Background Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage(IVH)rates.This study explores IVH prevalence and long-term outcomes of very low birt...Background Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage(IVH)rates.This study explores IVH prevalence and long-term outcomes of very low birth weight(VLBW)infants in Korea over a decade.Methods Using Korean National Health Insurance data(NHIS,2010-2019),we identified 3372 VLBW infants with IVH among 4,129,808 live births.Health-related claims data,encompassing diagnostic codes,diagnostic test costs,and administered procedures were sourced from the NHIS database.The results of the developmental assessments are categorized into four groups based on standard deviation(SD)scores.Neonatal characteristics and complications were compared among the groups.Logistic regression models were employed to identify significant changes in the incidence of complications and to calculate odds ratios with corresponding 95%confidence intervals for each risk factor associated with mortality and morbidity in IVH.Long-term growth and development were compared between the two groups(years 2010-2013 and 2014-2017).Results IVH prevalence was 12%in VLBW and 16%in extremely low birth weight(ELBW)infants.Over the past decade,IVH rates increased significantly in ELBW infants(P=0.0113),while mortality decreased(P=0.0225).Major improvements in certain neurodevelopmental outcomes and reductions in early morbidities have been observed among VLBW infants with IVH.Ten percent of the population received surgical treatments such as external ventricular drainage(EVD)or a ventriculoperitoneal(VP)shunt,with the choice of treatment methods remaining consistent over time.The IVH with surgical intervention group exhibited higher incidences of delayed development,cerebral palsy,seizure disorder,and growth failure(height,weight,and head circumference)up to 72 months of age(P<0.0001).Surgical treatments were also significantly associated with abnormal developmental screening test results.Conclusions The neurodevelopmental outcomes of infants with IVH,especially those subjected to surgical treatments,continue to be a matter of concern.It is imperative to prioritize specialized care for patients receiving surgical treatments and closely monitor their growth and development after discharge to improve developmental prognosis.展开更多
Background An echocardiographic right/left ventricular end-diastolic diameter ratio （RV/LV ratio） 〉0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dila...Background An echocardiographic right/left ventricular end-diastolic diameter ratio （RV/LV ratio） 〉0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dilation is a common characteristic of both acute pulmonary embolism and idiopathic pulmonary arterial hypertension （IPAH）. However, the prognostic value of the RV/LV ratio in patients with IPAH is unknown. Methods Ninety-five consecutive patients with newly diagnosed IPAH were included, 17 were re-evaluated by echocardiography after 3-12 months of targeted therapy, Follow-up data were obtained by telephone interviews and review of the patients＇ records.展开更多
Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium.Compared with vaginal delivery,the risk of pulmonary disease is almost twice as high with cesarean section.However,diagnosin...Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium.Compared with vaginal delivery,the risk of pulmonary disease is almost twice as high with cesarean section.However,diagnosing a pulmonary embolism can be challenging.Case presentation A 31-year-old nulliparous woman underwent cesarean section.Postoperatively,the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly.Venous ultrasonography confirmed thrombosis of the left common iliac vein.Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale.An acute pulmonary embolism was confirmed by pulmonary angiography.Catheter-directed thrombus fragmentation and thrombolysis were then performed.Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism.In extreme emergencies,when acute pulmonary embolism is the most likely diagnosis and life-threatening,catheter-directed angiography may be preferred over other approaches.展开更多
基金supported by the Korea Medical Device Development Fund grant funded by the Korea government(the Ministry of Science and ICT,the Ministry of Trade,Industry and Energy,the Ministry of Health&Welfare,the Ministry of Food and Drug Safety)(Project Number:1711138055,KMMDF_PR_20200901_0057).
文摘Background Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage(IVH)rates.This study explores IVH prevalence and long-term outcomes of very low birth weight(VLBW)infants in Korea over a decade.Methods Using Korean National Health Insurance data(NHIS,2010-2019),we identified 3372 VLBW infants with IVH among 4,129,808 live births.Health-related claims data,encompassing diagnostic codes,diagnostic test costs,and administered procedures were sourced from the NHIS database.The results of the developmental assessments are categorized into four groups based on standard deviation(SD)scores.Neonatal characteristics and complications were compared among the groups.Logistic regression models were employed to identify significant changes in the incidence of complications and to calculate odds ratios with corresponding 95%confidence intervals for each risk factor associated with mortality and morbidity in IVH.Long-term growth and development were compared between the two groups(years 2010-2013 and 2014-2017).Results IVH prevalence was 12%in VLBW and 16%in extremely low birth weight(ELBW)infants.Over the past decade,IVH rates increased significantly in ELBW infants(P=0.0113),while mortality decreased(P=0.0225).Major improvements in certain neurodevelopmental outcomes and reductions in early morbidities have been observed among VLBW infants with IVH.Ten percent of the population received surgical treatments such as external ventricular drainage(EVD)or a ventriculoperitoneal(VP)shunt,with the choice of treatment methods remaining consistent over time.The IVH with surgical intervention group exhibited higher incidences of delayed development,cerebral palsy,seizure disorder,and growth failure(height,weight,and head circumference)up to 72 months of age(P<0.0001).Surgical treatments were also significantly associated with abnormal developmental screening test results.Conclusions The neurodevelopmental outcomes of infants with IVH,especially those subjected to surgical treatments,continue to be a matter of concern.It is imperative to prioritize specialized care for patients receiving surgical treatments and closely monitor their growth and development after discharge to improve developmental prognosis.
文摘Background An echocardiographic right/left ventricular end-diastolic diameter ratio （RV/LV ratio） 〉0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dilation is a common characteristic of both acute pulmonary embolism and idiopathic pulmonary arterial hypertension （IPAH）. However, the prognostic value of the RV/LV ratio in patients with IPAH is unknown. Methods Ninety-five consecutive patients with newly diagnosed IPAH were included, 17 were re-evaluated by echocardiography after 3-12 months of targeted therapy, Follow-up data were obtained by telephone interviews and review of the patients＇ records.
文摘Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium.Compared with vaginal delivery,the risk of pulmonary disease is almost twice as high with cesarean section.However,diagnosing a pulmonary embolism can be challenging.Case presentation A 31-year-old nulliparous woman underwent cesarean section.Postoperatively,the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly.Venous ultrasonography confirmed thrombosis of the left common iliac vein.Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale.An acute pulmonary embolism was confirmed by pulmonary angiography.Catheter-directed thrombus fragmentation and thrombolysis were then performed.Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism.In extreme emergencies,when acute pulmonary embolism is the most likely diagnosis and life-threatening,catheter-directed angiography may be preferred over other approaches.
