A Clinical Study about Symptomatic Spontaneous Pneumothorax / 대한주산의학회잡지

OBJECTIVE: Spontaneous pneumothorax is more common during the newborn period than at any other time in childhood. We intended to analyze the incidence, clinical course and the result of treatment of symptomatic spontaneous pneumothorax by distinguishing primary and secondary pneumothorax. METHODS: Infants who were born at Cheil General Hospital from January 1, 2002 to May 31, 2005 having respiratory difficulty, being shown pneumothorax in the chest X-ray were enrolled. Pneumothorax was divided into two groups:primary pneumothorax, not having preceding disease; secondary pneumothoax, having preceding and accompanied pulmonary disease. RESULTS: 169 out of 31,156 infants had symptomatic pneumothorax, which was 0.54%. The average gestational age was 38.+/- (25.5~42.2) weeks and the average birth weight was 3130+/-1041 g (925~4225) g. Premature infants were 12 (7.1%) and full?term infants were 157 (92.9%). It occurred more frequently to male (male:female=1.32:1) and Rt. side (Rt 63.9%; Both 32%; Lt 4.1%) and most of them occurred within 12hrs after birth. Primary pneumothorax was seen in 150 (88.8%) cases and secondary ones was seen in 19 cases (11.2%). Preceding pulmonary disease included respiratory distress syndrome, neonatal pneumonia, meconium aspiration syndrome, persistent pulmonary hypertension and pulmonary hypoplasia. All infants received oxygen therapy and 2 of them had chest tube insertion, which were secondary pneumothorax. There were no significant accompanied intracranial hemorrhage or urinary tract abnormalities. CONCLUSION: In this study, the incidence of symptomatic pneumothoax was 0.54%. Most of them occurred in 12hrs after the birth. They did not accompany other anomalies. Primary pneumothorax showed good prognosis by conservative therapy.

Analysis of newborn hearing screening using automated auditory brainstem response / 소아과

PURPOSE: As hearing ability affects language and cognitive development, early detection and intervention of congenital hearing defects is very important. We analyzed the result of newborn hearing screening using automated auditory brainstem response and estimated the incidence of congenital hearing defects in newborn infants in Korea. METHODS: Hearing screening tests were done on 7,218 newborn infants who were delivered at Cheil General Hospital from July 1, 2004 to June 30, 2005. The first screening test was done on the second day of life with automated auditory brainstem response(AABR) using ALGO(3) Newborn hearing screener(Natus(R) Medical Incorporated, San Carlos, USA) with 35 dB sound level. The newborn infants who did not pass the initial screening test took the second screening AABR test before discharge from the nursery. Infants who did not pass these screenings at the nursery were followed up at the Department of Otorhinolaryngology, Samsung Seoul Hospital. RESULTS: Total 7,218 infants(83.3 percent of total 8,664 live births of the Cheil General Hospital) were screened in the nursery, and 55 of them failed to pass the newborn screening. Among 55 infants who were referred, six were lost during follow-up, and 14 were confirmed as hearing impaired. Six of them(42.8 percent) do not have any risk factors for hearing impairment. We can estimate that the incidence of hearing defects is about 1.9-2.8 per 1,000 live births. CONCLUSION: Automated auditory brainstem response is an effective tool to screen the hearing of newborn infants. Congenital hearing loss is more frequent than metabolic diseases on which screening tests are available in the newborn period. About 40 percent of infants who have hearing defects do not have any risk factors for hearing impairment. Therefore, universal newborn hearing screening must be recommended to all neonates.

Etiology and Clinical Features of Viral Lower-respiratory Tract Infections in Children in Winter, 2003 / 소아과

PURPOSE: This study was performed to characterize the etiology and clinical features of acute viral lower-respiratory tract infections (LRI). METHODS: Etiologic agents and clinical features of acute viral LRI were studied from October. 2003 through March. 2004 in hospitalized children with LRI (253 cases) at Samsung Cheil Hospital. The viruses were identified by indirect immunofluorescent method. Medical records of patients with proven viral LRI were reviewed retrospectively. RESULTS: Ninety two cases (36.4%) were confirmed as viral infections. The identified pathogens were respiratory syncytial virus (RSV, 76.0%), adenovirus (ADV, 12.0%), influenza virus type A (INFA, 9.8 %), influenza virus type B (INFB, 1.1%) and parainfluenza virus (PIV, 1.1%). Eight four point eight% of patients were younger than 2 years of age. Clinical diagnosis of LRI were pneumonia (56.5%), bronchiolitis (35.9%), tracheobronchitis (4.3%) and croup (3.3%). The clinical symptoms and signs were cough (98.8%), rhinorrhea (82.6%), fever (70.7%), rale (67.4%), wheezing (29.3%), chest retraction (28.3%) and cyanosis (4.3%). The severe respiratory symptoms and signs were more common in RSV-infected patients, even cyanosis could be observed. Seventeen point four percent of patient had fever of 38.5degrees C or higher and their most common etiologic agent was INFA (66.7%). Twenty three point nine percent had fever more than 5 days and common etiologic agent was INFA (77.8%). The elevated WBC count (> 14x10 (3)/microliter) was in 14.1%, and common etiologic agents were INFA (22.2%) and ADV (18.2%). C-reactive protein (CRP > 4.0 mg/dL) was increased in 13.0%, and common in ADV (63.6 %). Increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was detected in 10.9%, and the most common etiologic agent was RSV (12.9%). CONCLUSION: The common agents of acute viral LRI were RSV, ADV and INF, respectively. Because the etiologic agents present variable clinical features, it may be helpful to treat and to evaluate acute viral LRI that we should understand their etiologic variability.