The Comparison of Interferon-alpha Treatment by Dosages and Retreatment for Chronic Hepatitis B in Children / 대한소아소화기영양학회지

PURPOSE: We compared the therapeutic efficacy of low dose with that of standard dose of interferon (IFN) treatment and also compared the first IFN treatment with retreatment. METHODS: We have studied 51 children (age, 2~14) treated for chronic hepatitis B from March 1990 to August 1999. Twenty seven children had been treated with 3 MU/m2 (2.66+/-0.66 MU/m2) of IFN-alpha three times a week for 6 months (range, 6~12 months), whereas 24 children with 6 MU/m2 (4.45+/-0.94 MU/m2). There was no significant difference in gender, age, initial ALT and HBV DNA levels between each comparative group. RESULTS: Among the 27 children treated with 3 MU/m2 of IFN, ALT level had normalized in 11 children (41%) and anti-HBe seroconversion occurred in 9 children (33%) one year after the initiation of treatment. In comparison, among the 24 children treated with 6 MU/m2 of IFN, ALT normalized in 12 children (50%) and anti-HBe seroconversion occurred in 7 children (29%). In comparing the first treatment group to retreatment group, ALT level had normalized in 23 children (45%) and anti-HBe seroconversion occurred in 16 children (31%) among the 51 children treated with the first course of IFN treatment. In comparison, ALT normalized and anti-HBe seroconversion occurred in 3 children (25%) among the retreated 12 children. CONCLUSION: There was no significant difference in the therapeutic efficacies between 3 MU/m2 and 6 MU/m2 dose of IFN treated groups in ALT normalization and anti-HBe seroconversion. The retreatment efficacy of IFN-alpha was as effective as the first treatment.

Screening for Retinopathy of Prematurity: Optimal Timing of First Examination

PURPOSE: Early detection and proper treatment of retinopathy of prematurity (ROP) is crucial. The postnatal age of 4-6 weeks has been considered the most optimal time to screen the high risk infants for ROP. However, ROP rarely appears even before this period of age and we experienced several cases ROP detected before 4 weeks of age at NICU of Kyungpook University Hospital. This study was conducted to evaluate the most optimal time of first ophthalmic examination for ROP screening. METHODS: A retrospective analysis of ROP screening records of 106 infants who admitted to the NICU of Kyungpook University Hospital from January 1996 to March 1999 was performed. Infants with a gestational age or =1,500 gm) and Group II (birth weight <1,500 gm). Ophthalmic examinations were commenced between 3 weeks and 6 weeks postnatal age and recorded using the International Classification of ROP. RESULTS: Out of 106 infants screened, 35 infants were found to have some degree of ROP in at least one eye on at least 1 occasion. Of 35 infants with ROP, 11 infants were screened before the postnatal age 4 weeks. Eight ROP, including one stage 3 ROP, were detected at this first ophthalmic examination. Review for the time of first detection of ROP by postconceptional age revealed that stage 3 ROP and threshold ROP did not develop before 34 weeks. Postnatally ROP developed and progressed earlier in Group I than in Group II. The time of onset and highest stage represented by postnatal age in Group I and II were 28+/-7 days, 57+/-19 days and 32+/-15 days, 69+/-26 days respectively. The time of onset and highest stage represented by postconceptional age in Group I and II were 35.4+/-2.3, 36.3+/-2.9 weeks and 36.0+/-1.6, 38.0+/-3.6 weeks respectively, revealed no significant difference between two groups. CONCLUSION: These data indicate that the time of onset and progression of ROP are correlated more closely with postconceptional age than with postnatal age. In other words, the postconceptional age is superior to postnatal age in determining when to initiate ROP examination. Our study suggests that screening infants at 34 weeks postconceptional age seems to reliable for early detection of severe ROP in larger, and more mature preterm infants.

Pain Reduction Effects of Continuous Fentanyl Infusion to Intensive Care Neonates

PURPOSE: To determine whether pain control using fentanyl would effectively reduce behavioral distress, physiologic and hormonal responses to postoperative pain and mechanical ventilation in neonates. METHODS: Neonates who were admitted to the NICU(neonate intensive care unit) of Kyungpook University Hospital, requiring surgery or mechanical ventilation were evaluated. Twelve neonates undergoing operation were randomised into two groups. After operation, one group received fentanyl and the other was given saline. Behavioral distress using postoperative comfort scores, heart rate, blood pressure and blood glucose were evaluated before and after operation. Cortisol concentration and beta endorphin were measured before and at the end of operation and at 60 minutes after fentanyl infusion. The values were compared between the two groups. In eight neonates on mechanical ventilation, behavioral distress using pain scores, heart rate, blood pressure, oxygen saturation and concentrations of cortisol and beta endorphin were measured before and 60 minutes after fentanyl infusion. RESULTS: In neonates undergoing surgery, fentanyl infusion diminished the elevation of post operation heart rate and blood glucose(P<0.05) and induced the improvement of postoperation comfort scores(P<0.05). Cortisol levels were significantly lower in neonates receiving fentanyl(P< 0.01) at 60min after infusion. In neonates on mechanical ventilaion, fentanyl infusion diminished the elevation of systolic blood pressure and heart rate on endotracheal suction(P<0.05). At 60 minutes after infusion, cortisol levels were markedly lower in neonates receiving fentanyl(P<0.05). CONCLUSION: Neonates feel pain during postoperation and on mechanical ventilation. As fentanyl therapy appears to be effective in controlling the pain, anaesthetic agents should be given to all neonates undergoing painful procedures or under painful situations.

A Case of Intestinal Perforation with Candida Infection in Extremely Low Birth Weight Infant

Necrotizing enterocolitis(NEC) is considered to be the leading cause of intestinal perforation in extremely low birth weight infants. We have seen an infant with intestir 1 perforation whose clinical, surgical and histopathological features were different from the presenting features of NEC. A male infant, the 995 gm product of 29-week gestation revealed intermittent abdominal distension which was managed conservatively with fluid and antibiotics. On the nineteenth day of life, free peritoneal air was seen on radiograph, and laparotorny was performed. At surgery, a discrete perforation was found in the terminal ileum. The intestine surrounding the perforation appeared normal without evidence of NEC. Biopsy specimen at the site of perforation was noted to have Candida invading the bowel wall. All blood cultures obtained before surgery were subsequently negative.