The Factors associated with Oliguria after Indomethacin Administration in Preterm Infants with Patent Ductus Arteriosus

PURPOSE: Oliguria is an occasionally encountering phenomenon after indomethacin administration for the treatment of patent ductus arteriosus. This study was conducted to determine factors contributing to oliguria after indomethacin administration. METHODS: Sixty five infants with patent ductus arteriosus who had been administrated indomethacin in our NICU were enrolled in this study. The patients were divided into two groups; Oliguria group as a study group (n=17), and non-oliguria group as a control group (n=48). The oliguria was defined when urine output is more than or equal to 1.5 mL/kg/hr before indomethacin administration and less than 1.5 mL/kg/hr after indomethacin administration. Patients in oliguria group also included those urine output markedly decreased after indomethacin administration from pre-indomethacin urine output of less than 1.5 mL/kg/hr. Factors including intrauterine age, birth weight, sex, apgar score, respiratory distress syndrome, surfactant instillation, weight loss, ductal size, intraventricular hemorrhage, phototherapy, mechanical ventilation, oxygen therapy, dopamine injection, aminoglycoside injection, serum BUN, creatinine, sodium, potassium, glucose, platelet, hemoglobin, blood pressure were compared between oliguria group with non-oliguria group. RESULTS: Statistically significant factors contributing to oliguria after indomethacin administration included ductal size, gestational age and birth weight (P<0.05). The incidence of oliguria after indomethacin administration increased with increased gestational age, birth weight and ductal size. CONCLUSION: The ductal size, gestational age and birth weight prior to indomethacin administration are important factors contributing to oliguria after indomethacin administration.

Two Cases of Pierre Robin Syndrome Managed with Tongue-Lip Adhesion and Tracheostomy

Pierre Robin syndrome presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress and feeding difficulties. This is potentially fatal and surgical intervention in these cases is necessary. We experienced two newborns with pronounced micrognathia who were managed with tongue-lip adhesion and tracheostomy. Herein, we report these two cases with literature reviews.

A Case of Listeria Meningoencephalitis in a Healthy Child

Listeriosis in a healthy child is extremely rare. A previously healthy 9-year-old male was admitted with pyrexia, headache and lethargy. The CSF cultures, taken on admission and on the 5th day, showed growth of Listeria monocytogenes. L. monocytogenes was identified by various methods, including polymerase chain reaction(PCR). Serologically, it showed type 1/2a. However, blood cultures, which were taken on the same days, revealed no growth of L. monocytogenes. Ceftriaxone and amikacin had no effect on the progress of the disease. The combination of ampicillin plus gentamicin, which is regarded as the treatment of choice for L. monocytogenes infection, had an effect in this case. Patient showed severe neurological symptoms and signs, such as diplopia, esotropia, nystagmus, ptosis and other meningeal signs during the hospital days, even though all such symptoms and signs were improved at discharge. We report the case with brief review of related literatures.

Two Cases of Neonatal Arrhythmia Observed by Fetal Echocardiography / 대한주산의학회잡지

M-mode, pulsed Doppler and Doppler color flow mapping, in addition to two-dimensional echocardiography, have greatly improved imaging of the fetal heart through identification of abnormal cardiac anatomy and rhythm in utero. The early detection of cardiac disturbance in utero permits alteration in obstetric management such as delivery in a high-risk center for optimal neonatal care and/or decision in optimal delivery time. We report two cases of the neonatal arrhy-thmia which were observed by fetal echocardiography. In the first case, female baby showed neonatal arrhythmias including tachycardia and brady-cardia until 3 days after birth, and then turned to bradyarrhythmia due to non-conducted atrial bigeminy. These events lead us to review the fetal echocardiographs of the patient carefully. Premature atrial contractions were observed in her fetal echocardiography. At 2 months after birth, the patient's electrocardiogram showed normal sinus rhythm. Severe neonatal bradycardia of the second case was due to congenital complete heart block, identified clearly by electrocardiogram after birth. This case also showed complete heart block in her fetal echocardiography. After insertion of the temporary pacemaker, cardiomegaly was improved. Both the neonate and the mother had positive anti-SSA/Ro autoantibody. But any other symptoms and signs of neonatal lupus did not appear in the neonate. Patient's mother also did not show any symptoms and signs of systemic lupus erythematosus. Since the prognosis depends upon the cause of bradyarrhythmia in fetus and neonates, differential diagnosis is important in obstetric management and optimal neonatal treatment.

Natural Killer Cell Activity in Rheumatoid Arthritis Measured by a Single Cell Cytotoxicity Assay

The natural killer(NK) cell activity of mononuclear cells (MNC) from peripheral blood (PB) and synovial fluid (SF) of 40 rheumatoid arthritis(RA) patients was investigated by employing 51-chromium-(51Cr) release microcytotoxicity and single cell cytotoxicity assays against K562 target cells. It has been revealed that SF-MNC from RA patients showed a significantly lower NK activity than PB-MNC from the same patients and this might be due to an impaired target binding capacity of the effector cells and not due to a deficiency of active NK cells.

In Vitro Study of Nonspecific Cellular Immunity in Rheumatoid Arthritis

Nonspecific immune parameters such as natural killer(NK) activity, antibody-dependent cellular cytotoxicity(ADCC), production of leukocyte migration inhibitory factor(LlF) and levels of immune complex(IC) were assessed in 47 patients with rheumatoid arthritis (RA) 20 with degenerative arthritis (DA) and 40 healthy controls. Peripheral blood (PB) as well as synovial fluid (SF) were collected from both RA and DA patients before treatment. Mononuclear cell suspensions and sera were prepared and submitted for the in vitro tests; 4-hr chromium-release assays using human K562 and mouse L1210 cells as targets for NK and ADCC assays respectively, 2-step agarose assay for LIF and platelet aggregation test for IC. Results revealed that 1) LIF activity of PB lymphocytes (PBL) from both RA and DA patients showed a significant (P < 0.05) decrease as compared with that from healthy controls. 2) PB-NK activity from RA patients showed an insignificant decrease as compared with that from DA or healthy controls. However, mononuclear cells isolated from SF (SFL) of RA patients exhibited significantly(P < 0.02) lower NK activity than PBL from the same patients. 3) In ADCC assays with PBL no significant differencies were observed among the 3 groups. 4) Higher titers of IC were detected in both PB and SF from RA patients than DA, and a negative correlation was found between serum IC levels and PB-NK activity. These data are discussed in light of previous reports, and a hypothesis regarding a decreased nonspecific cell-mediated immunity in conjunction with an increased humoral immune response, particularly in local sites, is proposed as one of the mechanisms underlying the pathogenesis of RA.