Narae Lee

Jo KJ, et al. J Korean Med Sci. 2027 Jan;42:e75. https://doi.org/10.3346/jkms.2027.42.e75

Purpose: Early extubation from mechanical ventilation (MV) in preterm infants may reduce MV-related complications in this population. However, extubation failure (EF) remains a common clinical challenge associated with short-term morbidity and potentially adverse long-term neurodevelopmental outcomes. This study investigated the association between EF and subsequent neurodevelopment in very preterm infants using Bayley assessments performed at a corrected age of 12–18 months.Methods: This retrospective cohort study included preterm infants born at <32 weeks’ gestation between January 2017 and December 2021. Infants who required reintubation within 7 days of at least one extubation attempt were classified as having EF, whereas those who did not require further MV after extubation were classified as extubation success (ES). The infants were matched 1:1 by gestational age and birth weight. Clinical characteristics were compared between the two groups and neurodevelopmental outcomes were assessed during outpatient follow-up using the Bayley Scales of Infant and Toddler Development at a corrected age of 12–18 months.Results: The corrected age at Bayley assessment did not differ between the EF and ES groups (EF: 14.75 months [interquartile range, IQR, 12 to 19.1] vs. ES: 14.42 months [IQR, 11.7 to 21.7], P=0.95). Infants in the EF group demonstrated significantly lower composite scores across all developmental domains than those in the ES group, including cognition (93.88 vs. 94.41, P=0.021), language (89.24 vs. 89.76, P=0.030), and motor function (86.12 vs. 88.53, P=0.016).Conclusion: EF may be a clinically useful marker for identifying preterm infants at an increased risk of adverse short-term clinical courses, such as prolonged hospitalization and subsequent neurodevelopmental vulnerability. Accordingly, infants who experience EF should undergo structured, ongoing developmental surveillance, and early rehabilitative interventions should be considered when developmental delay is suspected.

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body size and the limited availability of appropriately sized equipment. Materials and Methods: We retrospectively reviewed 15 endoscopic TP tube placements performed in 12 LBWIs weighing less than 2.5 kg between May 2017 and March 2025. Emphasis was placed on procedural techniques, equipment selection, and troubleshooting strategies for successful bedside execution. Results: All procedures were performed without the use of additional accessories, by advancing a feeding tube preloaded with a guidewire under direct visualization provided by a 5.5 mm outer diameter endoscope. All procedures were technically successful, including 14 performed at the bedside using a portable endoscope. A 6 or 8 Fr feeding tube loaded with a soft-tipped guidewire was advanced through the pylorus under direct endoscopic visualization. The average body weight at the time of the procedure was 1950 ± 296 g. No complications such as mucosal injury, perforation, or tube dislodgement occurred during the procedure. The average enteral feeding volume increased from 33.4 ± 52.8 cc/kg to 92.0 ± 44.4 cc/kg within 7 days. Full enteral nutrition was achieved in all surviving patients within three weeks. The feeding tube remained in place for a mean duration of 26.1 ± 19.2 days. Conclusions: Endoscopic TP tube placement in LBWIs can be safely and reliably performed at the bedside with appropriate technical modifications. It facilitates earlier advancement to full enteral nutrition and may serve as a viable option for LBWIs unresponsive to standard feeding methods.

Background: Successful sepsis treatment depends on early diagnosis. We aimed to develop and validate a system to predict sepsis and septic shock in real time using deep learning. Methods: Clinical data were retrospectively collected from electronic medical records (EMRs). Data from 2010 to 2019 were used as development data, and data from 2020 to 2021 were used as validation data. The collected EMRs consisted of eight vital signs, 13 laboratory data points, and three demographic information items. We validated the deep-learning-based sepsis and septic shock early prediction system (DeepSEPS) using the validation datasets and compared our system with other traditional early warning scoring systems, such as the national early warning score, sequential organ failure assessment (SOFA), and quick sequential organ failure assessment. Results: DeepSEPS achieved even higher area under receiver operating characteristic curve (AUROC) values (0.7888 and 0.8494 for sepsis and septic shock, respectively) than SOFA. The prediction performance of traditional scoring systems was enhanced because the early prediction time point was close to the onset time of sepsis; however, the DeepSEPS scoring system consistently outperformed all conventional scoring systems at all time points. Furthermore, at the time of onset of sepsis and septic shock, DeepSEPS showed the highest AUROC (0.9346). Conclusions: The sepsis and septic shock early warning system developed in this study exhibited a performance that is worth considering when predicting sepsis and septic shock compared to other traditional early warning scoring systems. DeepSEPS showed better performance than existing sepsis prediction programs. This novel real-time system that simultaneously predicts sepsis and septic shock requires further validation.

Background: Respiratory support is crucial for newborns with underdeveloped lung. The clinical outcomes of patients depend on the clinician’s ability to recognize the status underlying the presented symptoms and signs. With the increasing number of high-risk infants, artificial intelligence (AI) should be considered as a tool for personalized neonatal care. Continuous monitoring of vital signs is essential in cardiorespiratory care. In this study, we developed deep learning (DL) prediction models for rapid and accurate detection of mechanical ventilation requirements in neonates using electronic health records (EHR). Methods: We utilized data from the neonatal intensive care unit in a single center, collected between March 3, 2012, and March 4, 2022, including 1,394 patient records used for model development, consisting of 505 and 889 patients with and without invasive mechanical ventilation (IMV) support, respectively. The proposed model architecture includes feature embedding using feature-wise fully connected (FC) layers, followed by three bidirectional long short-term memory (LSTM) layers. Results: A mean gestational age (GA) was 36.61 ± 3.25 weeks, and the mean birth weight was 2,734.01 ± 784.98 g. The IMV group had lower GA, birth weight, and longer hospitalization duration than the non-IMV group (P < 0.05). Our proposed model, tested on a dataset from March 4, 2019, to March 4, 2022. The mean AUROC of our proposed model for IMV support prediction performance demonstrated 0.861 (95%CI, 0.853–0.869). It is superior to conventional approaches, such as newborn early warning score systems (NEWS), Random Forest, and eXtreme gradient boosting (XGBoost) with 0.611 (95%CI, 0.600–0.622), 0.837 (95%CI, 0.828–0.845), and 0.0.831 (95%CI, 0.821–0.845), respectively. The highest AUPRC value is shown in the proposed model at 0.327 (95%CI, 0.308–0.347). The proposed model performed more accurate predictions as gestational age decreased. Additionally, the model exhibited the lowest alarm rate while maintaining the same sensitivity level. Conclusion: Deep learning approaches can help accurately standardize the prediction of invasive mechanical ventilation for neonatal patients and facilitate advanced neonatal care. The results of predictive, recall, and alarm performances of the proposed model outperformed the other models.

Pyocele in infants is rarely described in the literature, but it is an emergent condition that requires rapid recognition and treatment to prevent testicular loss. If peritonitis due to gastrointestinal perforation occurs, abdominal contamination may spread through a patent processus vaginalis in an infant, which may lead to pyocele. We report the cases of three infants with scrotal pyocele due to the spread of infection or inflammatory material from the intraperitoneal cavity through a patent processus vaginalis. Two infants were surgically treated, while the other was treated with percutaneous aspiration and intravenous antibiotic administration. Although rare, pyocele should be considered in the differential diagnosis of acute scrotum in infants, especially in infants who previously had peritonitis due to gastrointestinal perforation.

Sacrococcygeal teratoma is the most common congenital tumor in neonates, and is reported in approximately 1/35,000 to 1/40,000 live births. Oligodendroglioma is a rare central nervous system tumor that is usually found in the cerebral hemisphere of young and middle aged adults. When associated with a teratoma, it is mainly identified in ovarian teratoma in adolescents and adults. We describe a rare case of a preterm infant with oligodendroglioma in a mature sacrococcygeal teratoma. The male neonate was born at a gestational age of 30 weeks with a protruding mass in the sacrococcygeal region. Pelvic magnetic resonance imaging showed a sacrococcygeal teratoma of approximately 11 cm comprising fat components and skeletal structure, that extended from the anterior part of the sacrum to the abdominal cavity. Radical resection was performed at 36 days of age. Macroscopically, the resected intra-abdominal mass had the characteristics of a cystic lesion, and the intrapelvic mass was a predominantly solid mixed cystic-solid lesion. Histologically, this solid lesion in the intrapelvic mass was composed of mature glial tissue, which comprised as a proliferation of monotonous cells with small and round nuclei, surrounded by a perinuclear halo (“fried egg” appearance). Additionally, these cells were immunohistochemically positive for glial fibrillary acidic protein. These findings confirmed the diagnosis of oligodendroglioma in sacrococcygeal mature teratoma. After the treatment, no recurrence was observed during the follow-up period, and no additional intervention was required. However, the patient is undergoing treatment for voiding dysfunction caused by a neurogenic bladder.

연구 목적: 본 연구는 마약중독자들 대상으로 이들이 인식한 우울감 및 갈망감과 약물심각도 관계에서 사회적지지의 매개효과를 검증하는데 목적을 두었다. 연구 방법: 인천 참사랑병원과 소망을 찾는 사람들을 통해 재활중인 약물중독자 164명을 대상으로 설문조사를 통해 자료를 수집하였고, SPSS 프로그램을 이용하여 자료를 처리하였다. 연구 내용: 마약중독자들의 약물심각도에 대한 우울감, 갈망감, 사회적지지의 영향, 우울감 및 갈망감과 약물심각도 관계에서 사회적지지의 매개효과를 분석하였다. 결론 및 제언: 마약중독자들이 인식한 우울감 및 갈망감은 약물심각도에 정적인 영향, 사회적 지지는 부적인 영향을 미치고, 우울감 및 갈망감과 약물심각도 관계에서 사회적 지지는 유의한 매개변수로서 역할을 하였다. 연구결과의 신뢰성 확보를 위해 후속연구에서는 연구 대상을 모집함에 있어 어려움이 있지만 대상의 범위를 확대할 필요가 있을 것이다.

Background: The etiology of small for gestational age (SGA) is multifactorial and includes maternal/uterine-placental factors, fetal epigenetics, and genetic abnormalities. We evaluated the genetic causes and diagnostic effectiveness of targeted-panel sequencing (TES) or whole-exome sequencing (WES) in SGA infants without a known cause. Methods: A prospective study was conducted on newborn infants born with a birth weight of less than the 10th percentile for gestational age between January 2019 and December 2020 at the Pusan National University Hospital. We excluded infants with known causes of SGA, including maternal causes or major congenital anomalies or infections. SGA infants without a known etiology underwent genetic evaluation, including karyotyping, chromosomal microarray (CMA), and TES/WES. Results: During the study period, 82 SGA infants were born at our hospital. Among them, 61 patients were excluded. A total of 21 patients underwent karyotyping and chromosomal CMA, and aberrations were detected in two patients, including one chromosomal anomaly and one copy number variation. Nineteen patients with normal karyotype and CMA findings underwent TES or WES, which identified three pathogenic or likely pathogenic single-gene mutations, namely LHX3, TLK2, and MED13L. Conclusions: In SGA infants without known risk factors, the prevalence of genetic causes was 22% (5/21). The diagnostic yield of TES or WES in SGA infants with normal karyotype and CMA was 15.7% (3/19). TES or WES was quite helpful in identifying the etiology in SGA infants without a known cause.