Joo Hyung Roh

Kwak JI, et al. Korean Circ J. 2027 ;57:e47. https://doi.org/10.4070/kcj.2026.0106

To evaluate gestational age (GA)-specific associations between antenatal corticosteroid (ACS) exposure and early physiologic vulnerability and neonatal outcomes in preterm infants. This retrospective cohort study used Korean Neonatal Network data and included infants born 2013-2021 with birth weight <1500 g or GA < 32 weeks. ACS exposure was categorized as complete, incomplete, or none. Multivariable logistic regression estimated adjusted odds ratios, with GA-stratified analyses and a prespecified subgroup of infants born at <25 weeks. ACS exposure was associated with reduced need for advanced resuscitation at birth, reduced risk of severe intraventricular hemorrhage and decreased mortality, with the strongest associations before 32 weeks' gestation. In infants born at <25 weeks, any ACS exposure was associated with greater physiologic stability and improved survival versus no ACS exposure. ACS exposure was associated with improved physiologic stability and survival in preterm infants, with benefits greater at lower GAs.

To evaluate the feasibility and early physiologic effects of postoperative invasive neurally-adjusted ventilatory assist (NAVA) in neonates with severe congenital diaphragmatic hernia (CDH). Retrospective observational study of inborn neonates with CDH who received invasive NAVA during the post-repair ventilator weaning phase. Ventilator parameters, blood gas variables, respiratory indices, and diaphragm-based efficiency measures were evaluated serially within infants at 0, 12, 24, and 48 hours after NAVA initiation. Of 123 inborn infants with CDH, 19 with high disease severity received postoperative invasive NAVA. Oxygen requirements decreased over time, with favorable changes in gas exchange by 48 hours. The oxygenation index declined without increased ventilator pressures. Neuroventilatory and neuromechanical efficiency remained stable, including in infants with type D defects. All infants were successfully weaned from invasive mechanical ventilation. Postoperative invasive NAVA was feasible and well tolerated in neonates with severe CDH, including those with type D defects and prior extracorporeal membrane oxygenation support.

Objective Develop a birth anthropometry-based model to estimate initial endotracheal tube (ETT) insertion depth for infants with birth weight p < 0.001). A combined quadratic model showed the strongest fit (adjusted R² = 0.70), outperforming single parameter rules. Conclusion In neonates <500 g, a quadratic weight-length model improves the prediction of radiograph-defined midtracheal ETT depth and offers a practical bedside guide for initial placement.

Objective To evaluate gestational age (GA)-specific associations between antenatal corticosteroid (ACS) exposure and early physiologic vulnerability and neonatal outcomes in preterm infants. Study Design This retrospective cohort study used Korean Neonatal Network data and included infants born between 2013 and 2021 with birth weight < 1 500 g or GA < 32 weeks. ACS exposure was categorized as complete, incomplete, or none. Multivariable logistic regression estimated adjusted odds ratios, with GA-stratified analyses and a prespecified subgroup of infants born at < 25 weeks. Results ACS exposure was associated with lower delivery room resuscitation intensity, reduced risk of severe intraventricular hemorrhage, and decreased mortality, with strongest associations observed before 32 weeks. In infants born at < 25 weeks, any ACS exposure was associated with greater physiologic stability and improved survival compared with no ACS exposure. Conclusions ACS exposure was associated with improved physiologic stability and survival in preterm infants, with benefits greater at lower GAs.

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: This study aimed to characterize the clinical patterns and severity of brain injury in neonates who survived extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory failure during the neonatal period, to evaluate their short-term neurodevelopmental outcomes, and to identify the factors associated with these outcomes.Methods: We retrospectively reviewed the medical records of neonates who survived ECMO between 2018 and 2024. Based on brain magnetic resonance imaging (MRI) findings, the patients were classified into two groups: no/mild and moderate/severe brain injury. Neurodevelopmental outcomes were assessed at 12–40 months of age using the Bayley Scale of Infant Development II/III and/or the Korean Developmental Screening Test.Results: Among the 19 neonates included in the study, 18 (94.7%) showed varying degrees of brain injury on MRI (mild: 12, moderate: 1, severe: 5). Neonates with moderate/severe brain injury had significantly longer durations of ECMO support and extended durations of mechanical ventilation and were more likely to receive continuous renal replacement therapy than those with no or mild injury. Developmental delay was identified in 36.8% of survivors and was significantly associated with prolonged mechanical ventilation, longer neonatal intensive care unit stays, and a higher incidence of seizures.Conclusion: Brain injury is frequently observed on MRI in neonates treated with ECMO. However, its direct association with adverse neurodevelopmental outcomes is not definitive. Since MRI findings alone cannot predict developmental outcomes, clinical and environmental factors should be integrated into prognostic assessments.

Purpose: Congenital hypothyroidism (CH) is a major preventable cause of intellectual disability, particularly in very low birth weight (VLBW) infants, who are at increased risk due to hypothalamic-pituitary-thyroid axis immaturity. Early differentiation between transient CH (TCH) and permanent CH (PCH) is crucial to optimize L-thyroxine (LT4) treatment duration. This study aimed to determine the incidence of PCH among Korean VLBW infants and to identify clinical factors that may aid in distinguishing TCH from PCH.Methods: This retrospective cohort study included VLBW infants diagnosed with CH and treated with LT4 at a single tertiary neonatal intensive care unit between 2011 and 2020. Infants requiring LT4 beyond 3 years were classified as PCH, while those who discontinued earlier were considered TCH. Clinical characteristics, neonatal morbidities, and thyroid-related parameters were compared between the groups.Results: Among 1,292 VLBW infants, 122 (9.4%) were diagnosed with CH. After excluding deaths and those lost to follow-up, 73 infants were included in the final analysis (TCH, n=50; PCH, n=23). The PCH group had a significantly higher mean gestational age and greater LT4 requirements at both 12 and 36 months of age. Major anomalies were more frequently observed in PCH infants, including congenital heart defects. In multivariate analysis, higher gestational age, the presence of major anomalies, screening thyroid-stimulating hormone (TSH) >10 μIU/mL, and higher LT4 dose at 36 months were significantly associated with PCH.Conclusion: The incidence of PCH in Korean VLBW infants was relatively higher than that reported in previous studies studies. Screening TSH level and LT4 dose requirements may support individualized follow-up and help distinguish PCH from TCH.