Although impaired neurodevelopment is strongly associated with severe brain injury, most preterm infants survive without severe brain injury. In this study, the association of impaired neurodevelopment and neonatal morbidities of preterm infants was assessed after excluding those with severe brain injury. This was a retrospective study of very low birthweight infants in a single tertiary center. After excluding infants with severe brain injury, the study population was categorized as infants without intraventricular hemorrhage (IVH) and with low-grade IVH. Neurodevelopmental outcomes at a corrected age (CA) of 18–24 months were evaluated using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III). Cerebral palsy (CP), hearing impairment and blindness were also assessed and compared. Of 240 infants, 25 (11.6%) infants had combined neurodevelopmental impairment (NDI). In the multivariate analysis for combined NDI, small for gestational age (SGA) (adjusted OR 6.820, 95% confidence intervals (CI) 1.770–26.307), moderate to severe bronchopulmonary dysplasia (BPD) (aOR 3.21, 95% CI 1.032–9.999) and severe retinopathy of prematurity (ROP) (aOR 5.669, 95% CI 1.132–28.396) were associated with combined NDI. Among neonatal morbidities, moderate to severe BPD and severe ROP were associated with adverse neurodevelopmental outcomes in preterm infants without severe brain injury.

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Background: Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high.Purpose: We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center.Methods: This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016.Results: A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7–36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53–4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7–36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53–4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival.Conclusion: For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.

Background Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. Methods A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. Results Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month ( P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month ( P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals ( P = 0.003). A difference was also noted between occupation categories ( P = 0.019), but a more significant difference was found in the comparison between nurses and doctors ( P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts ( P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference ( P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. Conclusion In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.

Objective: It is difficult to make a distinction between acute pyelonephritis and lower urinary tract infection due to nonspecific clinical symptoms and laboratory findings. We measured the spot urine β2-microglobulin in children with urinary tract infection (UTI) to distinguish between acute pyelonephritis and lower UTI. We compared the accuracy of urine β2-microglobulin measurement with other inflammatory markers. Methods: We studied 83 children (mean, 86± 44.9 months) who suspected of having UTI. Leukocyte counts, erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP), β2-microglobulin were measured. Renal parenchymal involvement was evaluated by 99mTc dimercaptosuccinic acid scintigraphy in the first 7 days after admission. β2-microglobulin was measured by radioimmunoassay. Results: Urine β2-microglobulin values were correlated with the presence of renal defects in children with UTI (n= 22) (0.98± 0.24 μg/mL, P< 0.05). Using a cutoff of 0.4 μg/mL for spot urine β2-microglobulin and 20 mm/hr for ESR, 2.6 mg/L for CRP, sensitivity and specificity between UTI with and without renal involvement were 78.7% and 90.1% for spot urine β2-microglobulin, 77.2% and 90.1% for spot urine β2-microglobulin/creatinine (Cr), 77.2%, 68.8% for ESR, 86.3%, 68.8% for CRP, respectively. Positive and negative predictive values were 72.7%, 90.1% for spot urine β2-microglobulin, 73.9% and 91.6% for spot urine β2-microglobulin/Cr, and 57.5%, 94% for CRP, respectively. Conclusion: In febrile UTI, spot urine β2-microglobulin and β2-microglobulin/Cr values were more specific than CRP, ESR, and leukocyte count for determine the renal defects.