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Breaking Free from Your Fetal Chains: A Case-Based Review of the Literature on Gamma Chain Variant Hemoglobinopathies 从胎儿链中挣脱出来:基于病例的γ链变异性血红蛋白病文献综述
Pub Date : 2023-02-28 DOI: 10.5385/nm.2023.30.1.14
P. Varughese, Sajan Thomas, S. Nampoothiri, P. Bendapudi
Methemoglobinemia is a dyshemoglobinemia characterized by cyanosis and reduced oxygen saturation with increased methemoglobin values. The etiology may be congenital or acquired, with the latter being more common. We report a case of a full-term neonate who presented with transient cyanosis and methemoglobinemia caused by a mutation in the gamma chain of fetal hemoglobin.
高铁血红蛋白血症是一种以发绀和血氧饱和度降低为特征的高铁血红蛋白异常症。病因可能是先天性的,也可能是后天性的,后者更为常见。我们报告了一例因胎儿血红蛋白γ链突变而出现短暂性发绀和高铁血红蛋白血症的足月新生儿。
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引用次数: 0
First Successful Application of Preimplantation Genetic Diagnosis for Lethal Neonatal Rigidity and Multifocal Seizure Syndrome in Korea: A Case Report 植入前基因诊断在韩国首次成功应用于致命新生儿强直和多灶性癫痫综合征:一例报告
Pub Date : 2022-11-30 DOI: 10.5385/nm.2022.29.4.141
Gyeong Eun Yeom, Y. Jung, S. Kim, S. Choi, Hunmin Kim, Changwon Choi
Lethal neonatal rigidity and multifocal seizure syndrome (RMFSL) is a severe autosomal recessive epileptic encephalopathy characterized by rigidity, intractable multifocal seizures, microcephaly, apnea, and bradycardia immediately after birth. RMFSL is related to a mutation in breast cancer 1-associated ataxia telangiectasia mutated activation-1 protein (BRAT1). We report a case of a female infant born to non-consanguineous Korean parents who developed hypertonia, dysmorphic features, progressive encephalopathy with refractory seizures at birth, and worsening intermittent apnea, leading to intubation and death at 137 days of age. The initial repeated electroencephalographic findings were normal; however, a pattern of focal seizures emerged at 35 days of life. Rapid trio whole-exome sequencing revealed heterozygous mutations c.1313_1314delAG p.(Gln438Argfs*51) and c.1276C>T p. (Gln426*) in BRAT1. After genetic counseling for pregnancy planning, a preimplantation genetic diagnosis for targeted BRAT1 mutations was successfully performed, and a healthy baby was born. To our knowledge, this is the first reported case of a Korean patient with compound heterozygous mutations in BRAT1. An early and accurate genetic diagnosis can help provide timely treatment to patients and indicate the need for reproductive counseling for parents for family planning.
致命新生儿强直和多灶性癫痫综合征(RMFSL)是一种严重的常染色体隐性癫痫性脑病,其特征是出生后立即出现强直、顽固性多灶性发作、小头畸形、呼吸暂停和心动过缓。RMFSL与乳腺癌症1相关共济失调毛细血管扩张突变激活1蛋白(BRAT1)的突变有关。我们报告了一例非血缘韩国父母所生的女婴,该女婴在出生时出现强直、畸形、进行性脑病伴难治性癫痫发作,间歇性呼吸暂停恶化,导致插管并在137天大时死亡。最初的重复脑电图检查结果正常;然而,在生命的35天出现了局灶性癫痫发作的模式。快速三组全外显子组测序显示BRAT1中的杂合突变c.1313_1314delAG p.(Gln438Argfs*51)和c.1276C>T p.(Gln2426*)。在对妊娠计划进行基因咨询后,成功地对靶向BRAT1突变进行了植入前基因诊断,一个健康的婴儿出生了。据我们所知,这是韩国首例BRAT1复合杂合突变患者。早期准确的基因诊断有助于为患者提供及时的治疗,并表明父母需要为计划生育提供生殖咨询。
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引用次数: 0
A Case of Epidermolysis Bullosa Simplex (Dowling-Meara 1 Type) in Newborn 新生儿单纯大疱性表皮松解症1例(Dowling-Meara 1型)
Pub Date : 2022-11-30 DOI: 10.5385/nm.2022.29.4.130
Gahyun Hong, Minsun Choi
Epidermolysis bullosa is a rare genetic skin disease in which skin easily peels off and blisters are formed with mild mechanical trauma. It is classified into simple, borderline, dysmorphic, and mixed type. These four subtypes are further classified according to the location of gene mutation and genetic patterns. Epidermolysis bullosa simplex (EBS) is characterized by separation in the epidermal or subepidermal layer. And it is mostly caused by mutation of keratin 5 (KRT5) and KRT14 genes. Recently, genetic test has become increasingly important for diagnosis, confirming subtypes and genetic counseling. And there are moderate correlation exists between the EBS phenotype and genotype. Here, we report a case of 2-day-old boy with EBS Dowling-Meara type (EBS-DM) diagnosed by mutation analysis in KRT14.
大疱性表皮松解症是一种罕见的遗传性皮肤病,患者皮肤易脱落,形成水疱,伴轻度机械损伤。分为单纯型、边缘型、畸形型和混合型。这四种亚型根据基因突变的位置和遗传模式进一步分类。单纯大疱性表皮松解症(EBS)的特征是表皮层或表皮下层分离。主要由KRT5和KRT14基因突变引起。近年来,基因检测在诊断、确认亚型和遗传咨询方面变得越来越重要。EBS表型与基因型之间存在中度相关。在这里,我们报告了一例2天大的男孩,通过KRT14突变分析诊断为EBS Dowling-Meara型(EBS- dm)。
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引用次数: 0
Erythropoietin Reduces Death and Neurodevelopmental Impairment in Neonatal Hypoxic-Ischemic Encephalopathy 促红细胞生成素减少新生儿缺氧缺血性脑病的死亡和神经发育障碍
Pub Date : 2022-11-30 DOI: 10.5385/nm.2022.29.4.123
Seung Jun Bang, Juyoung Lee, G. Jeon, Y. Jun
Purpose: Erythropoietin (EPO) is a promising neuroprotective drug. We investigated whether EPO has beneficial effects on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE).Methods: We retrospectively reviewed the data of 56 infants with HIE born at or after 35 weeks of gestation who were admitted to Inha University Hospital between 2012 and 2021. Patients were divided into two groups based on EPO use and compared. In the EPO group, patients were administered 1,000 U/kg of EPO on days 1, 2, 3, 5, and 7, starting within 24 hours after birth. The primary outcome was death or neurodevelopmental impairment (NDI) at the age of 12 months.Results: EPO was administered to 38 infants, and 18 did not receive EPO. Only 37.5% of patients with HIE (21/56) and 60% of patients with moderate-to-severe HIE (21/35) received therapeutic hypothermia. Among all patients with HIE, death or NDI (21.1 % vs. 50.0%; odds ratio [OR], 0.09; 95% confidence interval [CI], 0.01 to 0.78; P=0.029) and brain injury on imaging (42.1% vs. 83.3%; OR, 0.16; 95% CI, 0.03 to 0.92; P=0.040) were significantly lower in the EPO group than in the control group. Among patients with moderate-to-severe HIE, brain injury on imaging (54.2% vs. 90.9%; OR, 0.04; 95% CI, 0.002 to 0.700; P=0.027) was significantly lower in the EPO group than in the control group.Conclusion: EPO administration significantly reduced mortality and NDI in infants with HIE. EPO can be considered an adjunctive therapeutic agent for neonatal HIE.
目的:促红细胞生成素(EPO)是一种很有前途的神经保护药物。我们研究了EPO是否对缺氧缺血性脑病(HIE)婴儿的神经发育结果有有益的影响。方法:我们回顾性分析了2012年至2021年间在仁荷大学医院收治的56例妊娠35周或之后出生的HIE婴儿的资料。根据EPO的使用情况将患者分为两组进行比较。在EPO组,患者在出生后24小时内开始,在第1、2、3、5和7天给予1,000 U/kg的EPO。主要结局是12个月时死亡或神经发育障碍(NDI)。结果:38例患儿接受EPO治疗,18例患儿未接受EPO治疗。只有37.5%的HIE患者(21/56)和60%的中重度HIE患者(21/35)接受了低温治疗。在所有HIE患者中,死亡或NDI (21.1% vs 50.0%;优势比[OR], 0.09;95%可信区间[CI], 0.01 ~ 0.78;P=0.029)和脑损伤影像学差异(42.1% vs. 83.3%;或者,0.16;95% CI, 0.03 ~ 0.92;P=0.040), EPO组明显低于对照组。在中重度HIE患者中,影像学显示脑损伤(54.2% vs. 90.9%;或者,0.04;95% CI, 0.002 ~ 0.700;P=0.027), EPO组明显低于对照组。结论:EPO可显著降低HIE患儿死亡率和NDI。EPO可作为新生儿HIE的辅助治疗剂。
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引用次数: 0
Rapidly Progressive Pericardial Effusion and Cardiac Tamponade in a Term Infant with an Umbilical Venous Catheter: A Case Report 使用脐静脉导管的足月婴儿快速进行性心包积液和心脏填塞1例
Pub Date : 2022-11-30 DOI: 10.5385/nm.2022.29.4.135
M. Park, Ja-Hye Ahn, H. J. Lee, Hyun-Kyung Park, Jae-Kyoon Hwang, Chang-Ryul Kim, J. Na
Pericardial effusion (PCE) in neonates has various clinical presentations depending on the amount and speed of fluid accumulation and can cause cardiac tamponade (CT). We report a case of rapidly accumulating PCE and near-fatal CT with an umbilical venous catheter successfully resolved by emergent echo-guided pericardiocentesis in a term infant who had been hospitalized with meconium aspiration syndrome and persistent pulmonary hypertension. This case report suggests that if a patient with an intracardiac umbilical catheter shows sudden cardiopulmonary instability, the possibility of PCE and CT should be considered. Furthermore, if necessary, emergency drainage of the PCE and removal of the umbilical catheter should be immediately performed.
新生儿心包积液(PCE)根据液体积聚的量和速度有不同的临床表现,并可导致心脏压塞(CT)。我们报告了一例因胎粪吸入综合征和持续性肺动脉高压住院的足月婴儿,通过紧急回声引导心包穿刺术,使用脐静脉导管成功解决了快速积聚的PCE和近乎致命的CT。该病例报告表明,如果有心内脐带导管的患者突然出现心肺不稳定,应考虑PCE和CT的可能性。此外,如有必要,应立即进行PCE的紧急引流和脐带导管的移除。
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引用次数: 0
Newborn Periventricular Nodular Heterotopia with Persistent Feeding Cyanosis and Apneic Spell: A Case Report 新生儿脑室周围结节性异位伴持续性喂养性紫绀和呼吸暂停1例
Pub Date : 2022-11-30 DOI: 10.5385/nm.2022.29.4.149
Seok Jin Hong, Ji Eun Park, Y. Sohn, Y. Suh, Jang Hoon Lee, M. Park
Periventricular nodular heterotopia (PNH) is a neuronal migration disorder that occurs during early brain development. Patients with PNH may be asymptomatic and have normal intelligence; however, PNH is also known to cause various symptoms such as seizures, dyslexia, and cardiovascular anomalies. PNH is not commonly diagnosed during early infancy because of the lack of clinical manifestations during this period. We present the case of a female infant diagnosed with PNH based on brain magnetic resonance imaging, who had symptomatic patent ductus arteriosus that had to be ligated surgically and had prolonged feeding cyanosis with frequent apneic spells.
脑室周围结节性异位(PNH)是一种发生在大脑早期发育过程中的神经元迁移障碍。PNH患者可能无症状,智力正常;然而,众所周知,PNH也会引起各种症状,如癫痫发作、阅读障碍和心血管异常。PNH在婴儿早期并不常见,因为这一时期缺乏临床表现。我们报告了一例根据脑磁共振成像诊断为PNH的女婴,她有症状性动脉导管未闭,必须通过手术结扎,并有长期的进食发绀和频繁的呼吸暂停期。
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引用次数: 0
A Rare Case of Oligodendroglioma in Sacrococcygeal Mature Teratoma Diagnosed in Preterm Infant 早产儿骶尾骨成熟畸胎瘤中少见的少突胶质细胞瘤1例
Pub Date : 2022-08-31 DOI: 10.5385/nm.2022.29.3.105
M. Jeong, S. Jeong, C. Hwang, Y. Cho, S. Byun, N. Lee
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.
骶尾翼畸胎瘤是新生儿中最常见的先天性肿瘤,据报道约有1/ 35000至1/ 40000活产。少突胶质细胞瘤是一种罕见的中枢神经系统肿瘤,常见于中青年的大脑半球。当与畸胎瘤相关时,主要见于青少年和成人卵巢畸胎瘤。我们描述了一个罕见的早产儿少突胶质细胞瘤在成熟的骶尾骨畸胎瘤。男婴出生时胎龄为30周,骶尾骨区有突出肿块。骨盆磁共振成像显示约11cm的骶尾骨畸胎瘤,包括脂肪成分和骨骼结构,从骶骨前部延伸到腹腔。36日龄行根治性切除。宏观上,切除的腹内肿块具有囊性病变的特征,盆腔内肿块以实性为主,囊性-实性混合病变。组织学上,盆腔内肿块的实性病变由成熟的胶质组织组成,由增生的单一细胞组成,细胞核小而圆,周围有核周晕(“煎蛋”状)。此外,这些细胞免疫组织化学阳性胶质原纤维酸性蛋白。这些结果证实了骶尾骨成熟畸胎瘤中少突胶质细胞瘤的诊断。治疗结束后,随访期间未见复发,无需额外干预。然而,患者正在接受由神经源性膀胱引起的排尿功能障碍的治疗。
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引用次数: 0
Case Series of Isolated Deep Gray Matter Injuries in Preterm Infants 早产儿孤立性深灰质损伤的病例系列
Pub Date : 2022-08-31 DOI: 10.5385/nm.2022.29.3.117
Ki Teak Hong, S. Shin, Y. Choi, E. Kim, Han-Suk Kim
Hypoxic-ischemic encephalopathy in neonates is an important cause of brain damage that leads to severe neurological sequelae or death. Brain injury patterns on magnetic resonance imaging (MRI) scans are used to predict neurodevelopmental outcome severity. This case series describes the clinical manifestations and neurologic outcomes of four preterm infants with isolated deep gray matter injuries. Basal ganglia and thalamic lesions were noted without white matter and cerebral cortex lesion on brain MRI. All patients were preterm infants born at less than 33 weeks’ gestation and required resuscitation in the delivery room. All had seizures during the neonatal period requiring anti-seizure medications. Severe neurologic disability was identified in three patients using neurodevelopmental assessment tools. Another patient has not been evaluated with assessment tools yet as he was 2 months’ corrected age, but he was supported by home ventilation via a tracheostomy due to insufficient self-respiration. This case series demonstrates that isolated deep gray matter injuries in preterm infants could predict severe neurodevelopmental outcomes.
新生儿缺氧缺血性脑病是导致严重神经系统后遗症或死亡的脑损伤的重要原因。磁共振成像(MRI)扫描的脑损伤模式用于预测神经发育结果的严重程度。本病例系列描述了四例孤立性深部灰质损伤的早产儿的临床表现和神经系统结果。在脑MRI上,基底神经节和丘脑病变没有白质和大脑皮层病变。所有患者均为妊娠不到33周出生的早产儿,需要在产房进行复苏。所有患者都在新生儿期癫痫发作,需要服用抗癫痫药物。使用神经发育评估工具在三名患者中发现了严重的神经功能障碍。另一名患者尚未使用评估工具进行评估,因为他是2个月大的矫正年龄,但由于自我呼吸不足,他通过气管造口术获得了家庭通气支持。这一系列病例表明,早产儿孤立的深部灰质损伤可以预测严重的神经发育结果。
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引用次数: 1
A Korean Child with Schaaf-Yang Syndrome Presented with Hearing Impairment: A Case Report 韩国儿童Schaaf Yang综合征伴听力障碍1例报告
Pub Date : 2022-08-31 DOI: 10.5385/nm.2022.29.3.112
Seung Hoon Lee, S. Shin, J. Ko, Boram Kim, H. S. Oh, M. Kim, Seul Gi Park, E. Kim, Han-Suk Kim
Schaaf-Yang syndrome (SYS) is a rare genomic imprinting disorder caused by truncating mutations in the paternally derived MAGE family member L2 (MAGEL2) allele. It is also responsible for Prader-Willi syndrome, characterized by neonatal hypotonia, developmental delay, intellectual disability, respiratory distress in early infancy, and arthrogryposis. More than 250 individuals with approximately 57 different molecular variants have been reported since 2013, but the phenotype-genotype association in SYS is not yet fully understood. Here, we describe the case of a Korean patient diagnosed with SYS harboring a mutation in the paternal allele of MAGEL2: c.2895G>A, resulting in a protein change of p.Trp965*. The patient’s phenotype included respiratory distress, arthrogryposis, hypotonia, and feeding difficulty in the early neonatal period. Mild renal dysfunction and hearing impairment were observed during infancy.
Schaaf-Yang综合征(SYS)是一种罕见的基因组印迹疾病,由父系遗传的MAGE家族成员L2 (MAGEL2)等位基因的截断突变引起。它也会导致Prader-Willi综合征,其特征是新生儿张力低下、发育迟缓、智力残疾、婴儿早期呼吸窘迫和关节挛缩。自2013年以来,已经报道了250多例具有大约57种不同分子变异的个体,但尚未完全了解SYS的表型-基因型关联。在这里,我们描述了一位被诊断为SYS的韩国患者,该患者携带MAGEL2父本等位基因c.2895G> a突变,导致p.Trp965*蛋白改变。患者的表型包括新生儿早期呼吸窘迫、关节挛缩、张力低下和进食困难。在婴儿期观察到轻度肾功能障碍和听力障碍。
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引用次数: 0
Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center 单中心14例新生儿心房扑动的临床特点
Pub Date : 2022-08-31 DOI: 10.5385/nm.2022.29.3.97
So Hye Park, G. Lim, Ki Won Oh, J. Ko
Purpose: Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates.Methods: The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively.Results: All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge.Conclusion: Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.
目的:心房扑动是新生儿期罕见的心律失常。本研究旨在描述新生儿心房扑动的病因和临床过程。方法:回顾性分析2008年3月至2020年8月在蔚山大学医院新生儿重症监护室(NICU)诊断为房扑的14名患者的病历。结果:14例均发生在出生第一天。其中,2名为足月儿,12名为早产儿。心房扑动的原因包括三例脐静脉导管错位,一例为糖尿病母亲,另一例为静脉注射氨茶碱后的象牙状心房扑动。13名患者心脏结构正常,无先天性心脏病。该患者的母亲患有糖尿病,患有房间隔缺损和心室肥大。首先给药腺苷是为了将其与阵发性室上性心动过速区分开来。11名患者尝试了同步复律,其中一名患者在注射艾司洛尔后接受了复律,但未能转换为窦性心律。一名患者在外周插入中心导管后复发;心房扑动复位后消失,出院后无复发。结论:新生儿心房扑动是一种罕见的快速性心律失常,其危险因素往往未知;然而,它可能发生在结构性心脏病、脐静脉导管定位错误以及母亲患有糖尿病的情况下。在脐静脉置管期间,临床医生应谨慎,并确保在新生儿重症监护室对婴儿进行适当的监测,因为这可能会导致并发症。
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引用次数: 0
期刊
Neonatal Medicine
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