기종격과 흉선 증식증을 동반한 신생아 1례

김묘징 ( Myo Jing Kim ),정진아 ( Jin A Jung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.4

인공 호흡기 치료를 받지 않거나 기존 폐병변이 없는 신생아에서 발생하는 자발성 기종격은 드믄 질환이다. 저자들은 출생 직후 호흡 곤란을 보이며 흉부 방사선 사진, CT, MRI 검사에서 낭성 기종격과 흉선 증식증을 동반한 신생아 1례를 경험하였기에 문헌 고찰과 함께 보고한다. Spontaneous pneumomediastinum in a term newborn without mechanical ventilation or underlying lung disease is rare. We present a case of a newborn baby who developed respiratory distress after birth and cystic pneumomediastinum which improved spontaneously with thymic hyperplasia as demonstrated on chest radiography, CT and MRI. The combination of cystic pneumomediastinum and thymic hyperplasia in a newborn has not been reported, thus far. [Pediatr Allergy Respir Dis(Korea) 2009;19:429-433]

Current Status of Therapeutic Strategies for Patent Ductus Arteriosus in Very-Low-Birth-Weight Infants in Korea

Lee, Jin A,Kim, Myo-Jing,Oh, Sohee,Choi, Byung Min The Korean Academy of Medical Sciences 2015 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.30 No.suppl1

<P>This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA ≥ 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.</P>

The Readmission of Preterm Infants of 30-33 Weeks Gestational Age within 1 Year Following Discharge from Neonatal Intensive Care Unit in Korea

Lee, Jang Hoon,Kim, Myo Jing,Kim, Young Don,Lee, Soon Min,Song, Eun Song,Ahn, So Yoon,Kim, Chun Soo,Lim, Jae Woo,Chang, Meayoung,Jin, Hyun-Seung,Hwang, Jong Hee,Lee, Woo Ryoung,Chang, Yun Sil The Korean Society of Neonatology (KAMJE) 2014 Neonatal medicine Vol.21 No.4

극소 저체중 출생아에서 초기 경험적 항생제 치료 기간이 신생아기 예후에 미치는 영향

박누리 ( Nu Ry Bag ),김묘징 ( Myo Jing Kim ) 대한주산의학회 2012 大韓周産醫學會雜誌 Vol.23 No.2

목적: 극소 저체중 출생아의 경우 출생 후 수일간 경험적 항생제 치료를 받게 되는 경우가 많다. 하지만 혈액 배양 검사에서 음성이지만 조기 패혈증이 의심되는 경우 경험적 항생제의 사용 기간에 대한 합의가 적다. 이에 극소 저체중 출생아에서 경험적 항생제의 사용 기간이 신생아기 예후에 미치는 영향을 알고자 하였다. 방법: 2007년 1월부터 2010년 12월까지 동아대학교 병원 신생아 집중 치료실에 입원하였던 출생 체중 1,500 g 미만의 극소 저체중 출생아를 대상으로 의무기록지를 통해 후향적으로 연구하였다. 출생 후 3일 이내 항생제 치료를 시작한 경우를 경험적 항생제 치료군으로 정의하였고, 경험적 항생제 치료 기간이 5일 미만인 단기 치료군(n=50)과 5일 이상인 장기 치료군(n=72)으로 나누어 신생아기 주요 임상적 예후를 비교하였다. 결과: 경험적 항생제 장기 사용군은 단기 사용군에 비해 출생 체중이 의미 있게 적었고(1,039.0±284.0 g vs. 1,145.5±294.6 g, P=0.04), 원외 분만(12.5% vs. 2.0%), 질식 분만의 빈도가 높았으며(38.9% vs. 14.0%), 1분(4.7±1.6 vs. 5.4±1.6)과 5분(7.1±1.2 vs. 7.7±1.0) 아프가 점수가 통계적으로 의미 있게 낮았다. 산과적인 위험 요인을 비교하였을 때 경험적 항생제 장기 사용군에서 산전 스테로이드 사용이 적었고(38.9% vs. 70.0%, P<0.01), 산전 산모의 항생제 치료가 유의하게 적었다(55.6% vs. 32.0%, P=0.02). 병리학적 융모 양막염(37.5% vs. 10.0%, P<0.01)과 조기 양막 파수(34.7% vs. 18.0%, P=0.03)는 항생제 장기 사용군에서 많았다. 경험적 항생제를 장기간 사용할 경우 신생아기 예후에서 장관 수유의 시작을 지연시켰고(OR 2.6; 95% CI: 1.7-9.1), ESBL의 출현 빈도를 증가 시켰다(OR 5.3; 95% CI: 1.4-65.9). 결론: 극소 저체중 출생아에서 초기 경험적 항생제 치료를 장기간 시행하는 것은 장관 수유 진행을 지연시키고, ESBL의 출현을 증가 시켰다. 앞으로 경험적 항생제의 제한적 사용에 대한 합의가 필요할 것이다. Purpose: Little is known about the duration of antibiotics for suspected early-onset sepsis (EOS) with negative blood cultures. The purpose of this study is to identify associations between the duration of empirical antibiotics and neonatal outcomes. Methods: We retrospectively reviewed medical records of very low birth weight infants (VLBW) who admitted to NICU in 2007-2010. We defined empirical antibiotic therapy group as those who started antibiotic therapy in first 3 postnatal days. We compared the neonatal outcomes between short empirical antibiotic therapy (<5 days) and long empirical antibiotic therapy (≥5 days). Results: Of 122 VLBW, 72 infants were long empirical antibiotic therapy group. In the long empirical antibiotic therapy group, there were lower birth weight, higher rate of out-born, higher rate of vaginal delivery, and had lower Apgar scores. Prolonged antibiotic therapy was associated with delayed start of enteral feeding and incidence of ESBL. Conclusion: Prolonged antibiotic therapy may be associated with some adverse neonatal outcomes. Therefore, wide spread agreement regarding the short empirical antibiotic therapy was needed.

Associated Factors with Respiratory Virus Detection in Newborn with Suspected Infection

( Jin-hyeok Lee ),( Sun-young Cho ),( Myo-jing Kim ) 대한주산의학회 2017 大韓周産醫學會雜誌 Vol.28 No.4

Objective: The objective of this study was to determine the detection rate of respiratory viruses and investigate the associated factors with respiratory virus detection in newborn infants with suspected infection. Methods: From January 2013 to December 2015, respiratory virus real-time polymerase chain reaction (RT-PCR) results were obtained from 136 newborn infants aged ≤28 days who admitted to the neonatal intensive care unit (NICU) of Dong-A University Hospital with suspected infectious diseases. We performed a retrospective analysis of the detection rate of respiratory virus, classes of respiratory viruses, clinical characteristics, and social environment characteristics associated with respiratory virus detection. Results: Of the 136 infants, 36 infants (26.5%) had the 37 following respiratory viruses: Respiratory syncytial virus (n=23), Rhinovirus (n=10), Parainfluenza virus (n=2), Influenza virus (n=1), and Corona virus (n=1). The detection of respiratory viruses was significantly associated with the old age at admission (17.3±5.8 vs. 10.6±6.8 days), the presence of respiratory symptoms: cough (72.2% vs. 7%), rhinorrhea (63.9% vs. 10%), rale (16.7% vs. 1%), a family history of respiratory illness (38.9% vs. 13%), especially siblings’ respiratory illness (33.3% vs. 8%), and a seasonal preference (October-March) (80.6% vs. 50%) (P<0.01). Conclusion: Respiratory virus is an important pathogen in newborn infants admitted to the NICU, who are suspected with infectious diseases. Respiratory virus detection was associated with admission age, presence of respiratory symptoms, a family history of respiratory illness, and seasonality.