Résumé
PURPOSE: A malpositioned endotracheal tube poses a serious threat to the intubated patient. After intubation in newborn infants, the position of the endotracheal tube must be checked by a chest radiograph to ensure a minimum number of complications. The most commonly used reference point for placement is the medial ends of the clavicles, but it is known that the position of clavicles on a chest radiograph can be variable. The purpose of this study was to evaluate whether e body of the first thoracic vertebra (Tl) can be used as the standard reference point for endotracheal intubation instead of the clavicles because its fixed position on the chest radiographs. METHODS: Eighty-one radiographs of newborn who were admitted in NICU during the period from January 1, 1998 to December 31, 1998 at Kangdong Sacred Heart Hospital, Hallym University were reviewed prospectively and the following informations were recorded: ( I ) positions of the clavicles and the carina in relation to the cervical or thoracic vertebra, or intervertebral disc space, and ( ii ) the distances in cm using a ruler on the films, from the carina to the clavicles and Tl. RESULTS: The carina overlay from T2-3 to T5, most commonly at T3 to T4 (74.1%) although the clavicles are placed from C3-4 to T1-2, most commonly at C6 to C7 (62.9%). On 74 (91.4%) examinations the clavicles lay above the Tl. The distance in centimeters from the carina to the clavicles and Tl increases in length as gestational age, birth weight, and height increases. Analysis of variance shows that the position of the clavicles was determined with significantly higher variation than Tl (F=6.92 vs F=3.80, P<0.01). CONCLUSION: Because the clinical sign we describe are unreliable for detecting endotracheal intubation, chest radiographs at the bedside should be obtained routinely immediately after intubation and daily thereafter to determine the position of the tube. In neonatal period, the tip of endotracheal tube should be placed at Tl on chest radiograph, and its use would obviate the need to measure the distance from carina.
Sujets)
Humains , Nouveau-né , Poids de naissance , Clavicule , Âge gestationnel , Coeur , Disque intervertébral , Intubation , Intubation trachéale , Études prospectives , Radiographie thoracique , RachisRésumé
The authors evaluated the clinical significance of the bilirubin values as screening test means for predicting the occurrence of neonatal jaundice earlier after birth, by using the transcutaneous bilirubinometry which is known to measure the bilirubin values in a noninvasive, accurate and simple way. The results obtained were as follows: 1. In comparison between the test group(showing the symptom of a jaundice within 72 hours after birth) and the control group, there were found no statistically significant differences in terms of sex, delivery type, birth weight, gestational age and mother's age, while being found statistically significant differences in terms of transcutaneous bilirubin at birth(TcBbirth), transcutaneous bilirubin at 24 hours after birth(TcB24hr), increase in transcutaneous bilirubin per hour during the first 24 hours after birth(TcBin/hr) and transcutaneous bilirubin at 72 hours after birth(TcB72hr)(p<0,05). 2. The correlation test using the Pearson's coefficient produced statistically significant correlationship between each transcutaneous bilirubin index (TcBbirth, TcB24hr, TcBin/hr and TcB72hr) and serum bilirubin concentration at 72 hours after birth(B72hr)(p<0.05), while the result of the correlation test using the Spearman's roh showed statistically significant correlationship only between TcB24hr or TcB72hr and B72hr(p<0.05). As it was, the correlationship between TcB72hr and B72hr was highest in both Pearsons coefficient and Spearman's roh tests, followed by that between TcB24hr and B72hr. 3. In view of the ROC graph, the most effective means of predicting the occurrence of the neonatal jaundice was TcB72hr followed by TcB24hr, TcBbirth and TcBin/hr in their order. In particular, TcB24hr was conceived to be useful as screening test for determining an early discharge from the nursery within 48 hours. On the other hand, since the negative predictive value of TcBbirth, and TcB24hr is higher, the possibility that those infants showing a lower value of these indices may well be free later from a serious neonatal jaundice even if they should be discharged earlier from the nursery. In conclusion, those four indices predicting the neonatal jaundice in a simple, quick and noninvasive manner using the transcutaneous bilirubinometry were considered to be effective screening test means whereby any serious neonatal jaundice developed earlier after delivery can be successfully predicted.
Sujets)
Humains , Nourrisson , Nouveau-né , Bilirubine , Poids de naissance , Âge gestationnel , Main , Ictère , Ictère néonatal , Dépistage de masse , Crèches , ParturitionRésumé
Anti-c is an important Rh antibody that causes hemolytic disease of the newborn. Recently we had a case of hemolytic disease of the newborn in identical twin due to anti-c. The five-day-old female twin were admitted at our hospital due to jaundice. There were no ABO and Rh (D) incompatibilities between mother and babies. The newborn's direct and indirect antiglobulin tests were positive and the maternal serum showed a positive antibody screening test. The laboratory findings warranted hemolytic disease of newborn due to other Rh antibodies. The specificity of unexpected antibodies were anti-c in maternal serum and fetal serums. The babies were treated with only phototherapy for 10 days and discharged in recovery.
Sujets)
Femelle , Humains , Nouveau-né , Anticorps , Test de Coombs , Érythroblastose du nouveau-né , Ictère , Dépistage de masse , Mères , Photothérapie , Sensibilité et spécificité , Jumeaux monozygotesRésumé
PURPOSE: We used MRI to retrospectively analyze the brain of patients suffering from cerebral palsy. Our aim is to determine MRI's role in the assessment of brain damage, the relationship of gestational age. METHODS: A total of 66 patients(29 preform group and 37 term group), who visited Kang-Dong Sacred Heart Hospital from January, 1994 to July, 1998, were enrolled in this study. RESULTS: Among the 29 in the preform group, 13 patients showed MR images of hypoxic ischemic injury in which periventricular leukomalacid(PVL) and multifocal ischemic necrosis in 12(41.3%) and 1(3.4%) respectively. Neuronal migration disorders were 6(20.8%), other congenital malformations 5(17%) and normal MR images 5(17%) in this preform group. Among the 37 in the term group, 22 patients showed MR images of hypoxic ischemic injury in which selective neuronal necrosis were 11(29.7%), PVL 4(10.8%), focal and multifocal ischemic necrosis 4(10.8%) and status marmoratus 3(8.1%). Neuronal migration disorders were 4(10.8%), other congenital malformations 5(13.5%) and normal MR images 6(16.2%) in the term group. CONCLUSION: MRI provided useful information in a majority of children with cerebral palsy. Hypoxic ischemic injury was significantly different in preform and term groups. PVL was frequent in the preterm group and selective neuronal necrosis was statistically common in the term group.
Sujets)
Enfant , Humains , Encéphale , Paralysie cérébrale , Âge gestationnel , Coeur , Imagerie par résonance magnétique , Troubles de la motricité , Nécrose , Malformations corticales du groupe II , Neurones , Paralysie , Études rétrospectivesRésumé
PURPOSE: We used MRI to retrospectively analyze the brain of patients suffering from cerebral palsy. Our aim is to determine MRI's role in the assessment of brain damage, the relationship of gestational age. METHODS: A total of 66 patients (29 preterm group and 37 term group), who visited Kang-Dong Sacred Heart Hospital from January, 1994 to July, 1998, were enrolled in this study. RESULTS: Among the 29 in the preterm group, 13 patients showed MR images of hypoxic ischemic injury in which periventricular leukomalacia (PVL) and multifocal ischemic necrosis in 12 (41.3%) and 1 (3.4%) respectively. Neuronal migration disorders were 6 (20.8%), other congenital malformations 5 (17%) and normal MR images 5 (17%) in this preterm group. Among the 37 in the term group, 22 patients showed MR images of hypoxic ischemic injury in which selective neuronal necrosis were 11 (29.7%), PVL 4 (10.8%), focal and multifocal ischemic necrosis 4 (10.8%) and status marmoratus 3 (8.1%). Neuronal migration disorders were 4 (10.8%), other congenital malformations 5 (13.5%) and normal MR images 6 (16.2%) in the term group. CONCLUSION: MRI provided useful information in a majority of children with cerebral palsy. Hypoxic ischemic injury was significantly different in preterm and term groups. PVL was frequent in the preterm group and selective neuronal necrosis was statistically common in the term group.
Sujets)
Enfant , Humains , Nouveau-né , Encéphale , Paralysie cérébrale , Âge gestationnel , Coeur , Leucomalacie périventriculaire , Imagerie par résonance magnétique , Troubles de la motricité , Nécrose , Malformations corticales du groupe II , Neurones , Études rétrospectivesRésumé
We experienced one case of tuberous sclerosis occurred in brothers. Case 1 is 8-year-old male patient who presented seizure, mild mental retardation, subependimal nodule and Shagreen patch. Case 2 is 9-year-old male patient who presented adenoma sebaceum, Shagreen patch, subependymal gient cell astrocytomas. Diagnosis was confirmed by brain CT and biopsy. Brief review and related literatures were also presented.
Sujets)
Enfant , Humains , Mâle , Astrocytome , Biopsie , Encéphale , Diagnostic , Déficience intellectuelle , Crises épileptiques , Fratrie , Complexe de la sclérose tubéreuseRésumé
One fullterm infant whose clinical feature initially was that of necrotizing enterocolitis eventually developed intussusception. The symptomatology of these two conditions is strikingly similar, and when they coexist, recognition of a complicating intussusception is difficult. The pathogenic relationship between necrotizing enterocolitis and intussusception remains obscure. When a presumptive diagnosis of necrotizing enterocolitis is made but the infant's clinical course varies from that expected, other diagnoses, such as intussusception, must be considered.
Sujets)
Humains , Nourrisson , Diagnostic , Entérocolite nécrosante , IntussusceptionRésumé
No abstract available.