Comparison of Synthetic Surfactant with Modified Bovine Surfactant in Neonatal Respiratory Distress Syndrome

PROPOSE: This study was designed to compare the efficacy of a synthetic surfactant (Exosurf) and a modified bovine surfactant (SurfactenR) in the treatment of neonatal respiratory distress syndrome. METHODS: A total of 90 infants with respiratory distress syndrome who were admitted to neonatal intensive care unit at Samsung Medical Center between October 1994 to September 1996 were includeeach surfactant. RESULTS: There was no significant difference in between two groups regarding birth weight, gestational age, and initiation of treatment after birth. ExosurfR group received less supplemental oxygen therapy and ventilator care. Survival rate were 81.3R in Exosurf group and 79.2% in SurfactenR group. The incidences of patent ctus arteriosus in the ExosurfR and SurfactenR groups were 75% and 62.5%, grade 3-4 intcular hemorrhage were 18.8% and 10.4%, respectively,' retinopathy of prematurity were 9.4% and 18.8%, respectively. There was significant improvernent of a/APO2 and VI at 30 minutes and 2 hours after the treatment in SurfactenR group', 2 hours and 6 hours after the treatment in ExosurfR group, however, dynamic compliance and respiratory resistance did not improve during 24 hours. CONCLUSION: Although SurfactenR treatment appears to induce faster improvement in oxygenation and pulmonary function than ExosurfR treatment, this study does not reveal any difference in clinical outcomes among those who received two different surfactant preparations.

A Study on the Incidence and Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

PURPOSE: Although advances in neonatal intensive care have led to improved survival of very low birth weight(VLBW) infants, nosocomial sepsis continues to be an important cause of morbidity and death among these infants. Our study was carried out to estimate the incidence of nosocomial sepsis and to identify the attributable risk factors for sepsis. METHODS: The results of blood cultures taken from 182 infants with their birth weights less than 1,500 gram who were admitted to the NICU at Samsung Medical Center from October 1994 to December 1997 were retrospectively reviewed. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. RESULTS: Of 166 infants who survived beyond 3 days, 57(34.3%) had nosocomial sepsis(positive blood culture at age greater than 3 days and antibiotic therapy for more than 5 days). The incidence of nosocomial sepsis was 1.8/100 hospital days and the interval between admission and onset of sepsis was 18.4+17.8 days(meanSD). Coagulase negative staphylococci(35.3%) were the most common organism in nosocomial sepsis. On multiple logistic regression analysis, several risk factors appeared to be independently associated with sepsis. The risk of nosocomial sepsis rose with decreasing gestational age, with increasing ventilator duration, UAC(umbilical venous catheter) duration, PCVC(percutanous central venous catheter) duration, nasal prong duration. And infants with nosocomial sepsis were more likely to be outborn, resuscitated at delivery room and to have bronchopulmonary dysplasia. CONCLUSION: Directing quality improvement efforts toward decreasing exposure to invasive vascular catheter and reducing ventilator days may decrease the incidence of nosocomial sepsis in VLBW infants.

Congenital Intrahepatic Portosystemic Shunt in a Newbom Successfully Treated with Coil Embolization Via Umbilical Vein

Congenital intrahepatic portosystemic shunt is a rare entity and is mostly reported in adults. In embryonic period, the vitelline vein is broken up into the vitelline sinusoids, which become the intrahepatic portal vein branches and the hepatic veins. The portosystemic venous shunts may develop from embryonic vascular remnants, including the vitelline vein and ductus venosus. We report for the first time in Korea a case of congenital intrahepatic portosystemic shunt in a newbom infant presenting with congestive heart failure and hepatomegaly, successfully treated by coil embolization via umbilical vein.

The Usefulness of Pulmonary Function Test as Successful Weaning Index in Very Low Birth Weight Infants with Chronic Lung Disease

PURPOSE: To evaluate the usefulness of pulmonary function test for the prediction of successful weaning and extubation from the ventilator in very low birth weight(VLBW) infants with chronic lung disease. METHODS: This study included 15 VLBW infants(<1,500 g) with chronic lung disease who were admitted to Neonatal Intensive Care Unit of Samsung Medical Center from July, 1995 to June, 1996. They had extubation failure more than one time. This study was performed by reviewing of patients records retrospectively. The extubation criteria were based on clinical status, ABGA profiles and ventilatory parameters. At the time of last extubation failure and final success, we analyzed the distribution of age and weight of infants, ventilator profiles, ABGA profiles, dynamic and static pulmonary function test profiles measured by Bicore CP-100R from the infant with ventilator assistance daily in line monitoring. The paired T-test and linear logistic regression analysis were used to compare the variables between the evets of extubation failure and success. RESULTS: At the time of successful extubation, expiratory airway resistance was significantly lower and minute volume was significantly higher in dynamic pulmonary function test and respiratory system resistance was significantly lower in static pulmonary function test(P<0.05). In ventilator parameter, Fi02 and respiratory rate were lower at successful extubation(P<0.05). No statistically significant differences in ABGA profiles were seen between unsuccessful and successful extubation. CONCLUSION: The pulmonary function test is a useful predictor for successful weaning and extubation in VLBW infants with chronic lung disease. Among various parameters of pulmonary function test, expiratory airway resistance, minute ventilation and respiratory system resistance are suggested as successful weaning parameters.

Neurenteric Cyst Presented by Asymptomatic Mediastinal Mass

Neurenteric cyst is a rare bronchopulmonary foregut malformation, originating from notochord defect. Characteristics of this anomaly are the intrathoracic cyst associated with vertebral abnormalities, such as hemivertebrae, anterior and posterior spina bifida, absence of vertebrae and diastematomyelia. The most common symptom is respiratory distress and treatment is surgical excision of mass. We report a case of neurenteric cyst in a neonate presented with asymptomatic huge mediastinal cystic mass.