PurposeWe investigated the vitamin D status of preterm infants to determine the incidence of vitamin D deficiency.MethodsA total of 278 preterm infants delivered at Kyungpook National University Hospital between January 2013 and May 2015 were enrolled. The serum concentrations of calcium, phosphorous, alkaline phosphatase, and 25-hydroxyvitamin D (25-OHD) were measured at birth. We collected maternal and neonatal data such as maternal gestational diabetes, premature rupture of membranes, maternal preeclampsia, birth date, gestational age, and birth weight.ResultsMean gestational age was 33+5±2+2 weeks of gestation and mean 25-OHD concentrations were 10.7±6.4 ng/mL. The incidence of vitamin D deficiency was 91.7%, and 51.1% of preterm infants were classified as having severe vitamin D deficiency (25-OHD<10 ng/mL). The serum 25-OHD concentrations did not correlate with gestational age. There were no significant differences in serum 25-OHD concentrations or incidence of severe vitamin D deficiency among early, moderate, and late preterm infants. The risk of severe vitamin D deficiency in twin preterm infants was significantly higher than that in singletons (odds ratio, 1.993; 95% confidence interval [CI], 1.137-3.494, P=0.016). In the fall, the incidence of severe vitamin D deficiency decreased 0.46 times compared to that in winter (95% CI, 0.227-0.901; P=0.024).ConclusionMost of preterm infants (98.9%) had vitamin D insufficiency and half of them were severely vitamin D deficient. Younger gestational age did not increase the risk of vitamin D deficiency, but gestational number was associated with severe vitamin D deficiency.
He was born at gestation week 28 to a 30-year-old multipara at our hospital by Cesarean section delivery due to premature rupture of the maternal membrane. His birth weight was 1,450 g and his Apgar scores were 6 and 9 at 1 and 5 minutes, respectively. After birth, he was provided positive pressure ventilation and intubated. He also suffered respiratory distress and was treated with surfactant and by mechanical ventilation. On the 24th day after birth, he was presented with fontanel bulging with slight activity reduction. Moro reflex was partial but symmetric, and his pupils were of equal size and reactive to light bilaterally. Ultrasonography and MRI of the brain revealed severe hydrocephalus (Fig. 1). External ventricular drainage was performed, and 8 days later at a body weight of 1,600 mg, a ventriculo-peritoneal shunt was inserted using contoured-shape ultrasmall PS Medical vlave. Two months after shunt surgery, follow-up CT and MRI showed pericatheter ventricular cyst formation (Fig. 2). Burr hole drainage of the pericatheter cyst was performed, and 80 cc of a yellowish translucent fluid was aspirated. Fluid analysis revealed, a cell count of 6/uL (polymorphous nuclear cells 17%), glucose 36 mg/dL, protein 2633 mg/dL, and gram stain negativity, and culture showed no growth of bacteria and fungus. The drain catheter was removed on the 9th day after insertion and a follow up CT scan revealed near total cyst disappearance. Two months later, head enlargement and a tense fontanel were noted, and follow up MRI revealed intraparenchymal cyst regrowth with normally sized ventricle. Because reinsertion of the new proximal catheter into the ventricle was considered difficult without direct visualization, craniotomy and shunt revision was planned.Craniotomy and opening of the cyst revealed a pseudocyst INTRODUCTIONSince the introduction of cerebrospinal fluid (CSF) shunting procedures, they have been one of the main methods of managing hydrocephalus. However, complications of shunt surgery may impede the management of hydrocephalus, and have been reported to affect about 20 to 30 percent of cases during long term follow up 11,12) . Infection and obstruction are the most common complications, though improvements in shunt valve design have diminished complication rates caused by nonphysiologic hydrodynamics of the shunt system. The spread of CSF into brain parenchyma is a rare complication of a ventriculoperitoneal shunt 2,5,10,14,18) , and can take the form of CSF edema or a reversible porencephalic cyst 13) . Pericatheter cysts have been described in relation to a blocked shunt in children and adults, but it has not been previously reported in a premature infant. The authors present a case of an intraparenchymal CSF cyst in a premature infant who happens to be the youngest patient ever reported with this condition. CASE REPORTAn one-day-old male infant was admitted to our neonatal intensive care unit due to weak crying and whole body cyanosis. A ventriculo-peritoneal shunt is a standard surgical management for hydroc...
PurposeWe investigated the iron status of very low birth weight infants receiving multiple erythrocyte transfusions during hospitalization in the neonatal intensive care unit (NICU).MethodsWe enrolled 46 very low birth weight infants who were admitted to the Kyungpook National University Hospital between January 2012 and December 2013. Serum ferritin was measured on their first day of life and weekly thereafter. We collected individual data of the frequency and volume of erythrocyte transfusion and the amount of iron intake.ResultsA total of 38 (82.6%) of very low birth weight infants received a mean volume of 99.3±93.5 mL of erythrocyte transfusions in NICU. The minimum and maximum serum ferritin levels during hospitalization were 146.2±114.9 ng/mL and 456.7±361.9 ng/mL, respectively. The total volume of erythrocyte transfusion was not correlated to maximum serum ferritin concentrations after controlling for the amount of iron intake (r=0.012, p=0.945). Non-transfused infants took significantly higher iron intake compared to infants receiving ≥100 mL/kg erythrocyte transfusion (p<0.001). Minimum and maximum serum ferritin levels of non-transfused infants were higher than those of infants receiving <100 mL/kg erythrocyte transfusions (p=0.026 and p=0.022, respectively). Infants with morbidity including bronchopulmonary dysplasia or retinopathy of prematurity received a significantly higher volume of erythrocyte transfusions compared to infants without morbidity (p<0.001).ConclusionVery low birth weight infants undergoing multiply erythrocyte transfusions had excessive iron stores and non-transfused infants also might had a risk of iron overload during hospitalization in the NICU.
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