The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

Background@#Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs). @*Methods@#Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data. @*Results@#After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly. @*Conclusion@#From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN.

The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

Background@#Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs). @*Methods@#Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data. @*Results@#After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly. @*Conclusion@#From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN.

Effects of Music Intervention Techniques on Very-Low-Birth-Weight Infants in Neonatal Intensive Care Unit: A Preliminary Study

Purpose@#The aim of this study was to evaluate the physiological and behavioral effects of auditory stimulation with their own parent’s voice on heart rate and sleep states of very-low-birth-weight infants (VLBWIs) in neonatal intensive care unit. @*Methods@#The data of 28 VLBWIs at the Ewha Womans University Mokdong Hospital between October 2016 and May 2017 was analyzed. They were exposed to sounds similar to those of mothers’ heartbeat they had heard in the uterus and their own parent’s voice. Heart rate was assessed as the physiological responses and sleep state of infants as behavioral response. The sleep states were categorized into six states. The music intervention program was provided twice a week. @*Results@#Twenty-eight babies with an average gestational age of 28 weeks (average birth weight of 1.09 kg) had undergone the sessions (average of 16 times) average of 16 times. During the initial period, there were no meaningful differences of the heart rates measured by the physiological functions before and after the sessions. However, as we move to the adaptive phase, the average heart rate was 156.96±12.22, and the pre-discharge was 149.11±12.01, which indicates meaningful differences (P<0.05). Infants’ behavioral function was statistically insignificant. @*Conclusion@#The music intervention techniques in the neonatal intensive care unit environment in Korea have provided positive influence to VLBWIs' physiological reactions. We were not able to come up with the relevant indicators during this phase of the study but we do plan to announce the future study results after indexing the observation results.

Acquired Hypopituitarism in Diamond-Blackfan Anemia / 이화의대지

Diamond-Blackfan anemia (DBA) is a rare, inherited bone marrow failure syndrome that manifests as anemia in early infancy. Blood transfusion is a critical factor for survival. However, blood transfusions can result in iron overload. Endocrinopathies, hepatic cirrhosis, and cardiomyopathy are the most common complications of iron overload. Here, we report the case of an 18-year-old boy with DBA with hyperglycemia, short stature, and absence of puberty. The patient showed endocrine dysfunction associated with iron overload caused by repeated transfusions. He was eventually diagnosed with acquired hypopituitarism and was placed on testosterone replacement therapy. Endocrine dysfunction is common in patient with DBA, with an early manifestation of symptoms, even in teenage years. Patients receiving corticosteroid treatment or those in remission may also exhibit endocrine dysfunction, although its prevalence is the highest among chronic transfusion patients. Ongoing monitoring and evaluation of growth and pubertal development are needed for better management of these disorders.

Effects of Music Intervention Techniques on Very-Low-Birth-Weight Infants in Neonatal Intensive Care Unit: A Preliminary Study

Purpose@#The aim of this study was to evaluate the physiological and behavioral effects of auditory stimulation with their own parent’s voice on heart rate and sleep states of very-low-birth-weight infants (VLBWIs) in neonatal intensive care unit. @*Methods@#The data of 28 VLBWIs at the Ewha Womans University Mokdong Hospital between October 2016 and May 2017 was analyzed. They were exposed to sounds similar to those of mothers’ heartbeat they had heard in the uterus and their own parent’s voice. Heart rate was assessed as the physiological responses and sleep state of infants as behavioral response. The sleep states were categorized into six states. The music intervention program was provided twice a week. @*Results@#Twenty-eight babies with an average gestational age of 28 weeks (average birth weight of 1.09 kg) had undergone the sessions (average of 16 times) average of 16 times. During the initial period, there were no meaningful differences of the heart rates measured by the physiological functions before and after the sessions. However, as we move to the adaptive phase, the average heart rate was 156.96±12.22, and the pre-discharge was 149.11±12.01, which indicates meaningful differences (P<0.05). Infants’ behavioral function was statistically insignificant. @*Conclusion@#The music intervention techniques in the neonatal intensive care unit environment in Korea have provided positive influence to VLBWIs' physiological reactions. We were not able to come up with the relevant indicators during this phase of the study but we do plan to announce the future study results after indexing the observation results.

Expression of c-Met Is Different along the Location and Associated with Lymph Node Metastasis of Head and Neck Carcinoma

BACKGROUND: Activation of the c-Met pathway is involved in cancer progression and the prognosis. We aimed to identify any association of c-Met protein expression with a number of clinicopathologic variables including infection of human papillomavirus and Epstein-Barr virus (EBV) in head and neck carcinomas (HNCa). METHODS: Eighty-two cases were enrolled in this study. Expression of c-Met and p16 was investigated immunohistochemically. EBV was detected by in situ hybridization and amplification of the c-Met gene by fluorescence in situ hybridization. RESULTS: The c-Met protein was expressed in 41.5% (34/82), and gene amplification was found in 1.4% (1/71). High expression of c-Met was associated with the primary location of the tumor; the hypopharynx showed the highest expression, followed by the oral cavity, larynx, and nasal cavity. Squamous cell carcinoma expressed c-Met more frequently than undifferentiated carcinoma. Also, p16 immunoreactivity or EBV infection was associated with the tumor location and well-differentiated histologic type, but were not linked to c-Met expression. The patients with positive c-Met expression showed frequent lymph node metastasis. CONCLUSIONS: Activation of the c-Met pathway might be involved in a subset of HNCa. Cases showing positive c-Met expression should be carefully monitored because of the high probability of lymph node metastasis.