Clinical Efficiency of Cardiac Troponin T for Myocardial Damage in Neonatal Asphyxia

PURPOSE: The aim of this study was to evaluate the clinical efficiency of cardiac troponin T(cTnT) in detecting myocardial damage in neonatal asphyxia and to compare the diagnostic value of cTnT with creatine kinase MB(CK-MB). METHODS: Sixty-three neonates were enrolled in this study, consisting of 27 asphyxiated infants(asphyxiated group; 1-min or 5-min Apgar score0.05), whereas CK-MB in group II it was higher than in group I (P0.2 microgram/L). Ten of them(83%) had a tricuspid insufficiency of moderate or severe degree. CONCLUSION: cTnT is a more heart-specific serodiagnostic marker than other markers in asphyxiated neonates with suspected myocardial damage.

Prognostic Factors for Mortality in Neonates with Respiratory Distress Syndrome After Surfactant Replacement Therapy

PURPOSE: To evaluate the association between neonatal mortality and the initial response to surfactant replacement therapy, and to examine the correlation between the response type and other prognostic factors. METHODS: Sixty-seven neonates with respiratory distress syndrome (RDS) were divided into two groups; group I (n=51) who survived and group II (n=16) who died within the first 28 days of life after one trial of surfactant therapy. We observed the serial changes of several respiratory indices within the first 24 hours following surfactant therapy and performed a multiple linear logistic regression analysis to evaluate significant prognostic factors that reflected neonatal mortality. RESULTS: In group II, fraction of inspired oxygen (FiO2), respiratory rate (RR), peak inspiratory pressure (PIP), and mean airway pressure (MAP) were significantly higher for 24 hours after surfactant therapy (P<0.05). The mean serum pH was significantly lower before and at 30 minutes and 6 hours after surfactant administration (P<0.05), but mean PaCO2 was higher (P<0.05). Ventilation index (VI) and oxygenation index (OI) were higher before and for 1 day after surfactant therapy (P<0.05), but arterial/alveolar oxygen tension ratio (a/APO2) was lower (P<0.05). In multiple linear logistic regression analysis, birthweight, MAP and VI at 6 hours and PIP at 12 hours were significant indicators of neonatal mortality after surfactant replacement therapy (P<0.05). CONCLUSION: The response to surfactant treatment within the first 24 hours may be also a significant prognostic indicator for neonatal mortality as other factors are, such as birthweight.

Investigations of Familial Tendency in Idiopathic Hypercalciuria of Childhood / 대한신장학회잡지

Idiopathic hypercalciuria is one of the major causes of asymptomatic hematuria in children and adults. However, the etiology of idiopathic hypercalciuria(IH) is not conclusive. In spite of many hypothesis about its genetic predisposition, the evidence for a genetic basis in the pathogenic mechanism of IH is fragmentary. In this study, we evaluated familial tendency and environmental factors influencing the pathogenesis of this disorder in patients with IH and their families. We investigated 24 children with IH and their 72 first-and second-degree relatives in this study. Twenty four patients had visited department of Pediatrics, Korea University Guro Hospital between July 1991 and July 1994 and had been diagnosed as IH. We measured fasting urine Ca/Cr ratio of 72 relatives of patients and if it is over 0.21, measured excreted calcium level of 24-h urine and serum Ca, P, Mg, BUN, Cr concentrations and PTH level. To analyse some environmental factors, we interviewed them(24 patients and their 72 relatives) about socioeconomic statuses, medications, history of conditions leading to secondary hypercalciuria, and preference for calcium-rich foods. 1) Out of 24 patients, 15 were absorptive hypercalciuria(AH) and 9 were renal hypercalciuri(RH). 2) The family investigations revealed IH in 9 out of 72 relatives of the 24 index patients and also showed a familial tendency in 12.5%. The familial tendency was 26.7% in families of children with AH(4 of 15 families) and 55.6% in families of children with RH(5 of 9 families)(p<0.05). 3) In personal interviews, there were no significant differences of nutritional habit between patients with AH and patients with RH. And then, the mean urine Ca/Cr ratio was significantly higher in the group preferring calcium-rich diet(18 persons) than in the group preferring calcium-low diet(14 persons) (p<0.05). We conclude that idiopathic hypercalciuria, especially, renal hypercalcuria, seems to have a familial tendency.