Symptomatic Spontaneous Pneumothorax in the Newborn : Comorbidities and Outcomes

PURPOSE: This study was performed to determine the rate of neonatal symptomatic spontaneous pneumothorax, and the corresponding clinical characteristics, co-morbidities, and outcomes. METHODS: The demographic characteristics, clinical symptoms and signs, associated abnormalities, methods of treatment, and outcomes were investigated in 22 neonates with symptomatic spontaneous pneumothorax in the neonatal intensive care unit (NICU) of Chonnam University Hospital between March 2003 and February 2008. RESULTS: The rate of spontaneous pneumothorax was 0.55%. Among the 22 neonates, the number of outborns was 15 (68.2%) and the number of males was 12 (54.5%). The main symptoms and signs were chest retraction, tachypnea, and cyanosis. The pneumothoraces were more frequent on the right side (59.1%) and all cases were diagnosed within 3 days of life. Four cases (18.2%) had urologic abnormalities and 7 cases (31.8%) had cranial abnormalities by ultrasonography. The treatments included oxygen (81.8%) and oxygen with chest tube drainage (18.2%). All of the infants survived and the overall outcomes were favorable. CONCLUSION: When respiratory symptoms and signs are develop abruptly in otherwise healthy newborns, the clinician should suspect a spontaneous pneumothorax and check a chest x-ray as soon as possible. Although the outcome of neonatal symptomatic spontaneous pneumothorax is favorable, renal and cranial ultrasonography are needed because of the higher possibility of urologic abnormalities and germinal matrix/intraventricular hemorrhage than in newborns without a pneumothorax.

Clinical Use and Complications of Percutaneous Central Venous Catheterization in Very Low Birth Weight Infants / 소아과

PURPOSE: The administration of total parenteral nutrition (TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization (PCVC) in very low birth weight infants. METHODS: A total of 56 very low birth weight infants below 1, 500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group (n=32) included the babies who had undergone PCVC and a control group (n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. RESULTS: There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2, 000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1, 000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1, 000 to 1, 500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2, 000 g. CONCLUSION: Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

MYH9-related Disorder in a Family: Autosomal Dominant Epstein Giant Platelet Syndrome / 대한소아혈액종양학회지

The term MYH9-related disorders indicates a group of autosomal dominant illnesses, formerly known as May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome and Epstein syndrome, caused by mutations of MYH9, the gene encoding for the heavy chain of non-muscle myosin IIA (NMMHC-IIA). We experienced a family with macrothrombocytopenia without leukocyte inclusion. A 5-year-old girl was found to have macrothrombocytopenia incidentally. Her father also had macrothromtocytopenia, but had been suffering from hearing loss and chronic renal failure. Meticulous search by light and electron microscopy failed to detect leukocyte inclusions. To our knowledge, these cases seem to be the first description of autosomal dominant Epstein giant platelet syndrome in Korea.

Clinical Study on Acute Glomerulonephritis in Children

A clinical study was done on 199 cases of Acute Glomerulonehritis, who had been admitted to the department of Pediatrics, Chonnam National University Hospital during the five years period from January 1976 to December 1980. The following results were obtained. 1) Males were affected more frequently than females by a 2:1 ratio, and the highest incidence was noted in children between 4 and 6 years of age, with a seasonal peak in Autumn and Winter. 2) The 57.8% of the total patients had history of preceding infections. The upper respiratory tract infection was most common, which was 51.3% of the total patients, and the skin infection was identified in 4.0% of the total patients. 3) The most common chief complaint was edema. Blood pressure of greater than 90mmHg in diastolic pressure was noted in approximately half of the patients. 4) Chest X-ray revealed cardiomegaly in21.9%, pulmonary edema in 12.8%, and pleural effusion in 9.1%. 5) The percentage of positive beta-hemolytic streptococcal culture was 12.3%, and Anti-Streptolysin O titer of greater than 333 Todd units was noted in 64.5%. 6) The mean value of serum C3 concentrationin the Acute Glomerulonephritis Group as a whole was lower than that of the Control Group and the difference was statistically significant(p<.001). 7) Gross hematuria and edema disappeared in most of the patients within 2 weeks after the onset of the symptoms, and the elevated blood pressure returned to normal within 2 weeks after admission. 8) Microscopic hematuria and proteinuria disappeared in most of the patients within 3 months after admission.

Comparison of Ampicillin, Trimethoprim-Sulfamethoxazole and Rifampin therapy for Shigellosis in Admitted patients

Forty-Five cases of Shigellosis were treated with Ampicillin, TMP/SMX and Rifampin from April 1980. to November 1980. Of the 18 strains of shigellae, in-vitro sensitivity test was performed against twelve antimicrobial agents. The percentage of resistant strains was 77.8% in Ampicillin and 100% in TMP/SMX. Inhibition zone diameter by Rifampin disc was 8~10mm in all cases and clinical improvement with treatment was noted in nearly all cases, therefore we regarded inhibition zone diameter above 8mm sensitive to Rifampin. In clinical evaluation, the percentage of effectiveness by antibiotics was as follows; Ampicillin-60%, TMP/SMX-70% and Rifampin-93.3%. Rifampin appears to be the best, available drug bacteriologically and clinically for the treatment of Shilgellosis.