Publications by authors named "Kyong Soon Lee"
Background: Necrotising enterocolitis (NEC) in preterm infants is associated with high morbidity and mortality. In most neonates, it is a progressive disease from medical NEC (mNEC) to surgical NEC (sNEC); however, in some, it presents as sNEC from onset.
Objective: To evaluate the rate, the timing of progression, different surgical approaches, and outcomes of mNEC and sNEC in preterm neonates.
Late-onset sepsis (LOS) in the neonatal intensive care unit (NICU) causes significant morbidity and mortality, yet guidance on empiric management is limited. We surveyed NICUs across Canada and the United States regarding their empiric antimicrobial regimens for LOS, thereby identifying large practice variations and high rates of empiric vancomycin use.
View Article and Find Full Text PDFImportance: Neonates requiring surgery are often cared for in neonatal intensive care units (NICUs). Despite a breadth of surgical pathology, neonates share many perioperative priorities that allow for the development of unit-wide evidence-based Enhanced Recovery After Surgery (ERAS) recommendations.
Observations: The guideline development committee included pediatric surgeons, anesthesiologists, neonatal nurses, and neonatologists in addition to ERAS content and methodology experts.
Article Synopsis
- The study aimed to assess how different international clinical sites manage therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) and identify areas for standardization.
- An electronic survey was conducted, gathering responses from 105 sites, primarily from high-income regions, revealing varying practices in eligibility criteria, use of electroencephalography, and sedation methods.
- The findings indicated significant regional differences in TH management, suggesting that future guidelines should take into account the availability of resources globally.
Background And Objectives: Nasal intermittent positive pressure ventilation (NIPPV) has been shown to be superior to nasal continuous positive airway pressure (CPAP) postextubation in preterm neonates. However, studies have not permitted high CPAP pressures or rescue with other modes. We hypothesized that if CPAP pressures >8 cmH2O and rescue with other modes were permitted, CPAP would be noninferior to NIPPV.
View Article and Find Full Text PDFObjective: This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers.
Study Design: This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC).
Results: Survey response rate was 76%, and 97% of respondents had a formal NDFU program.
Introduction: Hypothermia in the neonatal surgical population has been linked with significant morbidity and mortality. Our goal was to decrease intra and postoperative hypothermia.
Intervention: In November 2021, a radiant warmer and hat were included along with standard warming methods prior to the start of General Surgery procedures to minimize episodes of hypothermia.
Objective: Our goal was to improve placement success rates for peripheral arterial line (PAL) placements by introducing an ultrasound-guided (USg) approach. Our aim was to maintain success rates over 70% within 18 months.
Study Design: Interventions included development of a training curriculum, and procedure standardization.
Article Synopsis
- The study aimed to evaluate the impact of inhaled nitric oxide (iNO) treatment on the neurodevelopmental outcomes of preterm neonates (born before 29 weeks) suffering from hypoxaemic respiratory failure.
- Researchers analyzed data from neonates born between 2010 and 2018, comparing those who received iNO in their first week of life with those who did not, focusing on outcomes measured at 18-24 months corrected age.
- The findings revealed that although the iNO group had more severe health issues and higher rates of complications, there was no significant difference in the likelihood of neurodevelopmental impairment among surviving infants treated with iNO compared to those not treated.
Background: Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes.
Objectives: To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA.
A survey was conducted among Canadian tertiary neonatal intensive care units. Of the 27 sites who responded, 9 did not have any form of antimicrobial stewardship, and 11 used vancomycin for empirical coverage in late-onset-sepsis evaluations. We detected significant variations in the diagnostic criteria for urinary tract infection and ventilator-associated pneumonia.
View Article and Find Full Text PDFArticle Synopsis
- Sepsis is a major health issue for newborns, but there are no standard guidelines for collecting blood cultures to diagnose it in neonatal intensive care units (NICUs) worldwide.
- A survey conducted across 29 Canadian level-3 NICUs revealed that while 65% have guidelines for blood culture collection, practices vary widely regarding volume and types of cultures collected for early and late-onset sepsis.
- The lack of standardization in these practices could hinder accurate estimates of neonatal sepsis incidence and the development of effective treatment strategies.
Importance: Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.
Objective: To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.
Article Synopsis
- Therapeutic hypothermia (TH) is the standard treatment for moderate to severe neonatal encephalopathy (NE), but there are notable variations in care practices across neonatal intensive care units (NICUs) in Canada, potentially affecting long-term outcomes.
- A survey sent to tertiary NICUs in Canada received a 92% response rate and indicated that while most centers adhere to national guidelines for certain initial assessments and protocols, significant differences exist in areas like ventilation, hypotension treatment, and follow-up practices.
- The findings highlight the need for a consensus-based care bundle to standardize practices during TH, which could enhance care quality and improve outcomes for neonates suffering from NE.
Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to analyze differences in treatment practices and outcomes for newborns with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia in Canadian neonatal intensive care units (NICUs) from 2010 to 2020.
- A total of 3,261 neonates were treated, with 11% dying before discharge and 37% showing MRI-detected brain injury, highlighting significant variations in mortality and brain injury rates across different NICUs.
- The findings point to notable discrepancies in treatment methods (like the use of inotropes and blood products), suggesting a need for standardization in care practices for HIE in neonates across Canada.*
Article Synopsis
- - The study aimed to evaluate the impact of opioid use during therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy on their health outcomes in the hospital.
- - Out of 1,484 infants analyzed, those with high opioid exposure (3-5 days) experienced a longer hospital stay and were less likely to achieve full oral feeding at discharge, while opioid use didn't link to abnormal MRI results.
- - The findings suggest that while opioids may not affect brain imaging results, their potential short-term negative effects need careful consideration during treatment.
Objective: This study aimed to determine the range of weight loss, at 3 days postnatal age, associated with the lowest risk of mortality/short-term morbidity in preterm infants <29 weeks gestational age (GA).
Study Design: This multicenter retrospective cohort study employed data from the Canadian Neonatal Network database. The primary outcome was a composite of mortality and/or severe neurological injury.
Objective: To compare 2% aqueous chlorhexidine gluconate (AQC) vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol (ALC) for pre-venipuncture skin antisepsis in very-low-birth-weight neonates (VLBW, birth-weight <1500 grams).
Study Design: Double-blind, non-inferiority trial randomized 199 VLBW neonates, age 2-28 days, to receive pre-venipuncture skin preparation using single application of swabstick impregnated with AQC (n = 99) or ALC (n = 100).
Objective: The aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success.
Design: Retrospective cohort study with propensity score matching.
Setting: Canadian national study.
Introduction: Neonates admitted to neurocritical care units frequently undergo continuous bedside cerebral function monitoring (CFM). Documentation of CFM findings that are complete and accurate can augment the quality of care through improved communication. We aimed to increase the compliance with and quality of CFM documentation in the electronic medical records by 50% in our neonatal intensive care unit over 6 months.
View Article and Find Full Text PDFObjective: To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at <26 weeks of gestation or <750 g birth weight.
Study Design: We conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network units between 2010 and 2018. Infants were classified into 2 groups based on receipt of antenatal steroids; the latter subgrouped as recent (≤7 days before birth) or latent (>7 days before birth) exposures.
Article Synopsis
- The study aimed to create predictive models for death or neurodevelopmental impairment (NDI) in infants with neonatal hypoxic-ischemic encephalopathy (HIE) based on data collected at the time of NICU admission and discharge.
- It analyzed a cohort of infants treated with therapeutic hypothermia from the Children's Hospitals Neonatal Consortium Database, identifying significant factors like HIE severity and certain treatments that were associated with outcomes.
- The predictive models developed demonstrated good accuracy, with the potential to help clinicians assess risk levels better and tailor early interventions for infants most at risk of negative outcomes.*