Effects of Polymorphonuclear Leukocyte Enzymes on the Physical properties of Surfactant / 대한주산의학회잡지

No abstract available.

Correlation of Serum Magnesium Concentrations and Diseases of Prematurity in Very Low Birth Weight Infants

PURPOSE: The purpose of the study was to evaluate serum magnesium(Mg) concentration in very low birth weight(VLBW) infants during the first three weeks of life and to assess its relation to diseases of prematurity. METHODS: We measured serum Mg level at 0, 1, 2, and 3weeks of life in VLBW infants and analyzed its correlations with diseases of prematurity. Ninety-five VLBW infants(mean gestational age 30.4wks, birth wt 1304gm) who survived 30days were selected. Seven infants who had been treated with magnesium sulfate prenatally were excluded. RESULTS: Serum Mg level decreased linearly during the first three weeks of life(P=0.03). Serum Mg level at birth had no significant relation to gestational age, birth weight and serum calcium concentration. Serum Mg level at birth were higher within normal range in infants with respiratory distress syndrome(n=20, 2.6mg/dl vs. n=68, 2.2mg/dl, P=0.036), patent ductus arteriosus (n= 19, 2.5mg/dl vs. n=69, 2.2mg/dl, P=0.035) and bronchopulmonary dysplasia(BPD)(n=15, 2.6mg/dl. vs. n=73, 2.2mg/dl, P=0.01) than in infants without them. Serum Mg level at first week of life were similar(2.3mg/dl. vs. 2.2mg/dl, P=0.51) and serum Mg level at second and third weeks of life were significantly lower in infants with BPD than in control(1.9mg/dl vs. 2.2mg/dl, P=0.002 and 1.6mg/dl vs. 2.2mg/dl, P=0.001, respectively). CONCLUSION: Serum Mg level during the first three weeks of life decreased linearly. Serum Mg level of infants with BPD at birth was higher within normal variation than in infants without BPD. And serum Mg level of infants with BPD at second and third weeks of life were lower than control. Thus, we suggest that Mg deficiency during the first three weeks of life might play a role in the pathogenesis of BPD.

Clinical Trial of Domestically Developed Bovine Lung Surfactant YY-38 in Neonatal Respiratory Distress Syndrome

PURPOSE: We previously reported modified bovine lung surfactant YY-38(Newfactan ) had a low surface tension, good hysteresis, and exhibited good pressure-volume curve in animal experiment(J Korean Pediatr Asso 1997;40:771-85). We performed multicenter clinical trial of Newfactan in neonatal RDS. METHODS: Seventy-seven infants with RDS(GA 31.8+/-2.9 wks and BW 1,809+/-592 gm) in 4 NICU were enrolled. After administration of Newfactan , we analyzed ventilator parameters and outcomes in 71 infants excluding mortality cases(n=6), and also compared risk factors between response(n=53) and redosing group(n=18). RESULTS: Newfactan was administered at 6.8+/-7.2 hr after birth. Ventilator parameters such as FiO2, alveolar-arterial oxygen difference(a-A PO2) and oxygenation index(OI) except mean airway pressure(MAP) were significantly improved from six hours after administration. All parameters were improved at 24 hours after administration and persisted for 5 days. Outcomes were as follows; PDA(n=24), BPD(n=16), IVH(n=13), sepsis(n=9), ROP(n=7), pneumothorax(n=4) NEC(n=3), PIE(n=2), and pulmonary hemorrhage(n=1). All patients survived 30 days after birth. Redosing rate was 25%. The incidence of PDA was greater in redosing(56%) than in response group(26 %)(P=0.025). CONCLUSION: In prospective multicenter clinical trial, Newfactan was effective in the treatmentof RDS.

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

Effects of Blood Pressure Cuffs on the Circulatory and Respiratory Status of Infants with Persistent Pulonary Hypertension of the Newborn

PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy. We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure. Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters, presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy. RESULTS: Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05). Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg) and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure, oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role in the management of infants with PPHN.

Cardiac Effect of Pulse Dexamethasone Therapy in Infants with Bronchopulmonary Dysplasia / 대한주산의학회잡지

PURPOSE: To examine the cardiac function, incidence and natural history of cardiac hypertrophy (CH) and the association of side effects with CH after pulse dexamethasone therapy in infants with bronchopulmonary dysplasia. METHODS: Twelve infants, gestational age 28.6+/-1.6(26-31)weeks, birth weight 1243+/-186 (1010- 1620)g, received a pulse course of dexamethasone, starting at 0.5mg/kg/d for three days and readministered ten days thereafter at a median of 19 days of age. Serial echocardiographic measurement of septal thickness(ST), left ventricular(LV) posterior wall thickness(PWT), LV diameter(LVD), LV length(LVL), LV mass, ejection fraction(EF) and acceleration time to right ventricular ejection time ratio(AT/RVET) were taken before, and 4, 11 days after starting dexamethasone. For infants diagnosed as CH, echocardiography was performed weekly until the parameters were normalized. Side effects of dexamethasone such as leukocytosis, hypertension, hyperglycemia and insulin therapy were recorded and compared. RESULTS: CH occurred in 5 of 12 infants(47%). ST, PWD, and AT/RVET increased significantly at 4 days and 11 days after starting dexamethasone than baseline. LVD decreased significantly at 4 days and 11 days after the administration of dexamethasone than before. Other parameter such as LVL, LV mass and EF were not changed and the evidence of left ventricular outflow obstruction was not observed. The incidence of hyperglycemia and insulin therapy were higher in CH group than in no CH group(p<0.05). Five infants with CH recovered until five weeks after starting dexamethasone on serial echocardiography, CONCLUSION: Infants receiving a pulse course of dexamethasone developed evidence of septal hypertrophy, thickened left ventricular wall and impaired filling of left ventricle immediately after starting dexamethasone but always resolved within five weeks Serial echocardiography is not probably routinely required in preterm infants with bronchopulmonary dysplasia receiving pulse dexamethasone therapy.

A Case of Toxic Epidermal Necrolysis in Early Infancy

Toxic epidermal necrolysis(TEN) is a bullous disorder affecting mainly basal layers of epidermis by hypersensitive reaction. It is rarely reported in infants under six months of age. It can be developed by drug, infection, and vaccination, which makes it difficult to differentiate from staphylococcal scalded skin syndrome(SSSS) especially in early infancy. We report a case of TEN in a 6-week-old infant with short bowel syndrome receiving total parenteral nutrition. A male infant(birth weight 2,570gm at 37 weeks) whose mother had polyhydramnios with bilous vomiting at birth was evaluated. Barium and histologic study showed total aganglionosis. Surgical resection was performed at 3 days of life and subsequently short bowel syndrome developed. Total parenteral nutrition via central venous catheter was done due to feeding intolerance. Staphylococcus aureus was cultured from blood at 37days of life, and we administered vancomycin. As multiple scaly eruption and fever developed at 47days of life, we were suspicious of SSSS. Blood culture done at 47days of life revealed Pseudomonas aeruginosa and skin biopsy showed the split at dermoepidermal junction at light microcopy and confirmed the diagnosis of TEN. Despite discontinuation of antibiotics, the infant did not improve and died due to shock at 54days of life. We emphasized that in case of acute, severe exfoliative disease in early infancy, the diagnosis of TEN should be considered and that skin biopsy should be performed to make the correct diagnosis.

Effects of Hydrogen Peroxide and Catalase on Physical Properties of Surfactant

PURPOSE: In the treatrnent of respiratory distress syndrome, Infants are often exposed to hyperoxia. It can generate oxygen free radical, damage to lung and bronchi, and inactivate pulmonary surfactant(PS). Antioxidant therapy in animal and human models has been tried to overcome this detrimental effects. We hypothesized that the addition of oxygen free radical such as hydrogen peroxide(H) could compromise surface active properties(SAP) of PS and that further addition of antioxidant such as catalaseR(CAT, Sigma chemical, St. Louis) could recover SAP. METHODS: We prepared combinations of mixtures with SurfactenR(S-TA, Tokyo Tanabe, Japan), H202 and CAT. 1)0.625mgPL(phospholipids)/ml or 1.25mgPL/ml S - TA and H202 were mixed to the final concentrations of 0.1 and 1mM H respectively, and incubated at 37C for one hour. 2) 0.625mgPL/rnl S - TA, H202 and CAT 10U were mixed to the final concentrations of lmM H202, and incubated at 37 degree C for one hour. We used Pulsating Bubble Surfactometer (Electronetics, NY) measure in vitro minimum and maximum surface tensions(ST) and area-surface tension relationship. RESULTS: 1) For 0.625mgPL/ml S-TA and 1mM H mixture minimum. ST after 5 min of pulsation increased significantly(P=0.007) and the area-surface tension curve was deformed. But they were comparable to control levels for 1.25mgPL/ml S-TA. 2) When CAT was added to 0.625mgPL/ml S-TA and 1mM H mixture, the resultant minimum ST after 5 min of pulsation dropped to the control levels with recovery of hysteresis curve(P=0.0001). CONCLUSION: PS could be inactivated by addition of high concentrations of H but SAP can be recovered either by increasing PS concentration or by further addition of antioxidant CAT. Therefore, we suggest that in case of suspected surfactant inactivation an increase in surfactant concentration or administration of antioxidant must be considered.

Serum 17-Hydroxyprogesterone Levels in Term and Preterm Infants / 대한소아내분비학회지

PURPOSE:The incidence of congenital adrenal hyperplasia(CAH) is 1/5,000- 1/20,000 births and thus the importance of the neonatal screening test is being emphasized. However, the reference value for the term and preterm infants has not yet been established and false positive values are frequent due the immature hypothalamic-adrenal axis of the preterm infants or the stress-induced adrenal dysfunction. Therefore, we analyzed the 17-hydroxyprogesterone(17-OHP) concentration in terms of gestational age, birth weight, and postnatal state to establish the reference range for the Korean term and preterm infants. METHODS:We analyzed the results of the CAH screening test retrospectively, which was performed on 737 neonates(624 fullterm neonates, 113 premature neonates) born between January 1998 through July 1998 in Inje University College of Medicine Sanggye Paik Hospital. Mean gestational age and birth weight of infants were 38.2+/-2.6 weeks and 3,116+/-674kg respectively. 17-OHP screening test was performed on 4.9+/-3.8days after birth by obtaining blood samples from the heelstick of neonates. 17-OHP concentration was measured by the ELISA kit(ICN Co.) and repeated the procedure if the result was higher than 35ng/ml. RESULTS: 1) 17-OHP concentration of the preterm infants was significantly higher than that of the fullterm infants(19.1+/-12.3ng/ml vs 11.7+/-7.8ng/ml, P=0.001). 17-OHP concentration was inversely proportional to gestational age. 2)17-OHP concentration was inversely proportional to birth weight(r=0.22, P>0.01). 17-OHP concentration according to birth weight was as follows.:below 1,500g was 26.7+/-11.7ng/ml, 1,500 to 2,000g was 18.0+/-13.9ng/ml, 2,001 to 2,500g was 17.9+/-10.5ng/ml, 2,501 to 3,000g was 12.1+/-7.9ng/ml, 3,001 to 3,500g was 11.5+/-8.1ng/ml, above 3,500g was 11.4+/-7.5ng/ml. There was a significant decline in the 17-OHP concentration as the birth weight increased. 3) 17-OHP concentration was gradually decreased as sampling date increased. 4) The gender of the infants did not influence the 17-OHP concentration(male 13.0+/-9.1 vs female 12.7+/-9.0). 5)17-OHP concentration were significantly higher in sick preterm infants than healthy preterm infants. 6)Six cases, whose 17-OHP concentration were greater than 35ng/ml, were all preterm and low birth weight infants. Reexamination after one week showed the value within normal range. No CAH cases were diagnosed in the study. CONCLUSION: 17-OHP concentration was inversely proportional to gestational age and birth weight. Therefore, reference ranges of 17-OHP concentration should be subdivided according to gestational age and birth weight. Further research about perinatal risk factors affecting the 17-OHP concentration will be required.

Pyloric Stenosis in Premature Infants: Report of two cases / 대한소아소화기영양학회지

The incidence of Hypertrophic pyloric stenosis (HPS) in premature infants is rare, the presentation is not typical, and the diagnosis delayed due to uncertain diagnostic criteria in abdominal ultrasonography (US). We report two premature infants with HPS diagnosed by US and upper gastrointestinal (UGI) contrast study. Patient 1. A premature female infant (birth weight 1950 gm at 34 week's gestation) with the onset of intermittent vomiting at 9 days of age was evaluated. US was normal at 13 days of life, however, abnormal at 41 days of life (pyloric muscle length 16.5 mm). Patient 2. A premature male infant (birth weight 1470 gm at 29 week's gestation) with the onset of intermittent vomiting at 10 days of age was evaluated. US showed pylorospasm at 11 days of life, however, findings compatible with HPS at 57 days of life (pyloric muscle thickness 11 mm).UGI contrast study at 48 days of life showed similar findings in both cases. Both patients had undergone pyloromyotomy. In conclusion, the diagnosis of HPS in premature infants requires careful follow-up by US and UGI contrast study.

Effect of Antenatal Steroid on fluid Balance and Clinical Outcome in Bery Low Birth Weight Infants Rceiving REstricted Fluid Regimen / 대한주산의학회잡지

PURPOSE: Antenatal steroid(ANS) therapy in premature infants is an effective therapeutic strategy in reducing the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and patent ductus arteriosus. For premature infants to gain improved survival, adequate weight loss during early postnatal days and maintenance of electrolyte balance is important, however, it is uncertain that ANS affect them. We hypothesized that ANS augment fluid and electrolyte balance and dinical outcome of very low birth weight(VLBW) who had received restricted fluid regimen. METHODS: Mechanically ventilated VLBW infants who survived over 30 days were selected. We reviewed medical records to compare weight loss, urine output, electrolyte concentration, blood pressure during five days of life and clinical outcome between premature infants who received ANS(n=15) and who were not(n=58). RESULTS: Gestational age, birth weight were similar between two groups. Volume of administered fluid, urine output, and initial weight loss during first five days of life were similar, however, weight loss on postnatal day five were lower in study group than control group(p=.039). Blood pressure, serum sodium concentration, serum potassium concentration, and urine specific gravity were similar between two groups. Incidence of respiratory distress syndrome was lower in study group(20%) than control group(48%)(p=.041), however, incidence of sepsis were greater in study group(33%) than control group(7%)(p=.029). CONDUSION: ANS did not affect fluid and electrolyte balance of very low birth weight(VLBW) infants who had received restricted fluid regimen. ANS decreased the incidence of respiratory distress syndrome in this population, however, increased the incidence of sepsis.

Effects of Parenteral Carnitine Supplemantation in Very Low Birth Weight Infants Receiving Totla Parentareal Nutrition / 대한주산의학회잡지

PURPOSE: Carnitine plays a key role in the oxidation of fatty acids by facilitating their transport. As very low birth weight(VLBW) infants receiving total parenteral nutrition(TPN) with limited oral intake are likely to be carnitine-deficient state, they require exogenous supplementation of carnitine, however, effects of it remains controversial. To demonstrate effects of parenteral camitine supplementation on fat metabolism, weight gain and clinical outcome. We analyzed plasma levels of biochemical markers, changes of weight, and incidence of complications in 23 VLBW infants receiving TPN. METHOD: We randomly assigned 23 VLBW infants(32.3umol/l) than control group(46.3umol/l->25.2umol/l)(p<0.05). Changes of FC and AC were similar in both groups. Levels of cholesterol and triglyreride were similar in both groups. Days of regaining birth weight were faster in carnitine group than control group(15.3+/-3.4 vs 20. 8+/-11.1 days)(p<0.05). Rate of weight gain for two weeks were significantly faster than carnitine group than control group(p<0.05). No significant differences in clinical outcome were found. CONCLUSIONS: Carnitine supplementation in VLBW infants receiving TPN has an supportive nutritional regimen in that it reduces decrement in carnitine level and facilitate weight gain.

Increase in IL-6 and Number of Inflammatory Cells in the Lung Lavage Fluid of Adult Mice Exposed to 95% Oxygen: Protective Effect of Budesonide

PURPOSE: Pulmonary oxygen toxicity is mainly an inflammatory process, triggered by reactive oxygen species via a number of biochemical pathways. Recent evidence implies that ROS may stimulate NF-Kb to promote the synthesis of genes for inflammatory cytokines. At the same time, corticosteroids have been implicated in the prevention of activating this step. However, adverse reactions of systernic corticosteroids cause physicians to hesitate their use, not to mention their doubtful effectiveness. Budesonide is a locally acting corticosteroid with little systemic effect. Inhaled either through nebulizers or metered dose inhalers, it has proved the antiinflammatory, and thus antiasthmatic, effects in patients with asthma. If oxygen-induced injury is mediated by factors involved in a similar pathway as described above, budesonide will have protective effects against inflammatory responses of pulmonary oxygen toxicity. METHODS: We used 10 adult mice in each of the three groups, AC is the room air control group, OC is the oxygen control group in which mice were exposed to 95% oxygen for 48 h; and TX is the treatment group in which mice were exposed to 95% oxygen for 48 h, and during that period they were given budesonide via a nebulizer 500 p g/dose every 12 h for 4 times. The mice were sacrificed with iection of a lethal dose of ketamine. Tracheotomy was done and an 18G ET tube was inserted. The lungs were lavaged with 80 ml/kg(or 80 microliter/g) isotonic saline slowly injected through the ET tube. The lung lavage fluid was centrifuged at 8000 rpm for 2 rninutes. Supernatant was used for analysis of IL-6, while the precipitate was resuspended in 200 microliter of isotonic saline for cell count. RESULTS: The simple mean IL-6 values did not show a significant difference between groups (AC 199.4+/-192.7; OC 274.5+/-31.3; and TX 269.8+/-127.G pg/Ml). But considering their skewed distribution in AC and TX groups, the median values showed a conspicuous difference among 3 groups, that is, the median IL-6 value of AC was 124.8 pg/Ml, OC 269.8 pg/Ml, and TX 217.4 pglmL. For the cell counts, AC was 189+/-56/mm, OC 424+/-111/mm, and TX 266+/-22/mm(P<0.05). CONCLUSION: In conclusion, budesonide nebulization appears to have protective effects against inflammatory responses of pulmonary oxygen toxicity in adult mice.

Thyroid Hormone Concentrations in Preterm Infants

PURPOSE: To establish reference ranges for thyroid hormone concentrations in premature infants, we measured T4 and thyroid stimulating hormone (TSH) concentrations and analyzed the relation to gestational age and birth weight. METHODS: Serum T4 and TSH concentrations were measured by radioimmunoassay for 391 premature infants born in Sanggye Paik Hospital for two years and eight months. RESULTS: Gestational age of the subjects was 33.3 +/- 2.4 weeks (range : 26-37 weeks). Birth weight was 2,016 +/- 520g (range : 880-3,510g). Sampling date was 10.5 +/- 8.6 day (median value 8 day). Serum T4 concentrations for the gestational age 26 to 28, 29 to 31, 32 to 34 and 35 to 37 week groups were 4.8 +/- 3.6, 5.6 +/- 3.6, 6.4 +/- 4.4 and 7.0 +/- 4.6 microgram/dl, respectively. Serum T4 concentrations for the birth weight below 1,500, 1,500 to 1,999, 2,000 to 2,499 and above 2,500g groups were 5.7 +/- 3.8, 5.8 +/- 3.6, 6.4 +/- 4.6 and 8.1 +/- 5.1 microgram/dl, respectively. Serum TSH concentrations for the gestational age 26 to 28, 29 to 31, 32 to 34 and 35-37 week groups were 6.5 +/- 3.0, 7.2 +/- 6.1, 5.8 +/- 5.0 and 5.6 +/- 5.1 mIU/ml, respectively. Serum TSH concentrations (mean +/- SD) for the birth weight below 1,500, 1,500 to 1,999, 2,000 to 2,499, above 2,500g groups were 8.3 +/- 6.8, 5.7 +/- 4.3l, 5.5 +/- 5.1 and 5.6 +/- 5.2 mIU/ml, respectively. Serum T4 concentrations correlated positively with gestational age (y=0.31x-3.7, R2=0.03, P<0.05) and birth weight (y=0.001x+3.33, R2=0.33, P<0.05). Serum TSH concentrations correlated negatively with gestational age (y=-0.25x+16.1, R2=0.01) and birth weight (y= -0.001x+10.6, R2=0.01). CONCLUSION: Serum T4 concentration in premature infants positively correlated with gestational age and birth weight. Transient elevation of serum TSH concentration was normalized at follow- up test. We recommend that a reference value should be set according to gestational age and birth weight.

Comparison of Treatment Course and Outcome between Medically and Surgically Treated Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Early intervention is needed to treat patent ductus arteriosus (PDA) as it is a major cause of increased mortality in preterm infants. However, it is uncertain which is better, medical versus surgical management. We reviewed medical records to compare the treatment course and outcome between medically and surgically treated preterm PDA infants. METHODS: Thirth-two Mechanically ventilated pretem infants (gestational age<34 wks, birth weight<2,000gm) who survived beyond 30 days were studied. Treatment course and outcome were compared between indomethacin-treated (INDO, n=15) and surgically treated who have not responded to indomethacin (Surg, n=17). RESULTS: Volume of administered fluid and urine output during the first five days of life were similar, however, initial weight loss were lower in the SURG group than INDO group (p=0.031). Size of PDA on the echocardiogram were larger in SURG group (mean 3.4 mm) than INDO group (mean 2.5 mm) (p=0.046). Duration of hospitalization was longer in the SURG group (mean 46 days) than INDO group (mean 72 days) (p=0.033), however, time to start feeding, ventilator duration and weaning time were similar in both groups. Incidence of intraventricular hemorrhage was lower in the SURG group (47%) than INDO group (6%) (p=0.009). CONCLUSION: Preterm infants with poor initial weight loss and large size of PDA were likely to become surgical candidates and required longer periods of hospitalization and showed increased incidence of IVH. Although surgical treatment of PDA in preterm infants is definitive, fluid restriction and medical management at early postnatal period is recommended.

A Case of Chylous Ascites Secondary to Congenital Ileal Atresia / 대한주산의학회잡지

Chylous ascites in neonates is an unusual and etiologically poor understood entity. We report a male newborn who suffered from abdominal distension and respiratory distress after birth. Paracentesis was performed and ascitic fluid was obstained. Analysis of the fluid revealed cell count (RBC 10,000/mm3, WBC 800/mm3: segmented form-72%, lymphocyte form- 28%), protein 4,100 mg/dl, glucose 57 mg/dl, cholesterol 53 mg/dl, triglyceride 28 mg/dl. Culture of ascitic fluid grew no bacteria. A plain film of abdomen and abdominal sonogram showed massive ascites. On the 4th hospital day, gastrografin enema showed microcolon and ileal atresia. On the 6th hospital day, ileocolostomy has been performed and operative findings sho- wed blind pouch in terminal ileum, massive inflammation and extensive adhesion on peritoneum. After operation, he gained weight by continuous gavage feeding. He discharged on the 36th hospital day.

Risk Factors of Paternt Ductus Arteriosus in Very Low Birth Weight infants

PURPOSE: Hemodynamically significant patent ductus arteriosus (PDA) may increase the mortality of premature infants who received ventilator care by aggravating hypoxia, acidosis, pulmonary edema and hypotension. The risk factors for PDA in premature infants are low gestational age, infusion of excessive fluid, and severity of neonatal respiratory distress syndrome. We studied the risk factors of PDA in very low birth weight infants (VLBW) to establish a guideline for the treatment. METHODS: VLBW infants who were born at Severance Hospital, Yonsei Medical Center from January, 1989 through December, 1995 and survived for at least 5 days with ventilator care were recruited for this study. Patent ductus arteriosus was diagnosed according to the clinical diagnostic criteria of Yeh (Yeh et al, 1981b). Thirty six infants had diagnosed as PDA (PDA group), and thirty seven infants who had not PDA were selected as control. Both groups of infants received restrictive fluid therapy. RESULTS: 1) Gestational age, sex, Apgar score, administration of surfactant, mode of delivery, toxemia and use of antenatal dexamethasone were similar between PDA and control infants. 2) In PDA group, ventilatory index and duration of vetilator care were significantly greater (P<0.05), and a/ApO2 was significantly lower than control group (P<0.05). There was no difference in peak inspiratory pressure at initial setting, the highest peak inspiratory pressure and mean airway pressure during ventilator care. 3) During the first 3 days of life, the urine output was similar between groups. On the 4th and 5th days of life, PDA group had significantly reduced urine ouput compared with control (on day 4; 2.6+/-1.1 ml/kg/h vs. 3.2+/-1.2ml/kg/h, P<0.05; on day 5, 2.9+/-1.4ml/kg/h vs. 3.6+/-1.6ml/kg/h, P<0.05) . 4) The percent weight loss compared to birth weight was siginificantly lower in PDA group (12.5% vs. 15.1%, P<0.05). 5) The PDA group had higher incidences of bronchpulmonary dysplasia and intraventricular hemorrhage (P<0.05). CONCLUSION: Among Vlnfants who received restrictive fluid therapy during the first 5 days of life, infants with PDA had reduced urine output and percent weight loss than control group.

Risk factors for Pulmonary Interstitial Emphysema (PIE) in Mechanically Ventilated Neonates with Hyaline Membrane Disease

PURPOSE: Pulmonary interstitial emphysema (PIE) is a common and serious complication of mechanical ventilation in infants with hyaline membrane disease. This abnormal collection of gases has two basic roentgenographic features; linear and cyst-like radiolucencies. High positive inspiratory pressure was found to be the most significant parameter associated with development of fatal pulmonary interstitial emphysema. Without prompt conservative management such as lowering peak inspiratory pressure, PIE often progress to a pneumothorax with increased mortality. We studied the incidence and risk factors of PIE and associated risk factors which progress to pneumothorax in mechanically ventilated infants with hyaline membrane disease. METHODS: We reviewed retrospectively the charts of infants who had been admitted to the neonatal intensive care unit between Jan. 1990 and Mar. 1995. A hundred and two infants who were diagnosed as hyaline membrane disease and mechanically ventilated were included in the study. Analysis of clinical characteristics and ventilator parameters were made. Chest radiographs were reviewed for hyaline membrane disease, PIE, pneumothorax by a pediatric radiologist without knowledge of their clinical course. RESULTS: 1) We observed PIE in 14 of 102 infants (13.7%) of which 11 infants progressed to develop pneumothorax. 2) Low gestational age, low apgar score and high peak inspiratory pressure were the factors significantly associated with development of PIE. 3) PIE was frequently located bilaterally (52%), distributed on whole lung parenchyme (92%). Sizes of radiolucency were variable including blebs. 4) Early onset PIE and failure to promptly lower peak inspiratory pressure were the associated risk factors for development of pneumothorax. 5) Pneumothorax developed within a mean 7.5 hours after apperance of PIE. Right side pneumothorax was more frequent (67%). Mortality increased to 73% with development of pneumothorax in PIE. CONCLUSIONS: Early diagnosis of PIE and prompt lowering of peak inspiratory pressure should be emphasized to improve the survival and outcome of mechanically ventilated hyaline membrane diasease infants.

Risk Factors of Cerebral Palsy and Delayed Development in Term Infants with Perinatal asphyxia / 대한주산의학회잡지

Although prenatal and neonatal intensive care in recent years improved survival of infants, the risk of cerebral palsy (CP) in infants with perinatal asphyxia persisted. Screening criteria for risk factors of cerebral palsy and delayed development (DD) in term infants with perinatal asphyxia are required so that early diagnosis and rehabilitation and physical therapy could decrease the neurologic complications and maximize quality of life. To identify the risk factors of CP and DD in infants with perinatal asphyxia, we undertook a case-control study of 25 infants with perinatal asphyxia (5 min Apgar score below 6). At one year follow-up, 12 infants developed CP and DD and 13 control infants showed normal development. Risk factors associated with an increased risk of CP and DD were the number of abortion (p=0. 031), history of neonatal seizure (p=0.021), hypoxic ischemic encephalopathy (p=0.046), and poor response to resuscitation immediately after birth (p=0.017). In term infants with perinatal asphyxia, the risk factors of CP and DD were increased number of abortion, history of neonatal seizure, and hypoxic ischemic encephalopathy and poor response to resuscutation. Thus infants with these risk factors should be carefully followed up after hospital discharge and further extensive and prospective study in term infants with perinatal asphyxia could elucidate possible mechanisms related to cerebral palsy and delayed development.