A Study on the Changes in Ventilator Care Rate and Outcome of Very Low Birth Weight Infants During Last Four Years

PURPOSE: Recently there has been a decrease in ventilator care rate and duration of very low birth weight infants(VLBWI) in Fatima Hospital. The aims of this study were to survey the frequency and duration of ventilation in VLBWI and to develop a non-invasive neonatal intensive care unit (NICU) policy. METHODS: We performed a retrospective study of 284 newborn of infants less than 1,500 gm admitted to NICU and discharged from January 1998 to December 2001. Patients were intubated or applied continuous positive airway pressure(CPAP) via nasal prong immediately after presenting signs of respiratory distress. We analyzed epidemiologic data to study the changes in ventilator care rate, duration and outcome of ventilator care groups. RESULTS: Of 284 newborn infants, 146 required invasive management, such as endotracheal intubation and assisted ventilation. The characteristics, the severity of clinical symptoms and laboratory findings in ventilator care groups at birth showed no significant differences. The annual proportion of infants requiring assisted ventilation decreased according to increasing gestational age. The median duration of ventilation decreased markedly from 6.0 days in 1998 to 2.7 days in 2001. Final complications and outcomes in ventilator care groups showed no significant differences. CONCLUSION: Our study shows a significant reduction in the invasiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. A non-invasive strategy for the VLBW infant with minimal to moderate respiratory distress after birth in NICU is better than immediate invasive management. Non-invasive nasal CPAP is a simpler and safer method than invasive assisted ventilation.

The Effect of Atopy and Airway Eosinophilic Inflammation on Exercise-Induced Bronchospasm in Asthmatics / 소아알레르기및호흡기학회지

PURPOSE: Exercise-induced bronchospasm (EIB) is widely prevalent in asthmatic patients. Recently, eosinophilic airway inflammation and atopy (defined as skin sensitivity to common aeroallergens) are considered to be a important factors in the pathogenesis of asthma. Thus we studied to find out the effect of atopy and airway eosinophilic inflammation on exercise- induced bronchospasm. METHODS: We followed up the cases of 132 mild asthmatics for 2 years. On their first visit, skin prick tests, with 29 common allergens including dust mites antigen, and sputum induction were performed. And 3 days later, methacholine challenge was done. 24 hours after methacholine challenge, treadmill test was performed and the positive EIB was defined as a 15% reduction or more in FEV1 from baseline after exercise. RESULTS: EIB was observed in 54 (40.9%) of 132 asthmatic subjects. There was no significant difference in atopy between EIB positive and EIB negative asthmatics. Eosinophil and eosinophil cationic protein in induced sputum were significantly higher in EIB positive asthmatics. We also found the significant correlation between bronchial responsiveness (BR) index and maximal % fall in FEV1. CONCLUSION: The severity of bronchospasm evoked by exercise was more closely related to eosinophilic airway inflammation and airway hyperresponsiveness to methacholine than atopy.

A Study on the Effects of the Early Use of Nasal CPAP in the Weaning of Mechanical Ventilators

PURPOSE: This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). METHODS: Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. RESULTS: There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in PaCO2. However, the control group showed a slight CO2 retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. CONCLUSIONS: Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.