Oxygen Desaturation during Nutritive Sucking in Premature Infants with Bronchopulmonary Dysplasia: Its Effect on Feeding and Growth until 4 Months of Corrected Age

PURPOSE: This study examined the occurrence of oxygen desaturation events during nutritive sucking in premature infants with bronchopulmonary dysplasia (BPD) and its effects on feeding and growth outcomes until 4 months of corrected age (CA). METHODS: Thirty-four premature infants with BPD free from major cardiac, gastrointestinal, respiratory anomalies were included. By reviewing medical records, clinical characteristics, feeding conditions at 36 weeks of postmenstrual age (PMA), we focused on oxygen desaturation, and short-term outcomes in 14 infants with no or mild desaturation (group A) and in 20 infants with moderate or severe desaturation (group B). RESULTS: Group B had lower birth weight and shorter gestational age at birth, longer duration of hospitalization, was discharged at higher weeks of PMA, and needed ventilatory assist and oxygen supplementation longer than group A (P<0.05). Group B started nutritive sucking later, with a greater decrease in SpO2 during sucking, being more indicative of feeding problems at 40 weeks of PMA, but not at 4 months of CA. Percent of infant needing oxygen supplementation and percent of infants with growth failure were not different between groups at 40 weeks of PMA and 4 months of CA. Body weight and growth velocity differences noted at 40 weeks of PMA became insignificant at 4 months of CA. CONCLUSION: The severity of desaturation during nutritive sucking in premature infants with BPD influenced the infant's feeding and growth at 40 weeks of PMA. However, it disappeared at 4 months of CA.

A Case of Pseudohypoaldosteronism Type l Diagnosed after Infancy / 대한소아내분비학회지

Pseudohypoaldosteronism (PHA) type l is a rare neonatal disease characterized by salt wasting, dehydration, hyperkalemia and metabolic acidosis. It is unresponsive to mineralocorticoid treatment with elevated aldosterone concentration. The three different modes of inheritance has been described. The autosomal dominant form has a mild clinical course and gradually improves with age. In this form, resistance to aldosterone seems to be restricted to the kidney. The autosomal recessive form displays generalized aldosterone resistance including kidney, colon, lung, sweat and salivary gland system. This form is more severe and requires life-long supplement with high-dose salt. The sporadic form is mild and resembles the autosomal dominant form. In this paper, we describe a male patient diagnosed as PHA type l at the age of 19 months. He presented with recurrent vomiting, diaphoresis accompanying hyponatremia, hyperkalemia, metabolic acidosis, elevated plasma renin activity and aldosterone level. Ultimately he has improved with treatment by oral sodium bicarbonate.