Removal of a Peripherally Inserted Central Catheter Remnant using Cardiac Catheterization in Preterm Infant

The peripherally inserted central catheter (PICC) is used frequently in preterm infants. The known complications associated with the PICC include infection, thrombosis, extravasation, phlebitis, leakage of insertion site, fracture, accidental removal, occlusion of the PICC, and arrhythmia. We herein report a case of a spontaneously fractured PICC remnant that was successfully removed by cardiac catheterization.

Study on Meconium Peritonitis Associated with Intrauterine Intestinal Perforation / 대한주산의학회잡지

OBJECTIVE: This study was aimed to study clinical characteristics of patients with intrauterine meconium peritonitis, differences of various factors in between those who required operation and those who did not, risk factors leading into operation, and prognosis in the era of high prenatal diagnosis. METHODS: A retrospective review of 53 patients was done. Various factors for operation group (n= 41) and non-operation group (control, n=12) were compared. The risk factors for operation were analyzed by logistic regression analysis. RESULTS: The mean gestational age and birth weight for 53 including 41 (77%) of prenatally diagnosed cases were 36+/-3.4 weeks and 2,819+/-755 g, respectively. The most frequent antenatal sonographic finding was calcification. The most common etiology was ileal atresia. The first and full feeding was at 1.4+/-1.5 and 4.2+/-1.9 day, respectively for control (11.3+/-10.9 and 32.3+/-24.7 day). Risk factors for operation included requirement of mechanical ventilation and cesarean delivery. Overall survival rate was 94%. Survivial rate of those who were antenatally diagnosed was 97.6% in comparison to 83.3% who were not. The growth at 12 months was satisfactory. CONCLUSION: Favorable outcome of intrauterine meconium peritonitis is reassuring and stems from multidisplinary team approach.

The Evaluation of Left Ventriclular Function Determined by Conventional Echocardiography and Tissue Doppler Imaging in Obese Children less than 10-year-old

PURPOSE: The objective of the study was to determine the anatomical and functional changes of the left ventricle (LV) in obese children less than 10 years old using the conventional echocardiography and tissue doppler. METHODS: A total of 45 children were enrolled for the study of which all including 12 obese children whose body mass index (BMI) exceeded 95th percentile for age and sex adjusted standard BMI of Korean children were screened by conventional echocardiographic and tissue doppler imaging examinations at Kangneung Asan hospital during June 2005 to October 2005. RESULTS: There was no statistical difference in age between control and obese group (CG vs. OG: 7.1+/-1.2 yr. vs. 8.0+/-1.5 yr). The average BMI in OG was 22.6+/-2.4 kg/m2. The conventional echocardiographic indices of LV including the diastolic LVID (LV Internal Dimension), LVPWT (LV Posterior Wall Thickness), the systolic IVST (Interventricular Septal Thickness), LVID and LVPWT were higher in OG compared to CG. Also, the LV mass (LVm), LV mass index (LVmI), fractional shortening (FS) and ejection fraction (EF) were higher in OG than CG. however, the early and late diastolic mitral inflow velocities (E, A) and their ratios (E/A) showed no differences between the two groups. The myocardial performance index (MPI) was higher in OG than CG: 0.42+/-0.09 vs. 0.35+/-0.07. The isovolemic relaxation time (IVRT) was prolonged in OG compared to CG: 55+/-8 ms vs. 46+/-9 ms. The indices of TDI including the systolic peak velocity (s') and late diastolic peak velocity (a') at mid-IVS were higher in OG than CG, but the early diastolic peak velocity (e'), e'/a', E/e' at mid-IVS showed no differences between the two groups. The indices of TDI at the lateral portion of mital annulus showed no differences between the two groups. CONCLUSION: This study showed that increased LVm, LVmI, EF, FS, MPI, IVRT and a' in obese children less than 10 years old. This result showed anatomical and functional early change of LV due to obesity similar to adult and adolescence more than 10 years old.

Immune responses of hepatitis B vaccination among very low birth weight infant / 소아과

PURPOSE: To evaluate the immunogenicity of hepatitis B vaccine among very low birth weight infants(VLBWI) who were vaccinated at 0, 1, 6 months of chronological age and to determine the factors associated with antibody formations. METHODS: A total of 243 VLBWI admitted to Seoul and Gangneung Asan Medical Center neonatal intensive care units from 1997 to 2004 were included. Of 243, 13 infants were born to HBs Ag positive mother. All infants were given DNA recombinant vaccine at 0, 1, and 6 months of chronological age. Infants born to HBs Ag positive mothers received hepatitis B immunoglobulin at birth and a total of 4 doses of vaccinations. An antibody level over 10 mIU/mL, tested at 3-4 months after last vaccination, was regarded as a positive seroconversion. RESULTS: The seroconversion rates were 84.4 percent and 84.5 percent for VLBWI and extremely low birth weight infants(ELBWI), respectively. Of 28 seronegative infants who were given revaccinations, 60.7 percent seroconverted, resulting in 95.3 percent, 97.5 percent seroconversion rates for VLBWI and ELBWI, respectively. 76.9 percent of infants born to HBsAg positive mothers seroconverted and none became hepatitis B carriers. Factors such as gestational age, sex, various neonatal illness, and kinds of vaccinations did not influence the formation of the hepatits B antibody, however, the higher the weight at time of first vacciation yielded better seroconversion rate. CONCLUSION: Revaccination of seronegative VLBWI after 3 doses of hepatitis B vaccinaton is very effective. Therefore, testing the immune status after the hepatitis B vaccination, a practice not routinely done, is highly recommended.

Prognosis of Bochdalek Hernia in Neonate after Change in Management Principle

There are considerable controversies in the management of congenital diaphragmatic hernia. By 1997, early operation, routine chest tube on the ipsilateral side and maintainingrespiratory alkalosis by hyperventilation were our principles (period I). With a transition period from 1998 to 1999, delayed operation with sufficient resuscitation, without routine chest tube, and permissive hypercapnia were adopted as our practice. High frequency oscillatory ventilation (HFOV) and nitric oxide (NO) were applied, if necessary, since year 2000(period II). Sixty-seven cases of neonatal Bochdalek hernia from 1989 to 2005 were reviewed retrospectively. There were 33 and 34 cases in period I and II, respectively. The neonatal survival rates were 60.6 % and 73.5 %, respectively, but the difference was not significant. In period I, prematurity, low birth weight, prenatal diagnosis, inborn, and associated anomalies were considered as the significant poor prognostic factors, all of which were converted to nonsignificant in period II. In summary, improved survival was not observed in later period. The factors considered to be significant for poor prognosis were converted to be nonsignificant after change of the management principle. Therefore, we recommend delayed operation after sufficient period of stabilization and the avoidance of the routine insertion of chest tube. The validity of NO and HFOV needs further investigation.

Candida albicans Brain Abscesses in Extremely Low Birth Weight Infant Treated with Amphotericin B, Flucytosine, and Fluconazole

Systemic candidiasis in premature infants often involves the central nervous system (CNS) but only a few reported cases of candidiasis involving the brain parenchyma were found in a recent search of the literature and there is no uniformly accepted approach for treatment of CNS Candida infection in neonates. We report a case of extremely low birth weight infant who had candiduria and Candida meningitis with multiple abscesses formation in brain parenchyma who was successfully treated with long term amphotericin B, flucytosine, and fluconazole therapy without surgical drainage.

Infant Follow-up of Premature Infants

Agrowing number of premature infants including those with extremely low birth weight (birth weight <1,000g) are surviving in recent years with advances in neonatal intensive care. The infant follow-up program is a service that provides a continuum of care to high-risk infants who have increased risk for major and minor neuro-developmental impairments after they have been discharged from the hospital's intensive care unit. The goals of the outpatient clinic include the followup of the growth and development, identification of medical, neurological, developmental or psychological abnormalities, referral and consultation services as needed, and the enhancement of infant-parental bonding. All high-risk premature infants who are at risk for developmental delays should be evaluated with the Bayley Scales of Infant Development at corrected 7~8, 18, and 24 months and appropriate developmental assessment tools later in life to identify problems and to make appropriate referrals for early interventional therapies such as physical, occupational, speech, hearing, feeding and play group.