Clinical courses and diagnoses of neonates who are transferred due to mild respiratory distress soon after birth in a university hospital / 영남의대학술지

BACKGROUND: This study was conducted to investigate the epidemiological features, clinical courses, and diagnoses of neonates who are transferred to neonatal intensive care unit of Yeungnam University Hospital due to tachypnea soon after birth. METHODS: Based on medical records, we performed a retrospective study of neonatal intensive care unit admissions due to tachypnea from January 2010 to December 2013. RESULTS: A total of 311 neonates were included in this study. The patient characteristics showed male predominance at 2.65:1. Among the 311 neonates with tachypnea, 127 (40.8%) neonates needed oxygen supply, and 54 (17.4%) neonates needed assisted mechanical ventilation. Transient tachypnea of the newborns (TTN) (158, 50.8%) showed the highest incidence, followed by pneumonia (63, 20.3%), extrapulmonary infection (37, 11.9%), respiratory distress syndrome (21, 6.8%), air leak (16, 5.1%), meconium aspiration syndrome (12, 3.9%), congenital heart disease (5, 1.6%), metabolic acidosis (3, 1%), primary pulmonary hypertension of newborns (2, 0.6%) and anemia (2, 0.6%). CONCLUSION: Although the neonates with tachypnea showed no other respiratory distress symptom, clinicians should be aware of the possibility of other pulmonary diseases as well as TTN and their extra-pulmonary causes. If tachypnea does not improve within a few hours, the clinician should consider further evaluation and management as soon as possible.

Surgical Management of Unruptured Aneurysm

The surgical management of patients with unruptured intracranial aneurysm continues to be controversial. To provide current data about surgical outcome of patients with unruptured intracranial aneurysm, we retrospectively reviewed 494 consecutive intracranial aneurysm patients who underwent surgery between January 1990 and May 1995. Among these 494, 16 patients with unruptured aneurysms were evaluated; those with unruptured aneurysm associated with ruptured aneurysm or arteriovenous malformation were excluded. Mode of presentation, location and size of aneurysm, surgical method and complications, and surgical result were analyzed. Evaluation revealed four patients with asymptomatic and 12 with symptomatic unruptured aneurysm. Of these 12, seven presented with mass effect, four with headache, and one with cerebral infarction. The aneurysms were located in the internal carotid artery(n=8), the middle cerebral artery(n=3), the vertebral artery(n=3), the anterior communicating artery(n=2), and the basilar artery(n=2). They ranged in size from smaller than 10mm to larger than 25mm(25mm: 1 case). An excellent or good outcome was achieved in 12 patients, including four with asymptomatic intracranial aneurysm. In three patients there were complications or sequelae and one died due to premature rupture of the aneurysm. We concluded that in patients harboring an unruptured intracranial aneurysm, aggressive early detection and surgical treatment may improve the outcome by preventing the devastating effects of subarachnoid hemorrhage.

Arterio-Jugular Oxygen Difference in Severe Intracranial Lesions

Research seems to support the proposition that hyperoxia of the internal jugular vein is indicative of brain death. The test to determine this can be easily carried out at the bedside. Recently many authors have confirmed this also. This study concerned itself with the difference of oxygen content between internal carotid arterial and internal jugular venous blood in 19 patients with varied severe intracranial lesions. The results suggest that a carotid arterialjugular venous blood oxygen content difference lower than 1.7 vol. % is indicative of brain death. Possible mechanisms for high oxygen content in the jugular venous blood in the state of brain death are discussed.