Bo Kyeong Jin

Congenital diaphragmatic hernia (CDH) is a severe anomaly associated with significant pulmonary hypertension (PH) and high mortality, often requiring extracorporeal membrane oxygenation (ECMO). Early prognostic markers are essential to guide clinical decisions. This study evaluated the prognostic value of right-to-left (R-L) shunting in the patent ductus arteriosus (PDA) during the early postnatal period in predicting ECMO use and mortality in neonates with CDH. This retrospective cohort study included neonates with CDH admitted between 2013 and 2024. Echocardiographic evaluations within 24 h of birth categorized PDA shunting as left-to-right (L-R), R-L, or bidirectional. Outcomes were analyzed using two models. First, the pure R-L shunt group was compared with the combined L-R and bidirectional shunt groups. Second, bidirectional shunts were subclassified as L-R or R-L predominant based on Doppler spectral area, with the R-L predominant group analyzed together with the pure R-L shunt group and the L-R predominant group analyzed with the L-R shunt group. Primary outcomes were ECMO use or mortality, analyzed using logistic regression. Among 145 neonates, both models demonstrated that R-L shunting was associated with a higher ECMO requirement or increased mortality rate compared to L-R shunting (p < 0.001). Multivariate analysis identified R-L shunting as an independent predictor of adverse outcomes (Model 1: odds ratio [OR] 6.785, 95% confidence interval [CI] 2.333–19.730; p < 0.001; Model 2: OR 4.067, 95% CI 1.444–11.455; p = 0.008). The direction of early postnatal R-L PDA shunt, assessed within 24 h of birth, was significantly associated with ECMO use or mortality in neonates with CDH.

Purpose: Feeding intolerance (FI) is a prevalent clinically sequential condition in preterm infants. To clarify its relationship with the gut microbiota, we compared microbial diversity and taxonomic composition at 2 and 4 weeks of age in infants born before 32 weeks of gestation.Methods: Between August 2021 and December 2022, we prospectively enrolled infants who delivered before 32 weeks of gestation and were admitted to the neonatal intensive care unit at CHA Bundang Medical Center. Forty-four preterm infants were grouped based on the presence (n=16) or absence (n=28) of FI. Fecal samples were obtained at 2 and 4 weeks after birth and analyzed using 16S rRNA gene sequencing to determine microbial profiles.Results: Microbial α-diversity and β-diversity did not differ significantly between groups at either time point. At the genus level, Staphylococcus was significantly more abundant in the FI group than in the feeding tolerance group at 2 weeks postnatal age (P=0.016). Linear discriminant analysis effect size revealed that Staphylococcus, Pseudomonas, and Escherichia were markedly enriched in the FI group at all time points.Conclusion: Early colonization by potentially pathogenic genera, particularly Staphylococcus, may precede the development of FI in preterm infants. These findings highlight the potential microbial composition associated with FI and may provide preliminary insights for future microbiome-targeted research in neonatal care.

Of the Useful Parameters to Predict the Presence of Cortical Defects on the Acute DMSA Renal Scan Purpose: We investigated whether a renal size discrepancy on a renal sonogram (US) in children with febrile urinary tract infection (UTI) was correlated with the presence of cortical defects on their dimercaptosuccinic acid (DMSA) renal scan. Methods: We examined 911 children who were admitted consecutively to our hospital with their first episode of febrile UTI from March 2001 to September 2014. All enrolled children underwent a US and DMSA scan during admission. According to the US findings, including the renal size discrepancy, data were compared between children with positive and negative DMSA scan results. A positive DMSA scan result was defined as reduced or absent tracer localization and indistinct margins that did not deform the renal contour. Results: Mean renal lengths of the right and left kidneys were larger in children with positive DMSA scan results than in children with negative DMSA scan results (63.2±11.3 mm vs. 58.4±7.8 mm, P<0.001; 64.9±11.2 mm vs. 59.9±7.9 mm, P< 0.001; respectively). A significant difference was observed in both renal lengths between children with positive and negative DMSA scan results (4.6±3.8 mm vs. 3.3±2.6 mm, P<0.001). A multiple logistic regression analysis, revealed that a small kidney, cortical thinning, and a renal length discrepancy on US findings were significant factors for predicting the presence of cortical defects on an acute DMSA scan [P=0.028, 95% confidence interval (CI) 1.054-2.547; P= 0.004, 95% CI 1.354-4.810; P<0.001, 95% CI 1.077-1.190, respectively]. Conclusion: In conclusion, a renal size discrepancy on US findings in children with their first episode of febrile UTI was a helpful tool for predicting the presence of cortical defects on an acute DMSA scan.

Kang SJ, et al. J Cardiovasc Imaging. 2018 Aug;26:e12. https://doi.org/10.4250/jcvi.2018.26.e12