Comparison between Caffeine and Theophylline Therapy for Apnea of Prematurity

PURPOSE: Methylxanthines are commonly used to treat apnea of prematurity. Recent studies have reported that caffeine therapy reduces the rate of bronchopulmonary dysplasia (BPD) and improves the rate of survival in preterm infant without neurodevelopmental disabilities. This study was performed to compare the effects on apnea episodes, adverse effects and morbidity between the caffeine and theophylline groups. METHODS: A retrospective study was performed in 143 infants born at less than 33 weeks of gestation and treated with caffeine (n=54) or theophylline (n=89) from 2011 to 2012. The baseline characteristics of mothers and their infants were examined. The number of apnea events before and after treatment, the duration of respiratory support, and the rate of re-intubation were compared. Furthermore, adverse effects, clinical course, and morbidities such as BPD and periventricular leukomalacia were compared before discharge. RESULTS: There were no significant differences in the baseline characteristics. Theophylline and caffeine appeared to have similar short-term therapeutic advantages on apnea of prematurity in mean apnea rate after first two weeks of treatment. However, there were no statistically significant differences in the duration of respiratory support, rate of re-intubation, clinical course, and morbidity between the two groups. Adverse effects, indicated by feeding intolerance were lower in the caffeine group. CONCLUSION: Caffeine was as effective as theophylline in the short-term for reducing apnea in preterm babies and was better tolerated and was easier to administer. A prospective randomized study is needed to confirm the effect of caffeine on the lone-term neurodevelopmental outcome in prematurity.

Risk Factors and Outcome of Nephrocalcinosis in Very Low Birth Weight Infants / 대한주산의학회잡지

PURPOSE: The aim of this study was to determine the incidence, risk factors, and long-term outcome of nephrocalcinosis in very low birth weight (VLBW) infants. METHODS: A retrospective chart review was performed in VLBW infants between 2006 and 2012 in the neonatal intensive care unit. RESULTS: The incidence of nephrocalcinosis in VLBW infants was 10.2%. By univariate analysis, oligohydramnios and use of antenatal steroids were more frequent in the nephrocalcinosis group. In the nephrocalcinosis group, the gestational age and birth weight were lower and there were more number of female infants. Also, the initial blood pH, the lowest systolic blood pressure, and urine output on the first day of life were lower and bronchopulmonary dysplasia, sepsis, and urinary tract infection were more prevalent in the nephrocalcinosis group. The use of dexamethasone or ibuprofen and the lowest levels of phosphorus, protein and albumin were significantly lower in the nephrocalcinosis group. By binary logistic regression analysis, the use of antenatal steroids, female sex, 5-minute Apgar score, duration of oxygen therapy and total parenteral nutrition, and the lowest albumin level were found to be significant risk factors for nephrocalcinosis. Overall, the resolution rate was 64.1% and 88.6% within 12 months and 18 months, respectively. CONCLUSION: The incidence of nephrocalcinosis in VLBW infants showed increasing trend. The risk factors of nephrocalcinosis were parameters for sick VLBW infants. Although the prognosis of nephrocalcinosis was relatively good, we should pay close attention to the development of complication.

Gigantism caused by growth hormone secreting pituitary adenoma

Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL). Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings.

Total Anomalous Pulmonary Venous Return in Siblings

Total anomalous pulmonary venous return (TAPVR) is a rare and critical congenital vascular anomaly that requires an early operation. However, initial symptoms of TAPVR may be non-specific, and cardiovascular findings may be minimal. The heart may not be enlarged and there is often no cardiac murmur. Without cardiac murmur, these symptoms are similar to those of respiratory distress syndrome in newborns. Therefore, a high degree of suspicion and an early diagnosis of TAPVR are important. This condition generally occurs without a family history and has a low recurrence rate, but several familial cases, including siblings, have been reported worldwide. Additionally, several chromosomal or gene abnormalities associated with TAPVR have been reported. In the case presented here, two brothers with a 6-year age gap were diagnosed with TAPVR. Surgery was performed without cardiac or neurological complications. This is the first report on TAPVR in siblings in Korea.