Prognostic Factors in Premature Infants with Pulmonary Hemorrhage occuring after Surfactant Replacement

PURPOSE: Exogenous surfactant replacement therapy reduces morbidity and mortality rates for premature babies with respiratory distress syndrome (RDS). A significant increase in clinical pulmonary hemorrhage has been reported in premature babies treated with surfactant. Pulmonary hemorrhage, one of the major cause of death, may develop due to an increased pulmonary blood flow. We investigated the prognostic factors for mortality in premature infants with pulmonary hemorrhage after surfactant replacement, and to predict the survival of infants having RDS. METHODS: We investigated the characteristics and clinical courses of the 22 premature infants who developed pulmonary hemorrhage after surfactant therapy for RDS hospitalized at Seoul Red Cross Hospital between Dec 1994 and May 1998. We divided the patients into two groups ' Group I were those who survived (n=6) and Group II were those who expired after pulmonary hemorrhage (n=16). RESULTS: There were no differences in birth weight, gestational age and radiologic staging between two groups (P>0.05). Low Apgar score at birth was significantly related to mortality in premature infants with pulmonary hemorrhage (P<0.05). The interval between birth and onset of pulmonary hemorrhage and the interval between the surfactant replacement and onset of pulmonary hemorrhage were significantly longer in Group I than in Group II (P<0.05). CONCLUSION: The clinical conditions at birth, the interval between birth and onset of pulmonary hemorrhage, and the interval between surfactant replacement and onset of pulmonary hemorrhage were the prognostic factors of mortality in preterm infants with pulmonary hemorrhage.

Diagnosis of Fatty Liver Complicated by Simple Obesity in Children: Serum ALT and Its Correlation with Abdominal CT and Liver Biopsy / 대한소아소화기영양학회지

PURPOSE: The purpose of our study is to provide useful information for diagnostic methods of fatty liver by childhood simple obesity and to provide correlation between serum alanine aminotransferase (ALT) for screening test and abdominal computerized tomography (CT) and liver biopsy for confirmative diagnostic methods of fatty liver. METHODS: Among 78 obese childrens who visited our hospital, CT was carried out in 26 childrens. Of these, liver biopsy was carried out in 15 childrens who had high obesity index or severe elevated ALT. Based on the level of serum ALT, 26 cases were classified into 3 groups, and compared with physical measurements and degree of fatty infiltration on CT and liver biopsy. RESULTS: 1) Correlation between ALT and physical measurements: Of 26 obese children, ALT was abnormally elevated (>30 IU/L) in 17 cases (67.4%) but there was no significant correlation between ALT and physical measurements (p>0.05). 2) Correlation between degree of fatty infiltration on CT and ALT: Of 26 cases, 13 cases (50%) revealed fatty liver on CT. The degree of fatty liver on CT had significant correlation with elevation of ALT (p0.05), but significant correlation with ALT (p<0.05). 4) Correlation between CT and liver biopsy finding: Both CT and liver biopsy were performed in 15 cases of which 6 cases revealed normal finding on CT and 9 cases manifested fatty liver. There was significant correlation between CT and liver biopsy findings (r=0.6094). CONCLUSION: The results of our study suggest that abdominal CT and liver biopsy are useful and accurate methods of estimating fatty liver in the childhood obesity. But biochemical abnormalities of routine liver function tests dot not correlate well with severity of the fatty liver and liver injury.

A Case of Congenital Bronchoesophageal Fistula Accompanied with Hematemesis / 대한소아소화기영양학회지

Congenital bronchoesophageal fistula associated esophageal atresia usually presents in the newborn period or infancy but those without esophageal atresia are more insidious in disease process. Symptoms which include cough, hemoptysis, choking on swallowing liquids, uncommonly dysphagia, and epigastric discomfort may not begin until adult life. Most of the cases are curative unless there are serious underlying conditions. The diagnosis is usually made by gastroesophagoscopy, esophagogram, bronchogram and bronchoscopy. And the most of the cases can be cured by fistulectomy and resection of involved pulmonary lobes. We experienced one case of congenital bronchoesophageal fistula which occurred in a 13- year-old girl who complained of paroxysmal cough and intermittent hematemesis for 3 years.