Neonatal Systemic Candidiasis: Comparison of Albicans and Parapsilosis Infection

PURPOSE: Systemic Candidiasis has become an increasingly important cause of morbidity and mortality in NICU infants. Severe infections caused by non-albicans Candida species have been increasingly reported in NICU infants. The purpose of the present study was to compare relative severity, mortality rates for C albians(CA) and C parapsilosis(CP) infections in our NICU. METHODS: This study included 16 infants with systemic candidiasis who were admitted to the Neonatal Intensive Care Unit of Samsung Medical Center from Oct. 1, 1994 to Aug. 31, 1998. Systemic candidiasis was defined as candida recovery from blood with clinical symptoms and signs of infection. Systemic candidiasis was diagnosed in 16 infants, 11 with CA and 5 with CP. Retrospective analysis of the medical records of patients with systemic candidiasis was performed. The analysis included demographic findings, clinical feature, hospital course, morbidity and mortality. RESULTS: No differences were found between CA and CP for birth weight, sex, gestational age, age or weight at onset, presence of necrotizing enterocolitis, severe ROP, prior duration of antibiotics, endotracheal intubation, parenteral nutrition, steroids, or central line. Infants with CA were more likely to have antecedent thrush and perineal Candida derrnatitis(P<0.05). Infants with CP were more likely to have catheter-related infection(P<0.05) and treated with more curnulative dose of Amphotericin B and for a longer duration than those with CA(P<0.05). CONCLUSION: Though both pathogens occur in similar NICU infants and can cause severe disease, CA appears more likely to result in complications than CP.

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.