Comparison of Clinical Progress between Single- and Multiple-dose Surfactant Treatment in Neonatal Respiratory Distress Syndrome / 소아과

PURPOSE: In the case of serious respiratory distress syndrome (RDS) or relapse of clinical appearances after single treatment, we obtained more effective results with multiple-dose surfactant replacement therapy. We carried out this investigation for comparing and observing clinical progress between single-dose (group S) and multiple-dose (group M) pulmonary surfactant treatment group of neonatal RDS. METHODS: We investigated 48 neonates who were diagnosed as RDS and treated with pulmonary surfactant (PS) replacement therapy in NICU of Kyunghee University hospital from January 2002 to March 2004, then we compared and verified clinical progress of 32 neonates in group S with that of 16 neonates in group M. RESULTS: There were no significant statistical differences in average birth weights, average gestational periods, initial pH values of birth, whether operation of resuscitation at that time of birth was made or not, whether prenatal steroid prescription for mother, RDS classification standardized by Bomsel, and ventilation index (VI) before instillation of PS of two groups. However, there was significant statistical difference in a/A PO2 (P< 0.05). We could observe changes of VI and a/A PO2 within 72 hours have been continuously improved at group S rather than group M. In spite of relapses, group M changed for the better after second dose. There were also no significant differences between the two groups in duration of ventilator therapy, mortality within 28 days after birth, intraventricular hemorrhage by complication, retinopathy of premature, necrotizing enterocolitis, chronic lung diseases, sepsis, and DIC. CONCLUSION: In these relapse cases, as there were no significant differences in the mortality rate and the occurence of complication between group S and group M, the requirement of multiple-dose PS replacement therapy which brought improvement of prognosis was emphasized.

Clinical Analysis of Neonatal Microtia

PURPOSE: Neonatal microtia is an external ear deformity that takes various forms in degrees from minor deformity to aural atresia. Microtia causes not only simple deformity of the auricle but also the deformity of the middle ear or/and the internal ear leading to hearing loss. We intended to analyze the clinical manifestation of microtia in neonate period. METHODS: 17 neonates born with microtia who were admitted to Kyung Hee Hospital from January 1994 to June 2003 were evaluated for clinical characteristics including associated anomalies, outcomes, findings of temporal computer tomogram (CT) and auditory brainstem response test. RESULTS: The most common type of microtia was grade III (64.7%) followed by grade II (29.4%) and grade I (5.9%) according to the Marx classification. Temporal CT was carried out in 15 cases which showed external ear abnormalities in 7 cases, external and middle ear abnormalities in 5 cases, and external middle and internal ear abnormalities in 3 cases. 7/15 (46.7%) cases had partial hearing loss, followed by 4/15 (26.7%) cases of total hearing loss and 4/15 (26.7%) cases of normal hearing. Associated anomalies among 8/17 (47%) cases included congenital heart disease, celft palate and lip, microcephaly, micrognathia, CONCLUSION: Neonate born with microtia should be evaluated and followed closely for combined anomalies such as middle or internal ear deformities as these may lead to hearing loss affecting language and emotional development.

Neonatal Statistics of Korea in 2002: Collective Results of Live-Births, and Neonatal Mortality Rates from 62 Hospitals

PURPOSE: To evaluate the various nationwide statistical data for 2002 in Korea and to compare it to statistical data obtained in 1996. METHODS: Questionaires were distributed to 104 hospitals to obtain vital statistics for live-births, their gestational age and birth weight, incidence of preterm infants, low birth weight infants (LBWI), very LBWI (VLBWI), and neonatal mortality for year 2002. RESULTS: Based on 53, 831 inborn and 11, 151 outborn population, from 64 responded hospitals, the incidence of preterm, term, and postterm were 17.5%, 81.4%, and 1.1%, respectively among inborn group. The incidence of preterm among outborn group was lower than that of inborn. The incidences of LBWI, normal birth weight (2.5-4.0 kg) infants, and large birth weight (>4.0 kg) infants were 15.3%, 80.6%, and 4.2%, respectively among inborn group. The incidence of LBWI was lower in outborn group as compared with the inborn group. Overall neonatal mortality rates of preterm, term, and postterm were 5.5%, 0.3%, and 0% and those of LBWI, normal birth weight (2.5-4.0 kg) infants, and large birth weight (>4.0 kg) infants were 6.1%, 0.2%, and 0.1%, respectively. Neonatal mortality rates of VLBWI and extremely LBWI (ELBWI) were 22.5% and 43.9%, respectively. CONCLUSION: Based on statistical data obtained for 2002 from 64 hospitals, the incidence of preterm and LBWI increased, however, the neonatal mortality rates of LBWI and VLBWI declined in 2002 compared to 1996 in Korea. Further continuation of efforts need to be given to improve standarized neonatal care in Korea.

A Case of Acute Postobstructive Pulmonary Edema due to Parapharyngeal Abscess in a Child / 소아알레르기및호흡기학회지

Postobstructive pulmonary edema (POPE) is associated with upper airway obstruction and has two different types of mechanism. Type 1 POPE is due to acute airway obstruction and is related to forceful respiratory efforts leading to extremely negative intrathoracic pressure. Type 2 POPE is caused by chronic airway obstruction and occurs after sudden relief of obstruction which drop in airway pressure that can lead to pulmonary edema. We report a case of postobstructive pulmonary edema in a child who has peripharyngeal abscess.