Hypernatremia and Intraventricular Hemorrhage in Very Low Birth Weight Infants (<1,250 g)

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.

Platelet count and mean platelet volume in low birth weight infants (< or =2,000 g) with sepsis / 소아과

PURPOSE: Sepsis is a common complication in Neonatal Intensive Care Units (NICU), seen especially in low birth weight (LBW) infants. A recent study showed that fungal or gram-negative sepsis is associated with a greater degree of thrombocytopenia than is seen with gram-positive sepsis. So, this study was undertaken to examine the platelet counts and platelet indices in LBW infants during episodes of sepsis. METHODS: We analyzed 36 cases with culture-proven sepsis on chart review in LBW infants admitted to the NICU at Wonkwang University Hospital from January 2001 to June 2006. RESULTS: Patients were grouped by organism type: gram-positive bacteria (1,521+/-309 g, 31.3+/-2.9 wk, 15/36), gram-negative bacteria (1,467+/-290 g, 30.6+/-3.6 wk, 17/36), and fungi (1,287+/-205 g, 30.0+/-3.9 wk, 4/36). The most common organism was Staphylococcus epidermis and the incidence of thrombocytopenia was 88.9%. When compared with infants with gram-positive sepsis, those with gram- negative sepsis had significantly higher incidences of thrombocytopenia, lower initial platelet count, lower platelet nadir, and greater mean percentage decrease in platelet count from before the onset of sepsis. Those with fungal infections were similar to gram-negative sepsis, but they were not significant because of the small number of patients. And mean platelet volume (MPV) in sepsis was increased more significantly in time of platelet nadir than before the onset of sepsis. CONCLUSION: We conclude that decrease in platelet count was significantly greater in gram-negative sepsis than gram-positive sepsis, and also greater than fungal sepsis-which was insignificant because of the small number of patients-in LBW infants. And elevation in MPV will be helpful in the diagnosis and treatment of sepsis in LBW infants.

Clinical Study of Neonatal Group B beta-hemolytic Streptococcal Meningitis: 10 Years Experience / 대한주산의학회잡지

OBJECTIVE: Most common organism of bacterial meningitis was E.coli in the past. However, it is changed to group B beta-hemolytic streptococcus (GBS) recently. Incidence of neonatal GBS meningitis is still not reported in Korea, but sporadic cases were reported continuously. So, we investigated the exact incidence of neonatal GBS meningitis for 10 years including other clinical manifestations for it's diagnosis and treatment. METHODS: We analyzed 9 cases with chart review retrospectively who had been admitted to the pediatric ward or NICU in Wonkwang University Hospital from July 1994 to June 2004. They had proven neonatal GBS meningitis with culture or latex agglutination test in CSF. RESULTS: Incidence of disease was 0.79 with 0.09 in early onset and 0.7 in late onset type per 1,000 live births. Sex ratio was not different, and nearly all 8 cases (88.9%) were fullterm and late onset type. The associated obstetric factors were noted in 5 cases (55.6%), and c-section of 3 cases (33.3%) was most common factor. In clinical features, fever was seen in all cases, and lethargy and poor feeding in nearly all cases (88.9%), and irritability (55.6%), bulging fontanelle and convulsion (44.4%) were seen. There were abnormal findings in 7 cases (77.7%) CRP 5 mg/dL in peripheral blood exams on admission. There were abnormal CSF findings which were increased wbc of 5 cases (55.6%, > or =1,000/mm3), neutrophil of 8 cases (88.9%), protein of 8 cases (88.9%, >200 mg/dL) and CRP of 6 cases (66.7%, 3 mg/dL), and decreased sugar of 6 cases (66.7%, <45 mg/dL) and severely decreased of 4 cases (44.4%, <20 mg/dL). There were abnormal brain CT findings in 6 cases (66.7%) such as cerebral infarction, subdural effusion, hydrocephalus, and intracranial hemorrhage. Eight cases (88.9%) were alive, and mean duration of therapy was 26.1+/-9.9 days. CONCLUSION: Although the incidence of GBS is not high, it is reported to be an important organism in neonatal bacterial meningitis. So, we recommend early detection and active treatment for neonatal GBS meningitis to prevent severe complication and prolonged therapy.

Renal Anomalies in Neonates with Isolated Preauricular Tags / 소아과

PURPOSE: The aim of this study was to determine the role of renal ultrasonography in neonates with isolated preauricular tags. METHODS: We performed a retrospective study of 10,997 newborn infants delivered from January 1995 to June 2003 in Wonkwang University Hospital. Nineteen newborns born with isolated preauricular tags were assessed for renal anomalies by performing renal ultrasonography within one week after birth. The study group was compared with a control group of 25 healthy neonates without preauricular tags during the same period, also using renal ultrasonography. RESULTS: Preauricular tags were detected in 19 of 10,997(0.17%) neonates; 57.9% were found on the right side. Renal anomalies in neonates with isolated preauricular tags were detected in four infants (21.1%); this incidence was higher, but was not significant, compared with the control group. Types of anomalies were mild hydronephrosis of grade 1(3 cases) and 2(1 case) which were normalized within one year. CONCLUSION: Routine renal ultrasonography is not recommended for newborn infant with isolated preauricular tags.

Intraoperative Blood Salvage and Transfusion During Spinal Surgery / 대한마취과학회지

25 Patients were received major spinal surgeries at main operating theater of Kangnam General Hospital from May 1990 to December 1990 by using the Haemonetics cell saver which was employed as an intraoperative blood salvage and autologous blood transfuser. The products of washed red blood cells were an average of 1490 cc packed RBC per case. Under the Light Microscopy, Washed RBC disclosed the morphologies of normal RBC size and shape. Fragmented RBCs or cell debris were not found and in one case agglutinated and denaturated RBCs were seen. While 20 patients were received spinal surgery prior to the utilization of cell saver, an average of 7.85 units of banked whole blood was transfused compared with 5.55 units in the cases of using the cell saver (p<0.05). Homologous banked blood utilization during spinal surgery declined more than 30% with the use of the cell saver. There was no evidence of infection, renal and/or hepatic failure related to the use of the cell saver. Haemonetics cell saver appeared to be safe, efficient and more over in some instanes life saving.

The Effect of Aging on the Pulmonary Function of the Healthy Adults / 대한마취과학회지

Pulmonary function tests were conducted in 60 male adults and 60 female adults at 20~79 years of age. They showed noevidenee of pulmonary disease on clinical symptoms, X-ray finidngs and past history. We wanted to evaluate the deterioration of pulmonary functional reserve in the aged. The results were as follows: 1) In males, FVC decreased significantly (p <0.01) from 4440+/-271.38 ml in 20~29 year-old subjects to 3090+/-445.75 ml 70~79 year-old subjects. The correlation coefficient with age was-0.6846. 2) In females, FVC decreased significantly (p<0.01) from 2097+/-479.42ml in 20~29 year-old subjects to 2142+/-233.13ml in 70~79 year-old subjects The correlation coefficient woth age was 0.6454. 3) In males, FEV, decreased significantly (p<0.01) from 4005+/-268.26 ml in 20~29 year-old subjects to 2373+/-326.36ml in 10~79 year-old subjects. The correlation coefficient with age was-0.8229. 4) In females, FEV1 decreased significantly (p<0.01) from 2586+/-519.00 ml in 20~29 yrar-old subjects to 1645+/-330.36ml in 70~79 year old subjects The correlation coefficient with age was 0.7013. 5) In males, FEV1/FVC decreased significantly (p<0.01) from 90.17+/-4.90% in 20~29 year-old subjects to 76.72+/-8.13% in 70~79 year-old subjects. The correlation coefficient with age was-0.5595. 6) In females, FEV1/FVC decreased significantly (p<0.01) from 88.66+/-6.58% in 20-29 year-old subjects to 76.80+/-9.32% in 70~79 year-old subjects. The correlation coefficient with age wae-0.4489.