Comparison of Effectiveness of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation for the Initial Treatment of Preterm Respiratory Distress Syndrome: A Prospective Pilot Study

PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.

Effectiveness of double-dose oseltamivir for pediatric patients with severe 2009 pandemic influenza A H1N1

PURPOSE: We aimed to evaluate the use and safety of double dose oseltamivir for patients manifesting severe respiratory symptoms or showing no improvement of clinical symptoms after 72 hours' treatment with the usual oseltamivir dosage. METHODS: We analyzed the clinical features of 2009 influenza A H1N1 inpatients who had been admitted to a university hospital's Department of Pediatrics between August 2009 and January 2010. The Influenza A H1N1 diagnoses were confirmed by real-time reverse transcriptase polymerase chain reaction. RESULTS: The study participants numbered 157 (mean age, 5.0 years; male-to-female ratio, 1.1:1). Among them, twenty (mean age, 5.2 years) were administered double dose oseltamivir. This double dose group showed higher peak body temperatures and more abnormal radiologic results than the other, usual-dose group. The mean time duration between high fever and afebrile status after initiation of double-dose oseltamivir administration was 2.1 days, whereas that within the usual-dose group was 1.7 days. There were no adverse effects in the patients treated with double-dose oseltamivir. CONCLUSION: Double-dose oseltamivir was well tolerated in patients with severe 2009 influenza A H1N1 infection.

Effect of Short-term Exposure of Different Concentrations of Hyperoxia on Fetal Alveolar Type II Cell Death

PURPOSE: Lung injury imposed by hyperoxia is the most important cause of bronchopulmonary dysplasia (BPD) in premature lungs, and hyperoxia has the chief biological effect of inducing cell death. The objective of this study was to investigate the response of cell death in fetal alveolar type II cells (FATIICs) exposed to different concentrations of hyperoxia for 36 h. METHODS: FATIICs were isolated on embryonic day 19 and exposed to 65%- or 85%-oxygen for 36 h. Cells in room air were used as controls. FACScan was performed in hyperoxic and control samples at 0/6/12/24/36 h, and the patterns of cell death were compared at each time point using flow-cytometry. RESULTS: Cell necrosis as measured by selective propidium iodide staining increased significantly from 12 h of 65%-hyperoxia and 6 h of 85%-hyperoxia, respectively. Cell necrosis increased 1.6-fold, 3.0-fold and 4.6-fold after 12 h, 24 h, and 36 h, respectively during 65%-hyperoxia and increased by 2.4-fold, 3.1-fold, 6.3-fold, and 8.8-fold after 6 h, 12 h, 24 h, and 36 h, respectively during 85%-hyperoxia compared to controls. Apoptotic cells as measured by selective Annexin-V staining peaked at 1.3% at 24 h of 65%-hyperoxia and peaked at 1.2% at 6 h of 85%-hyperoxia, respectively and then decreased rapidly. CONCLUSION: This study shows that exposure to sublethal and lethal hyperoxia increases necrosis of FATIICs remarkably from the early stage of hyperoxia. These findings support the idea that short-term exposure to oxygen from birth may contribute to the evolution of "new" BPD in preterm lungs.

Interleukin-10 Down-Regulates Cathepsin B Expression in Fetal Rat Alveolar Type II Cells Exposed to Hyperoxia

PURPOSE: Hyperoxia has the chief biological effect of cell death. We have previously reported that cathepsin B (CB) is related to fetal alveolar type II cell (FATIIC) death and pretreatment of recombinant IL-10 (rIL-10) attenuates type II cell death during 65%-hyperoixa. In this study, we investigated what kinds of changes of CB expression are induced in FATIICs at different concentrations of hyperoxia (65%- and 85%-hyperoxia) and whether pretreatment with rIL-10 reduces the expression of CB in FATIICs during hyperoxia. MATERIALS AND METHODS: Isolated embryonic day 19 fetal rat alveolar type II cells were cultured and exposed to 65%- and 85%-hyperoxia for 12 h and 24 h. Cells in room air were used as controls. Cytotoxicity was assessed by lactate dehydrogenase (LDH) released into the supernatant. Expression of CB was analyzed by fluorescence-based assay upon cell lysis and western blotting, and LDH-release was re-analyzed after preincubation of cathepsin B-inhibitor (CBI). IL-10 production was analyzed by ELISA, and LDH-release was re-assessed after preincubation with rIL-10 and CB expression was re-analyzed by western blotting and real-time PCR. RESULTS: LDH-release and CB expression in FATIICs were enhanced significantly in an oxygen-concentration-dependent manner during hyperoxia, whereas caspase-3 was not activated. Preincubation of FATIICs with CBI significantly reduced LDH-release during hyperoxia. IL-10-release decreased in an oxygen-concentration-dependent fashion, and preincubation of the cells with rIL-10 significantly reduced cellular necrosis and expression of CB in FATIICs which were exposed to 65%- and 85%-hyperoxia. CONCLUSION: Our study suggests that CB is enhanced in an oxygen-concentration-dependent manner, and IL-10 has an inhibitory effect on CB expression in FATIICs during hyperoxia.

Fetal Alveolar Type II Cell Injury Induced by Short-term Exposure to Hyperoxia

A High concentration of oxygen (>40%) is used as a life-saving therapy in preterm newborns since birth. By generating excess reactive oxygen species, however, hyperoxia can cause lung injury leading to bronchopulmonary dysplasia (BPD). Although hyperoxia-induced lung injury contributes to the evolution of BPD, the mechanisms by which hyperoxia contributes to the genesis of lung injury in preterm lungs are not yet fully defined, and there are no specific measures for the protection of preterm lungs against injury secondary to hyperoxia. Alveolar type II cells are key components of the alveolar structure, and they are responsible for the restoration of normal alveolar epithelium after acute lung injury. However, hyperoxia is primarily delivered to the alveolar epithelium and alveolar type II cells can be the main target for the injury secondary to hyperoxia. To date, my researches have been focused on injury of fetal alveolar type II cells exposed to hyperoxia and the role of anti-inflammatory cytokine, IL-10 minimizing fetal type II cell injury induced by hyperoxia. Based on my previous studies, this article summarizes the cellular and molecular mechanisms of fetal type II cell injury induced in the early stage of hyperoxia and the protective potency of IL-10 in fetal alveolar type II cells and neonatal lungs injured by hyperoxia.

Giant Congenital Melanocytic Nevi with Hemangioma : A Case Report in a Newborn / 대한주산의학회잡지

Giant congenital melanocytic nevi are very rare skin lesions with an estimated prevalence of 1 in 20,000 live births, and have high risk of malignant melanoma development and leptomeningeal melanocytosis. Hence, its early and exact diagnosis in the neonatal period is important and essential. Only seven cases of giant congenital melanocytic nevi have been reported in Korea, of which none of the cases were associated with hemangioma. Herein, the authors describe a case of giant congenital melanocytic nevi with huge hemangioma with the pathologic findings that exhibited benign and provide a literature review.

A Case of Extreme Uterine Hypotrophy in Hypogonadotropic Hypogonadism with Partial GH Deficiency

Congenital hypogonadotropic hypogonadism is one of the causes of pubertal failure and primary amenorrhea, it is related to uterine hypotrophy. If the uterus is extremely hypotrophied, it is difficult to identify in imaging studies and can be misdiagnosed as a structural anomaly of internal genitalia. We report a case of extreme uterine hypotrophy in 18-year-old girl with primary amenorrhea that was finally diagnosed as hypogonadotrophic hypogonadism. The patient was initially suspected of Mullerian agenesis owing to the invisible uterus. After 4 months of treatment with estrogen, she showed significant growth of the uterus.

A Case of Extreme Uterine Hypotrophy in Hypogonadotropic Hypogonadism with Partial GH Deficiency

Congenital hypogonadotropic hypogonadism is one of the causes of pubertal failure and primary amenorrhea, it is related to uterine hypotrophy. If the uterus is extremely hypotrophied, it is difficult to identify in imaging studies and can be misdiagnosed as a structural anomaly of internal genitalia. We report a case of extreme uterine hypotrophy in 18-year-old girl with primary amenorrhea that was finally diagnosed as hypogonadotrophic hypogonadism. The patient was initially suspected of Mullerian agenesis owing to the invisible uterus. After 4 months of treatment with estrogen, she showed significant growth of the uterus.

Transient carnitine transport defect with cholestatic jaundice: report of one case in a premature baby / 소아과

Carnitine (beta-hydroxy-gamma-trimethylaminobutyric acid) is involved in the transport of long-chain fatty acids into the mitochondrial matrix and the removal of potentially toxic acylcarnitine esters. Transient carnitine transport defect is a rare condition in newborns reported in 1/90,000 live births. In this paper, we describe a case of transient carnitine transport defect found in a premature baby who had prolonged cholestatic jaundice and poor weight gain, and who responded dramatically to oral carnitine supplementation.

Transient carnitine transport defect with cholestatic jaundice: report of one case in a premature baby / 소아과

Carnitine (beta-hydroxy-gamma-trimethylaminobutyric acid) is involved in the transport of long-chain fatty acids into the mitochondrial matrix and the removal of potentially toxic acylcarnitine esters. Transient carnitine transport defect is a rare condition in newborns reported in 1/90,000 live births. In this paper, we describe a case of transient carnitine transport defect found in a premature baby who had prolonged cholestatic jaundice and poor weight gain, and who responded dramatically to oral carnitine supplementation.

Comparison of the accuracy of neutrophil CD64 and C-reactive protein as a single test for the early detection of neonatal sepsis / 소아과

PURPOSE: Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis. METHODS: A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP, neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry. RESULTS: CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%, respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 (P<0.01), respectively. CONCLUSION: These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.

Congenital Hemangiopericytoma in the Retroperitoneum: A Case Report in a Newborn / 대한주산의학회잡지

Hemangiopericytoma is a rare vascular tumor that usually occurs in adults. The tumor is believed to originate from pericytes that are closely related to the capillary walls. Congenital hemangiopericytoma is a more rare disease that occurs in approximately 0.03% of all heamngiopericytomas. Herein, we describe a 1-month-old male newborn with huge congenital hemangiopericytoma in the retroperitoneum that exhibited a typical morphological vascular pattern.

Cathepsin B is activated as an executive protease in fetal rat alveolar type II cells exposed to hyperoxia

Alveolar type II cells are main target of hyperoxia-induced lung injury. The authors investigated whether lysosomal protease, cathepsin B (CB), is activated in fetal alveolar type II cells in the transitional period from the canalicular to saccular stages during 65%-hyperoxia and whether CB is related to fetal alveolar type II cell (FATIIC) death secondary to hyperoxia. FATIICs were isolated from embryonic day 19 rats and exposed to 65%-oxygen for 24 h and 36 h. The cells exposed to room air were used as controls. Cell cytotoxicity was assessed by lactate dehydrogenase-release and flow cytometry, and apoptosis was analyzed by TUNEL assay and flow cytometry. CB activity was assessed by colorimetric assay, qRT-PCR and western blots. 65%-hyperoxia induced FATIIC death via necrosis and apoptosis. Interestingly, caspase-3 activities were not enhanced in FATIICs during 65%-hyperoxia, whereas CB activities were greatly increased during 65%-hyperoxia in a time-dependent manner, and similar findings were observed with qRT-PCR and western blots. In addition, the preincubation of CB inhibitor prior to 65%-hyperoxia reduced FATIIC death significantly. Our studies suggest that CB activation secondary to hyperoxia might have a relevant role in executing the cell death program in FATIICs during the acute stage of 65%-hyperoxia.

Lng Injury Induced during Resuscitation of the Preterm Newborns in the Delivery Room / 대한주산의학회잡지

Neonatologists are deeply concerned with the concept of ventilator-induced lung injury (VILI) and they are greatly careful in the neonatal intensive care unit to apply positive-pressure ventilation (PPV) strategies that are gentle to the lungs. To achieve adequate gas exchange after delivery, lung fluid should be cleared and replaced with air, and functional residual capacity (FRC) should be established. However preterm newborns have difficulties establishing FRC and maintaining upper airway patency at birth. Hence majority of preterm newborns need some assistance to initiate breathing after birth and some require extensive resuscitation. PPV is therefore commonly used in the delivery room, however most clinicians including neonatologists or obstetricians appear less aware that the gentle approach as in NICU should be applied to prevent lung injury during the first few minutes of life. PPV may cause lung injury through various mechanisms such as high Vt (tidal volume) and overdistension (volutrauma), repeated alveolar collapse and re-expansion (atelect-trauma), and infection and inflammation (biotrauma), through which leads to epithelial cell injury, leakage of proteinaceous fluid into the lungs, inhibiting surfactant function and interfering lung mechanics, and consequently generating lung injury. In this review, I describe briefly what causes preterm lung injury during PPV based on animal and human researches, and I suggest some strategies to help minimize lung injury during resuscitation of preterm newborns in the delivery room.

Amyoplasia Congenita of the Lower Extremity: Report in a Premature Baby

Amyoplasia congenita is a diagnostic subgroup of children with arthrogryposis multiplex congenita (AMC). AMC is a relatively rare syndrome characterized by multiple joint contractures at birth. Amyoplasia congenita is the most common type of this syndrome with an occurrence rate of 1 in 10, 000 live births, and mainly refers to the disorders with limb involvement. In this report, the author presents a premature baby with amyoplasia congenita, whose hips showed flexion, abduction, and external rotation contractures. The knees showed fixed extension contractures, so that his lower extremities were cylindrical with absent skin creases at birth.

6p23 Deletion Syndrome: Report of a Case in a Preterm Baby

Deletion of the short arm of chromosome 6 is relatively rare, with the characteristic features of craniofacial malformations, hypotonia, and defects of the heart and kidney, with hydrocephalus and eye abnormalities. Here author reports a premature girl with bilateral anophthalmia, bilateral hydrocephalus and marked hypotonia, whose chromosome analysis revealed a 46, XX, del(6)(p23) chromosome constitution.

Vulnerability to Minor Stressful Events in Young Women with Premenstrual Syndrome / 신경정신의학

PURPOSE: Although numerous etiological models of premenstrual syndrome(PMS) such as the biochemical, hormonal, psychosocial models have been proposed, there is no consistent conclusion. Especially, in psychosocial model, state-dependent changes in the perception of stressors according to menstrual cycle phases was suggested for PMS. In this study, we investigated relationship between menstrual cycle and daily minor stressors in young women, and vulnerability to minor stressors in young women with PMS. METHODS: 46 female college students completed modified daily rating form(DRF) of premenstrual symptoms which based on DSM-IV criteria for PMDD, and daily stress inventory(DSI) during at least one menstrual cycle. If the mean score of at least one DRF item during premenstrual phase were more than 3 on 6 point scale and 30% increase in symptom severity during premenstrual phase compared with during postmenstrual phase, they were referred as PMS group(N=20), and the others as non-PMS group(N=26). The event, impact, and impact/event ratio scores of DSI were compared in two groups. Data were analyzed by analysis of variance with repeated measure ANOVA. And post hoc simple; repeated contrast test were performed when indicated by significant repeated measure ANOVA. RESULTS: In all subjects, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. Among the DSI categories, the impact scores of interpersonal problem and cognitive stressors in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. In PMS group, there was a significant difference between premenstrual and postmenstrual phase in the impact score but not in the event score, and the event and the impact scores were significantly increased in menstrual phase than postmenstrual phase. In non-PMS group, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. There was no significant difference in the impact/event ratio scores in both groups. Between the PMS and non-PMS group, there was significant difference in the impact/event ratio scores in premenstrual phase, but not in the event score and the impact scores at any phase. CONCLUSION: Young women may experience more daily minor stressors and may be impacted more severely in premenstrual and menstrual phases than in postmenstrual phase. In premenstrual phase, the young women with PMS are likely to have more vulnerability to daily minor stressors than controls. Further studies using larger sample size with varied age are required.

A Case of Neonatal Alloimmune Thrombocytopenia Related to HLA Antibody

Neonatal alloimmune thrombocytopenia(NAIT) is a very rare disease caused by maternal alloantibodies' response to neonatal platelet antigens. Because the most common cause of NAIT is incompatibility for platelet-specific antigens, NAIT cases due to anti-HLA antibodies are very exceptional. The patient was a second born female. She had no petechia or purpura at birth. But her platelet count was 55,000/mm3 and other laboratory findings were normal. On family history, the first baby had thrombocytopenia at birth too without petechia or other abnormal symptoms and his platelet count became spontaneously normal later. The mother's platelet count was normal and she had no history of idiopathic thrombocytopenic purpura(ITP) or bleeding tendency. Platelet crossmatching test showed positive between citric acid untreated paternal platelets and maternal serum, but negative to citric acid treated paternal platelets. These findings suggest maternal serum which contain anti-HLA antibodies to attack neonatal platelets and paternal platelets. Therefore this report documents a patient with neonatal thrombocytopenia induced by maternal anti HLA antibody.

The Survey of the Concept about Using Herb-Medication & the Effect on Treatment-Seeking Behavior in Psychiatric and Non-Psychiatric Patients / 신경정신의학

OBJECTIVES: The anthors examined health-seeking behavior about using herbal medicine in psyciatric and other clinical patients. The effect, side effect and motives in selecting herbal medicine were examined also. This study aimed at presenting treatment guide for psychiatric patients hereafter. METHOD: Subjects were consisted of 277 patients who were 93 medical, 81 surgical, and 102 psyhiatric patients. We made a questionnaire checking circumstances on taking herbal medicine. The investigating psychiatrist conducted person to person semi-structured interview using this questionnaire. RESULTS: Psychiatric patients preferred herbal medicine to western medicine, as other clinical patients did. In their health seeking behavior, classical illness model of oriental herbal medicine occupied a central position. In addition, psychiatric patients not only regarded herbal medicine as a more symtom-specific therapeutic medication, but also accepted side effects of herbal medicine uncritically than other clinical patients. CONCLUSIONS: As it is known that many psychiatric patients take both oriental and western medical treatment, we should not have exclusive attitude to emphasize one side between oriental and western medicine. Rather, we should deepen our understandings about oriental herbal medicine.

Conservative Management of Spontaneous Pneumoperitoneum in an Immature Neonate: Report of a Case

The finding of extraluminal gas on plain abdominal radiogram is usually associated with a perforated viscus, and an emergency laparatomy is indicated. But we report herein an immature neonate with spontaneous pneumoperitoneum that was treated successfully with conservative management, although this infant she showed positive result in stool occult blood test. As this case shows, the finding of pneumoperitoneum is not of a surgical emergency, because there are many benign explanations for pneumoperitoneum. A through history taking and physical examination are most important in differentiating between surgical and nonsurgical pneumoperitonium.