Breastfeeding not only reduces infection-related morbidity, but also increases growth of preterm infants. Advantages of breast milk (BM) for preterm infants are significant. They continue to be studied. However, because not all preterm infants can receive breastfeeding, bovine-based infant formula (IF) is used as an alternative, which may increase the risk of several preterm complications. Exosomes isolated from biofluids are emerging as biomarkers in research of various diseases. Here, we characterized miRNA contents of exosomes in urine and serum samples of preterm infants who were BM and IF fed and performed transcriptomic analysis of small RNA libraries. We identified significantly up-regulated 6 miRNAs and 10 miRNAs, respectively. Gene Ontology (GO) analysis revealed that target genes of these miRNAs might participate in neuronal development, immunity modulation, detoxification of reactive oxygen species, and transmembrane exchange. Our data suggest that exosome-based systemic screening for preterm infants with breastfeeding might be a screening tool for identifying target molecules involved in therapy for preterm infants in neonatal intensive care unit (NICU) and for future application as nutraceutical formulations or pharmaceuticals.

Background/Objectives: Extrauterine growth restriction (EUGR) is associated with high mortality and an increased incidence of poor neurodevelopmental outcomes in preterm infants. In this study, we aimed to compare the Intergrowth-21ST (IG-21ST) and Fenton charts in predicting long-term neurodevelopmental and anthropometric outcomes of very low birth weight (VLBW) infants. Methods: Data were collected from 2649 VLBW infants registered in the Korean Neonatal Network born between 240/7 and 316/7 weeks of gestational age from January 2013 to December 2017. Follow-up assessments were conducted at 18–24 months of age, corrected for prematurity. Multiple logistic regression analysis was performed to evaluate the association between EUGR and long-term outcomes. Results: Among the 2649 VLBW infants, 60.0% (1606/2649) and 36.9% (977/2649) were diagnosed as having EUGR defined by the Fenton chart (EUGRF) and by the IG-21ST chart (EUGRIG), respectively. The EUGRIG group exhibited a higher proportion of infants with cerebral palsy, neurodevelopmental impairment (NDI), and growth failure. In multiple logistic regression analysis, adjusted for risk factors for long-term outcome, the EUGRIG group showed higher risk of cerebral palsy (adjusted odds ratio [aOR], 1.66; 95% confidence interval [CI], 1.04–2.65), NDI (aOR, 2.09; 95% CI, 1.71–2.55), and growth failure (aOR, 1.57; 95% CI, 1.16–2.13). Infants with EUGRF tended to develop NDI (aOR, 1.29; 95%CI, 1.03–1.63) and experience growth failure (aOR, 2.44; 95% CI, 1.77–3.40). Conclusions: The IG-21ST chart demonstrated a more effective prediction of long-term neurodevelopmental outcomes, whereas the Fenton chart may be more suitable for predicting growth failure at 18–24 months.

Amphotericin B is widely used in the treatment of neonatal invasive fungal disease. Liposomal amphotericin B (LAmB) is now preferred over conventional amphotericin B deoxycholate due to its lower kidney toxicity. However, it is essential to monitor the possible side effects of LAmB when treating extremely premature infants. Herein, we present a case of an extremely premature infant who exhibited persistent metabolic acidosis, hypoglycemia, and dyselectrolytemia after administration of LAmB for a suspected fungal infection.

Neonatal hyperinsulinism, whether permanent or transient, results in prolonged hypoglycemia, which increases the risk of hypoglycemic brain injury. Therefore, prompt diagnosis and management of hyperinsulinemic hypoglycemia is important. Drawing a “critical sample” at the time of hypoglycemia is useful for diagnosis. Genetic testing for defective insulin-regulating genes in pancreatic beta-cells might also be helpful in cases of prolonged hypoglycemia. High-calorie feeding or glucose infusion is necessary to maintain normoglycemia. Diazoxide is the treatment of choice for hyperinsulinism and should be continued until the hypoglycemia resolves. We describe a case of transient neonatal hyperinsulinemia hypoglycemia in a small-for-gestational-age preterm infant who underwent diazoxide treatment and achieved a favorable outcome.

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that persists for more than 2 weeks and requires insulin therapy. NDM principally occurs before 6 months of age. Transient NDM (TNDM) is a clinical form of NDM that persists for a median of 12 weeks and resolves completely by 18 months. However, it may relapse as type 2 DM during early adulthood. The major causes of TNDM are mutations in chromosome 6q24 or the KCNJ11 or ABCC8 genes; the latter encode the two subunits of the pancreatic adenosine triphosphate (ATP)-sensitive potassium channel (KATP-channel). This condition responds well to oral sulfonylurea therapy. Herein, we report a neonate who was small for gestational age and exhibited TNDM symptoms. Genetic analysis revealed a nonspecific mutation in ABCC8; he was successfully treated with oral sulfonylurea.

Background Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. We aimed to investigate whether preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Methods This prospective cohort study enrolled infants born before 30 weeks of gestation or with birth weight < 1250 g. Infants were grouped according to the presence of systemic inflammation: Control (no inflammation, n = 49), I (systemic inflammation, n = 45). Blood and cerebrospinal fluid samples for markers of brain injury and inflammation were collected and amplitude-integrated electroencephalography (aEEG) was performed within 4 h of septic workup. We evaluated aEEG at 35 weeks postmenstrual age (PMA), head circumference at 36 weeks PMA, and brain MRI at discharge. The Bayley Scales of Infant and Toddler Development III (Bayley-III) was performed at a corrected age (CA) of 18 months. Results The I group had more white matter injuries (2 vs. 26.7%, Control vs. I, respectively) at the time of discharge, lower brain functional maturation (9.5 vs. 8), and smaller head size (z-score − 1.45 vs. -2.12) at near-term age and poorer neurodevelopment at a CA of 18 months than the control ( p < 0.05). Among the I group, the proportion of immature neutrophils (I/T ratios) and IL-1 beta levels in the CSF were associated with aEEG measures at the day of symptom onset (D0). Seizure spike on aEEG at D0 was significantly correlated with motor and social-emotional domains of Bayley-III ( p < 0.05). The I/T ratio and CRP and TNF-α levels of blood at D0, white matter injury on MRI at discharge, head circumference and seizure spikes on aEEG at near-term age were associated with Bayley-III scores at a CA of 18 months. Conclusions Systemic inflammation induced by clinical infection and NEC are associated with neurodevelopmental impairment in preterm infants. The seizure spike on aEEG, elevated I/T ratio, CRP, and plasma TNF-alpha during inflammatory episodes are associated with poor neurodevelopment.

Neonatal mastitis is a localized infection of breast tissue which rarely occurs during the neonatal period. Staphylococcus aureus is the most common causative pathogen of neonatal mastitis. Intra­ venous antibiotic therapy is usually regarded as an effective treatment modality; however, in some cases breast abscess can be formed which might need further surgical incision and drainage. Here, we present a case of neonatal mastitis with breast abscess formation, which undergone ultrasono­ graphy­guided needle aspiration and fully recovered without additional surgical incision. Needle aspiration under ultrasonography guidance can be considered as an effective and less­invasive treat­ ment of neonatal mastitis with abscess.

BACKGROUND Hypoxia and anemia are among the risk factors for retinopathy of prematurity (ROP). The kidneys are important organs that sense oxygen levels and regulate red blood cell synthesis via erythropoietin production. We investigated the contribution of abnormal renal function (reflected by serum creatinine [SCr] levels) to severe ROP in very low birth weight (VLBW) infants. METHODS In the present study, we enrolled 242 VLBW infants of gestational age (GA) ranging between 25 and 32 weeks who were admitted at Soonchunhyang Cheonan University Hospital between Nov 2014 and Dec 2019. The cut-off value for normal SCr for each GA group based was defined as 95th percentile of SCr based on a reference chart developed in a previous study. Risk factors for ROP requiring treatment were analyzed using logistic regression. RESULTS Of the 242 infants, 63 (26%) were high SCr group and 30 (12.4%) infants had ROP requiring treatment. GA (odds ratio 0.38, 95% confidence interval 0.23–0.61) and high SCr group (4.68 [1.10–19.90]) were independent factors for ROP requiring treatment. CONCLUSIONS In VLBW infants, high SCr within the first 4 weeks after birth is one of the risk factors for ROP requiring treatment.

Premature ovarian failure (POF) is a rare medical condition in adolescents. Its common cause is gonadal dysgenesis and an abnormal karyotype. Herein we report a rare case of POF resulting from a deletion in the terminal portion of Xq, 46,XX,del(q24). A 17-year-old girl was referred to our hospital for amenorrhea. Menarche had occurred at age 16 years; since then, irregular menstruation and amenorrhea appeared. She was of normal height, but her bone age was delayed compared to her chronologic age. While her breast development was normal, she had scant pubic hair. Her serum levels of luteinizing hormone and follicle stimulating hormone were 26.83 mIU/mL and 99.36 mIU/mL, respectively. A pelvic ultrasound examination revealed a small uterus and ovaries. Following the initiation of hormone replacement therapy, her menstrual cycle returned. In addition to this case report, we provide a brief review of the X chromosome regions involved in ovarian function.

Purpose Many studies have reported associations of early postnatal growth failure in preterm infants with several morbidities. However, the risk factors for postnatal weight loss (PWL) in late preterm infants have not been identified. We investigated the independent risk factors for PWL in late preterm infants. Methods This was a retrospective cohort study. We enrolled 369 late preterm infants born at 34+0 to 36+6 weeks gestational age who were admitted to the Soonchunhyang University Cheonan Hospital between 2015 and 2017. PWL% was calculated as (birth weight–lowest weight)/birth weight×100. The infants were classified into lower (<5%) and higher (≥10%) PWL% groups by propensity score matching for gestational age, sex, and birth weight. Perinatal risk factors were analyzed using multivariable logistic regression. Results The lower and higher PWL% groups included 62 and 31 infants, respectively. Antenatal steroids administered within 1 week before birth (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.015 to 10.465; P=0.047), lower total calorie intake during days 1 to 7 (OR, 0.98; 95% CI, 0.977 to 0.999; P=0.027), and phototherapy (OR, 5.28; 95% CI, 1.327 to 21.024; P=0.018) were independent risk factors for the higher PWL%. Conclusion Further studies are needed to identify the risk factors that cause high PWL% according to gestational age and short- and long-term morbidities based on the degree of PWL.

Purpose: We aimed to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU) by using various decolonization methods and to evaluate their efficacy.Methods: Medical records of all neonates who were admitted to the NICU of Seoul National University Children's Hospital were retrospectively reviewed.Surveillance culture were obtained for all neonates in the NICU 48 hours after admission.Three periods with different decolonization methods were compared; Period 1 was without any decolonization measures (July 1, 2009 to August 26, 2010).In period 2, intranasal mupirocin and chlorhexidine gluconate bathing were administered to MRSA-colonized neonates (August 27, 2010 to September 6, 2011).In period 3, only chlorhexidine bathing was performed for MRSA-colonized infants (September 7, 2011 to August 31, 2012).Results: A total of 1,378 infants were admitted to the NICU during the study period.Baseline demographic and clinical characteristics were similar among the 3 periods.The incidence of MRSA colonization per 1,000 patient-days was 6.27 for period 1, 7.02 for period 2, and 6.29 for period 3; however, these values were not significantly different.The incidence of MRSA infection was highest in period 3, with 0.69 cases per 1,000 patient-days; however, this finding was not significant.The MRSA infection/ colonization ratio also did not differ significantly among the 3 study periods.Conclusion: Decolonization of MRSA in the NICU with the application of chlorhexidine gluconate bathing alone or in combination with intranasal mupirocin were not effective in decreasing the incidence of MRSA colonization and infection.