A Study on the Effects of Early Surfactant Replacement and Gentle Ventilation in the Treatment of Respiratory Distress Syndrome / 소아과

PURPOSE: Recently, early surfactant replacement and tidal volume based gentle ventilation has been a fundamental treatment of respiratory distress syndrome (RDS). The aims of this study were to survey the changes in ventilator care duration and rate of complication in RDS groups. METHODS: We performed a retrospective study of 255 newborn infants less than 1, 500 g admitted to the neonatal intensive care unit (NICU) and discharged from January 1999 to December 2003. 141 of 255 newborn infants were RDS groups that required invasive management, such as endotracheal intubation, surfactant replacement and assisted ventilation. We analyzed epidemiologic data to study the changes in ventilator care duration and outcome of RDS groups. RESULTS: Of 141 RDS groups, 135 were mild to moderate RDS groups and only 6 were severe RDS groups. 24 (17.8%) of 135 mild to moderate RDS groups and 3 (50%) of 6 severe RDS groups were antenatal no use of maternal dexamethasone. 127 (90.1%) of 141 RDS groups underwent replacement of surfactant during 3 hours after birth. 121 (85.9%) weaned within 48 hours. CONCLUSION: Our study shows a decreased frequency of severe RDS by a antenatal use of maternal dexamethasone and decreased duration of ventilator care by early surfactant replacement and gentle ventilation.

Development of Periventricular Leukomalacia and Severe Intraventricular Hemorrhage in Very Low Birth Weight Newborns and Relationship with Ventilator Care (Study of Ventilator Care as a Risk Factor of PVL and PV-IVH) / 소아과

PURPOSE: It has been suggested that changes in cerebral blood flow by ventilator care could be a risk factor in periventricular leukomalacia (PVL) and severe periventricular-intraventricular hemorrhage (PV-IVH). The study aims to assess the relationship between perinatal clinical events, including ventilator care, and the development of PVL and severe PV-IVH; especially, whether ventilator care could be causers of PVL and severe PV-IVH as an individual risk factor. METHODS: Among 255 very low birth weight infants who survived in the Fatima neonatal intensive care unit from January 1999 to December 2003, 15 infants with PVL and eight infants with severe PV-IVH were classified as a study group, while 231 infants were enrolled as a control group. The analysis was performed retrospectively with medical records. RESULTS: Twenty four infants were diagnosed with PVL or severe PV-IVH. Asphyxia, recurrent apnea, sepsis, acidosis and ventilator care were significantly increased in the PVL goup. Asphyxia, recurrent apnea, RDS, acidosis and ventilator care were significantly increased in the severe PV-IVH group. CONCLUSION: Infants with PVL or severe PV-IVH may have multiple perinatal risk factors including asphyxia, recurrent apnea, sepsis, acidosis, RDS and ventilator care. Because most patients with ventilator care have multiple perinatal risk factors, ventilator care does not cause PVL and severe PV- IVH independently. Therefore, incidences of PVL and severe PV-IVH can be decreased by not only gentle ventilation, but also more professional antenatal care.

A Study on the Risk Factors of Periventricular Leukomalacia in Combined Use with Gentle Ventilation and High-Frequency Ventilation

PURPOSE: It is suggested that persistent hypocarbia caused by ventilator therapy could be a risk factor in PVL. The study is aimed to discover whether for preventing hypocarbia with combined use of gentle ventilation and high frequency ventilation, other factors would be causers of PVL. METHODS: Among 45 infants who were born and survived through ventilator treatment in the Fatima neonatal intensive care unit for four years from April 1996 to June 1999, 15 infants with PVL were classified as a study group and 30 without PVL as control group. The analysis was performed retrospectively with medical records. Ventilator treatment was based on the combined use of ventilation by means of the flow interruptor type of Infant Star . The aggressive weaning was performed when the clinical state, chest X-ray and arterial blood gas analysis became stabilized. RESULTS: Among 15 cases with PVL : 9 cases(60.0%) with fetal distress, 1 case(6.6%) with placenta previa, 1 case(6.6%) with placenta abruptio. In the relationship between PaCO2 variance on arterial blood gas analysis and PVL, the highest average of PaCO2 is 44.9 +/- 7.8 mmHg in the study group and 45.0 +/- 10.5 mmHg in the control group, which means there was not statistically significant difference. The PaCO2 concentration lower than 25 mmHg for three days appeared in one case in the study group. CONCLUSIONS: In cases of preventing hypocarbia by combined use of ventilation, it is suggested that the birth history and weaning method is important as risk factor of PVL.

A Study on the Effect of the Combined Use of Gentle Ventilation and High-requency ntilation on the Incidence of Chronic Lung Disease

PURPOSE: This study was conducted to determine the correlation between the incidence of chronic lung disease and the combined use of gentle ventilation and high-frequency ventilation. METHODS: The subject group consisted of 63 very low birthweight infants of less than 1500gm who were born and survived through ventilator treatment in the Fatima neonatal intensive care unit for four years from January 1995 to December 1998. The analysis was performed retrospectively with medical records. Ventilator treatment was based on the combined use of gentle ventilation and high-frequency ventilation by means of the flow interruptor type of Infant star. High- frequency ventilation was carried out for 24 hours after surfactant replacement, when PaCO2 exceeded 60mmHg, or if the period of gentle ventilation exceeded one week. When the results of arterial blood gas analysis and the state of the body became stable, the aggressive weaning was performed. RESULTS: For 49(77.8%) of 63 infants, the weaning was possible within seven days. The other 14 infants(22.2%) needed ventilator treatment for more than seven days. The mean duration of ventilator treatment was 12.3 days. The causes of weaning failure included sepsis, patent ductus arteriosus, chronic lung disease, and intraventricular hemorrhage. Two infants who had received ventialtor treatment for more than two weeks were found to have incidence of chronic lung disease. CONCLUSION: It is suggested that the combined use of gentle ventilation and high-frequency ventilation can help reduce pulmonary damage, and it will be important to shorten the period of ventilator treatment.