Availability of Volume Guaranteed Ventilation in Very Low Birth Weight Infants

PURPOSE: During the last few decades, very low birth weight (VLBW) infants had been treated with time-cycled pressure-limited ventilation. According to a recent study, however, lung damage is much more likely following volutrauma rather than barotrauma. Therefore, other researchers have started to study volume-guaranteed (VG) ventilation as a new method for infant respiratory distress syndrome. The aims of this study are to compare the effects and safety of VG ventilation with conventional intermittent mandatory ventilation (IMV) on mechanical ventilation in VLBW infants with respiratory distress syndrome (RDS). METHODS: A prospective study was performed from Jan, 2005 to Jun, 2006 in Dong-A University Medical Center NICU on 28 VLBW infants who were diagnosed with respiratory distress syndrome. The infants were randomly assigned to IMV or VG ventilation. The IMV and VG groups consisted of sixteen and twelve patients, respectively. We compared arterial blood gas analysis (ABGA), fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), mean airway pressure (MAP) and ventilation index (VI) between the two groups during the four days after their birth. RESULTS: The mean gestational age of our infant patients was 27.8 (+/-2.2) weeks in the VG group and 27.7 (+/-2.3) weeks in the IMV group; the mean birth weight was 1103 (+/-239.1) g and 1061.2 (+/-322.4) g, respectively (P>0.05). Although the two groups had a similar FiO2 and VI, PIP and MAP were significantly lower in VG than IMV during the study pediod (P<0.001). There was no significant difference in the complications between the two groups. CONCLUSION: In this study, PIP and MAP are significantly lower in VG group than IMV group. These findings suggest that the new VG ventilation could reduce lung damage in VLBW infants with RDS. To achieve more effective results, this study needs to continue a long term study with a greater number of subjects.

Changes in the Outcomes of Very Low Birth Weight Infants in Busan Area

PURPOSE: To evaluate mortality and morbidity of very low birth weight infants(VLBW infants) born in the Busan area from 1996 to 2005. METHODS: A total of eight neonatal intensive care units (4 university hospitals and 4 general hospitals) in Busan participated in this study. A total of 1,414 VLBW infants were divided into three groups: period I, 1996 to 2000; period II, 1999 to 2002; period III, 2003 to 2005, based on date of birth. We performed a retrospective review of medical records of VLBWinfants and compared the survival rate, morbidity and mortality over the three periods. RESULT: The number of VLBW infants admitted to 8 NICUs in 1996-2005 was a total of 1,414 (1.3% incidence, mean gestational age 29.1+/-2.7 wk, mean birth weight 1158+/-235 g), including 361 (24.7%) extremely low birth weight infants (ELVW infants) who were less than 1,000 g at birth weight. Overall survival rate of VLBW infants was 66.1%. The survival rate of VLBW infants increased significantly over the three periods (period I:57.6%, period II:67.8%, period III:75.7%, P<0.01). Overall survival rate of ELBW infants was 33.8%, and increased from 26.4% in period I to 44.2% in period III (P<0.01). The incidence of respiratory distress syndrome was 45.1%; patent ductus arteriosus, 16.4%; bronchopulmonary dysplasia, 13.1%; blood culture positive sepsis, 12.7%; necrotizing enterocolitis, 6.6%; severe intracranial hemorrhage, 6.5%; and severe retinopathy of prematurity, 5.9%. The main causes of death were respiratory distress syndrome and sepsis. CONCLUSION: Overall survival rate of very low birth weight infant in Busan area during the last 10 years was 66.1%, and increased significantly over the three periods.

A Case of Kasabach-Merritt Syndrome Diagnosed by Fetal Ultrasonography

In 1940, Kasabach and Merritt first described the association of a large vascular tumor and thrombocytopenia and termed this Kasabach-Merritt syndrome. This is characterized by a rapidly enlarging hemangioma with thrombocytopenia and coagulopathy. We describe an infant with a large complex vascular lesion of the face that was diagnosed in utero and successfully treated interferon and pentoxyfylline. In a fetus at 36+0 weeks gestation, ultrasound demonstrated abnormality of the face and neck. she was delivered at 38+5 weeks gestation with a large facial hemangioma. She had severe thrombocytopenia in the first 24hr of life (platelets 22,000/microliter) and she was commenced on oral steroids(prednisolone 2 mg/kg/day). The hemangioma continued to grow and the baby required frequent platelet transfusions. When the infant was 17 days old, treatment with pentoxyfylline and subcutaneous alpha interferon(initially 60,000 units/m2/day) was started. From 1 month of age, the hemangioma gradually reduced in volume and the platelet count stared to rise. Recent, the hemangioma progressively diminished in size without any serious complication.

Clinical Studies of Aseptic Meningitis in Daejeon Area between 2000 and 2003 / 대한소아신경학회지

PURPOSE: Since 1990, several epidemics of aseptic meningitis have been reported in Korea. We report 327 children with aseptic meningitis in Daejeon for 4 years from 2000 to 2003. And the clinical features and laboratory data were compared between the positive enterovirus PCR group and the negative enterovirus PCR group. METHODS: We reviewed the clinical records of 327 aseptic meningitis children who were admitted to the Department of Pediatrics of Eulji University Hospital from 2000 to 2003. We described their age, sex, annual and monthly incidence rates, clinical manifestations and laboratory data. Reverse transcription-polymerase chain reaction(RT-PCR) method was used to identify enterovirus RNA in the cerebrospinal fluid. RESULTS: The male to female ratio was 2 : 1 and most of them were 5 to 9 years old. Meningitis occurred mostly from May to July. In the positive PCR group, a peak incidence was noticed in July with most of the cases from May to September. The patients showed symptoms of fever, vomiting, and headache with a wide range of WBC counts from 3,520 to 32,330(mean 9,470)/mm3 and relatively normal ranges of ESR and CRP. In the cerebrospinal fluids, leukocytes were in a range of 5-5,400(mean 270)/mm3, proteins 11-180 (mean 37.7) mg/dL and glucose 22-95(mean 55.86) mg/dL. The examination of the cerebrospinal fluids with RT-PCR for enterovirus showed positive in 103 out of 204 patients. There were not any statistically significant differences in the clinical features between the positive result group and the negative result group. However, the proportion of polymorphonuclear leukocytes in the peripheral blood and the leukocyte counts in the cerebrospinal fluids were higher in the positive result group. CONCLUSION: Aseptic meningitis was prevalent in Daejeon between 2001 and 2002. The clinical manifestations and the laboratory findings of the patients were compatible with those of previous reports. There were no statistically significant differences in the clinical features and the laboratory data between the positive enterovirus PCR group and the negative enterovirus PCR group except the proportion of polymorphonuclear leukocytes in the peripheral blood and the leukocyte counts in the cerebrospinal fluids.

Successful Response of Oral Etoposide for Refractory Neuroblastoma / 대한소아혈액종양학회지

Intensive chemotherapy with or without stem cell rescue has become widely accepted for treatment of neuroblastoma because increased dose-intensity correlates with improved response rates. For neuroblastoma that is resistant to intensive chemotherapy, further use of high-dose therapy is unlikely to be beneficial. For disease that recurs after myeloablative consolidation, high-dose salvage therapy may not be feasible because of poor bone marrow reserve and may not be justified in view of its morbidity in the absence of a realistic chance for cure. One treatment option in these difficult clinical settings is chronic oral administration of low-dose etoposide. However, there has been a few clinical reports for the experience of oral etoposide for refractory neuroblastoma. We now present 2 cases of successful response of oral etoposide for refractory neuroblastoma.