• Kosin Medical Journal
• /
• v.33 no.3
• /
• pp.380-385
• /
• 2018

Objectives: Aminophylline has been used for prevention or treatment of apnea in preterm infants with idiopathic apnea of prematurity. The aim of this study was to assess the clinical usefulness of prophylactic in comparison with therapeutic aminophylline therapy. Methods: This retrospective observational study included infants born with a birth weight of < 2,500 g or at < 36 weeks of gestation. Infants born between August 2013 and July 2014 who received aminophylline therapy within 24 hr after birth were assigned to the prophylactic group, while infants born between August 2014 and July 2015 who received aminophylline therapy after obvious apnea were assigned to the therapeutic group. We compared clinical characteristics, including days of ventilator and oxygen therapy and bronchopulmonary dysplasia (BPD) between both groups. Results: Sixty-four patients and 25 infants were identified in the prophylactic and therapeutic groups, respectively. The mean gestational age and birth weight were $32.57{\pm}1.96weeks$ and $1765{\pm}205g$, respectively, in the prophylactic group and $32.46{\pm}1.82weeks$ and $1770{\pm}250g$, respectively, in the therapeutic group. No significant differences in clinical characteristics were found between the two groups. Similar clinical outcomes, including days of ventilator and oxygen therapy, intraventricular hemorrhage (IVH), periventricular leukomalacia, and BPD, were observed between the two groups. Conclusions: The present study showed that the prophylactic use of aminophylline does not improve the clinical outcomes, including BPD, IVH, and ventilator dependency as compared with therapeutic use. In other words, routine prophylactic use of aminophylline is unnecessary.

• Neonatal Medicine
• /
• v.25 no.4
• /
• pp.178-185
• /
• 2018

Purpose: We aim to assess the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), Adaptive Behavior (AB) and Social-Emotional (SE) scales at 18 to 24 months of corrected age (CA) to examine their associations with school-age cognitive and behavioral outcomes in children born preterm. Methods: Eighty-eight infants born with a very low birth weight (<1,500 g) or a gestational age of less than 32 weeks who were admitted to the neonatal intensive care unit from 2008 to 2009 were included. Of the 88 children who completed school-age tests at 6 to 8 years of age, 37 were assessed using the Bayley-III, including the AB and SE scales, at 18 to 24 months of CA. Correlation, cross-tabulation, and receiver operating characteristic analyses were performed to assess the longitudinal associations. Results: A significant association was observed between communication scores on the Bayley-III AB scale at 18 to 24 months of CA and the Korean version of the Wechsler Intelligence Scale for Children (K-WISC) full-scale intelligence quotient (FSIQ) at school age (r=0.531). The total behavior problem scores of the Korean version of the Child Behavior Checklist (K-CBCL) at school age were significantly negatively related to the Bayley-III SE and AB scales but not to the cognitive, language, or motor scales. Conclusion: Our findings encourage AB and SE assessments during the toddler stage and have important implications for the early identification of children in need of intervention and the establishment of guidelines for follow-up with high-risk infants.

• Clinical and Experimental Pediatrics
• /
• v.63 no.11
• /
• pp.433-437
• /
• 2020

Background: Indonesia is one of the countries with the highest preterm birth rate. Preterm infants are more likely than term and normal weight infants to experience neonatal mortality and morbidity due to acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems. Kangaroo mother care (KMC) is a proven cost-effective intervention to help reduce mortality rates among preterm infants; however, it has not been fully implemented in hospitals. Purpose: Assess KMC knowledge and perceptions among health providers. Methods: This qualitative study was conducted from December 2015 to April 2016 and consisted of 21 in-depth interviews and 3 focus group discussions (FGDs). The 3 categories of health personnel in the study were clinical providers, hospital management representatives, and Indonesian Midwife Association members. Results: Most health providers know about the benefits of KMC including stabilizing temperatures, weight gain, and maternal-infant bonding and reducing human resources and labor costs. They were also aware of which newborns were eligible for KMC treatment. Their knowledge was mostly gained from observation or obtained from pediatricians and personal experience. They believed that a low birth weight infant in an incubator could not be treated with KMC and that it could only be practiced if a special gown was used when holding the baby. This perception could be caused by a lack of formal KMC training, leading to misunderstanding of its aspects. Conclusion: In conclusion, KMC knowledge of clinical providers in the 2 hospitals was sufficient, primarily due to their health-related educational background. Some perceptions could be potential barriers to or facilitate the implementation of KMC practice. These perceptions should be considered in future KMC training designs.

• Women's Health Nursing
• /
• v.27 no.1
• /
• pp.40-48
• /
• 2021

Purpose: This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for the period of 2008-2018. Methods: The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). Results: Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. Conclusion: Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in preterm birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent preterm births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.

• Obstetrics & gynecology science
• /
• v.61 no.6
• /
• pp.655-661
• /
• 2018

Objective There is concern regarding the safety of delayed cord clamping (DCC) in babies born at less than 34 weeks' gestation. Therefore, the primary objective of this study was to compare the rates of hyperbilirubinemia and polycythemia during initial 7 days in infants born at less than 34 weeks' gestation and randomized to receive DCC by 120 seconds or early cord clamping (ECC) within less than 30 seconds. Methods One hundred pregnant women were randomly subjected to DCC or ECC at the time of birth in a tertiary referral hospital setting. Blood samples were obtained from each newborn at 48 hours and 7 days for hematocrit measurement. Serum bilirubin levels were estimated once the infant had clinically significant jaundice or at 72 hours. For the statistical analysis, the ${\chi}^2$ test, Student's t-test, or Wilcoxon rank sum test was used. Results The hematocrit was significantly higher in the DCC group than in the ECC group (P<0.001). None of the babies had polycythemia. Mean total serum bilirubin level was 6.6 mg/dL in the DCC group and 8.7 mg/dL in the ECC group (P<0.001). There was no increased risk of hyperbilirubinemia in the DCC group. Conclusion DCC benefits preterm neonates with no significant adverse effects.

• Journal of Preventive Medicine and Public Health
• /
• v.54 no.6
• /
• pp.422-430
• /
• 2021

Objectives: Pregnant women are especially vulnerable to respiratory infections such as coronavirus disease 2019 (COVID-19), but insufficient research has investigated pregnancy and its outcomes in women with COVID-19. This cross-sectional study compared birth outcomes related to COVID-19 between Bangladeshi pregnant women with and without COVID-19. Methods: The study was conducted at 3 tertiary referral hospitals in Dhaka, Bangladesh, from March to August 2020. Pregnant women admitted for delivery at these hospitals with laboratory results (reverse-transcription polymerase chain reaction) were analyzed. Using convenience sampling, we included 70 COVID-19-positive and 140 COVID-19-negative pregnant women. Trained and experienced midwives conducted the interviews. Data were analyzed using the t-test, the chi-square test, and univariate and multivariable linear and logistic regression. Results: Pregnant women with COVID-19 were more likely to give birth to a preterm baby (adjusted odds ratio [aOR], 2.15; 95% confidence interval [CI], 1.06 to 4.37) and undergo a cesarean section (aOR, 3.27; 95% CI, 1.51 to 7.07). There were no significant differences in birth weight, premature rupture of membranes, and the Apgar score at 1 minute or 5 minutes post-delivery between women with and without COVID-19. All the newborn babies who were born to COVID-19-positive women were COVID-19-negative. Conclusions: Our study suggests that pregnant women with COVID-19 were more likely to give birth to a preterm baby and undergo a cesarean section. For this reason, physicians should be particularly cautious to minimize adverse birth outcomes among pregnant women with COVID-19 and their newborn babies.

• BMB Reports
• /
• v.55 no.8
• /
• pp.370-379
• /
• 2022

Human pregnancy is a delicate and complex process where multiorgan interactions between two independent systems, the mother, and her fetus, maintain pregnancy. Intercellular interactions that can define homeostasis at the various cellular level between the two systems allow uninterrupted fetal growth and development until delivery. Interactions are needed for tissue remodeling during pregnancy at both fetal and maternal tissue layers. One of the mechanisms that help tissue remodeling is via cellular transitions where epithelial cells undergo a cyclic transition from epithelial to mesenchymal (EMT) and back from mesenchymal to epithelial (MET). Two major pregnancy-associated tissue systems that use EMT, and MET are the fetal membrane (amniochorion) amnion epithelial layer and cervical epithelial cells and will be reviewed here. EMT is often associated with localized inflammation, and it is a well-balanced process to facilitate tissue remodeling. Cyclic transition processes are important because a terminal state or the static state of EMT can cause accumulation of proinflammatory mesenchymal cells in the matrix regions of these tissues and increase localized inflammation that can cause tissue damage. Interactions that determine homeostasis are often controlled by both endocrine and paracrine mediators. Pregnancy maintenance hormone progesterone and its receptors are critical for maintaining the balance between EMT and MET. Increased intrauterine oxidative stress at term can force a static (terminal) EMT and increase inflammation that are physiologic processes that destabilize homeostasis that maintain pregnancy to promote labor and delivery of the fetus. However, conditions that can produce an untimely increase in EMT and inflammation can be pathologic. These tissue damages are often associated with adverse pregnancy complications such as preterm prelabor rupture of the membranes (pPROM) and spontaneous preterm birth (PTB). Therefore, an understanding of the biomolecular processes that maintain cyclic EMT-MET is critical to reducing the risk of pPROM and PTB. Extracellular vesicles (exosomes of 40-160 nm) that can carry various cargo are involved in cellular transitions as paracrine mediators. Exosomes can carry a variety of biomolecules as cargo. Studies specifically using exosomes from cells undergone EMT can carry a pro-inflammatory cargo and in a paracrine fashion can modify the neighboring tissue environment to cause enhancement of uterine inflammation.

• Pediatric Infection and Vaccine
• /
• v.29 no.3
• /
• pp.161-165
• /
• 2022

We report a case of successful treatment of congenital syphilis in an extremely preterm baby. A 1,395 g female infant was born by emergency Caesarean section due to preterm labor and breech presentation at gestational age at 29 weeks and 3 days with an Apgar score of 2 and 4 at 1 minute and 5 minutes, respectively. The mother of the newborn, an illegal immigrant who did not receive any antenatal care, was diagnosed as active syphilis infection by reactive rapid plasma regain (RPR) (titer 1:128) just before the delivery. Upon birth, the newborn presented with various clinical manifestations, including severe respiratory distress syndrome, persistent pulmonary hypertension of the newborn, disseminated intravascular coagulopathy, desquamation and scaling of the whole body, and osteolytic changes of long bone ends. Results of laboratory tests showed signs of early congenital syphilis, including positive syphilis reagin test (12.7 R.U.), reactive with RPR titer of 1:64, and positive for immunoglobulin (Ig) M and IgG fluorescent treponemal antibody absorption test. However, after completion of penicillin G treatment for two weeks, laboratory results dramatically improved, showing a negative syphilis reagin test (0.5 R.U.) and non-reactive in RPR. In conclusion, the incidence of congenital syphilis is prone to be resurgent in South Korea, neonatologists should be fully aware of the clinical features of congenital syphilis because early diagnosis and prompt treatment are essential in order to reduce the social and economic burden due to congenital syphilis.

• Microbiology and Biotechnology Letters
• /
• v.51 no.1
• /
• pp.109-123
• /
• 2023

Preterm birth (PTB) is defined as giving birth prior to the 37th week of pregnancy and is a major cause of infant mortality. Studies have indicated that the vaginal microbiota's composition and its dysbiosis, particularly during pregnancy, may play a major role in PTB. While previous research work concentrated on well-studied microorganisms such as Lactobacillus, Prevotella, Gardnerella, various other microbes, and their significance in the vaginal microbiota's stability remain unknown. Moreover, current studies have focused primarily on the relative abundances of the microbes found, without considering their interactions with other members of the vaginal microbiota. In this work, we developed a novel computational approach and performed taxonomic classification of vaginal microbiota samples stratified longitudinally (Term/PTB) to observe compositional disparities and find underexamined microbes that may be contributing to PTB. Furthermore, we carried out a correlational analysis to build a microbial co-interaction network and investigated the functional implications of the genes present in both Term and PTB samples. The co-occurrence network revealed that Lactobacillus acts in solidarity to maintain the stability of the vaginal microbiota and did not have strong co-interactions with any of the other microbes. Similarly, microbes with strong interactions with Atopobium, a well-known marker microbe of PTB, were also observed. Additionally, several genes such as PTXA, FANCM, GPX, and DUSP were found to be playing an important role in the occurrence of PTB. This study provides a novel conceptual framework revealing distinct vaginal microbiota signatures that could be potential therapeutic targets for the prevention of PTB.

• Genomics & Informatics
• /
• v.21 no.3
• /
• pp.29.1-29.9
• /
• 2023

Preterm birth (PTB), a pregnancy-related disease, is defined as a birth before 37 weeks of gestation. It is a major cause of maternal mortality and morbidity worldwide, and its incidence rate is steadily increasing. Various genetic factors can contribute to the etiology of PTB. Vascular endothelial growth factor A (VEGFA) gene is an important angiogenic gene and its polymorphisms have been reported to be associated with PTB development. Therefore, we conducted a case-control study to evaluate the association between VEGFA rs699947, rs2010963, and rs3025039 polymorphisms and PTB in Korean women. A total of 271 subjects (116 patients with PTB and 155 women at ≥38 weeks of gestation) were analyzed in this study. The genotyping of VEGFA gene polymorphisms was performed using polymerase chain reaction- restriction fragment length polymorphism. No significant association between the patients with PTB and the control groups was confirmed. In the combination analysis, we found a significant association between PTB and VEGFA rs699947 CC-rs2010963 GG-rs3025039 CC combination (odds ratio, 3.77; 95% confidence interval, 1.091 to 13.032; p = 0.031). The VEGFA rs699947, rs2010963, and rs3025039 polymorphisms might have no genetic association with the pathogenesis of PTB in Korean women. However, the combination analysis indicates the possibility that VEGFA acts in PTB pathophysiology. Therefore, larger sample sets and replication studies are required to further elucidate our findings.