Radiodensity on Serial Chest X-rays for the Diagnosis of Foreign Body Aspiration in Children.

Objectives: To evaluate the utility of measuring lung radiodensity from chest X-ray for the diagnosis of foreign body aspiration Methods: Records of 59 children with foreign body aspiration were retrospectively reviewed. Lung radiodensity and radiodensity ratio (right/left lung radio density) before and after foreign body removal were measured. Radiodensity was calculated as the relative score compared with the tenth thoracic vertebra body (100 points) and the background (0 point). The change of radiodensity ratio (difference in radiodensity ratio of the second X-ray from that of first X-ray) was compared between 22 patients (foreign body group) and 22 normal subjects (control group). Results: In the group of foreign body in the left bronchus, the mean (SD) radiodensity of the left lung [53.5 (12.8)] was lower than that of the right lung [60.8 (7.7), P<0.01] and it increased after foreign body removal [60.0 (6.9), P=0.02]. The radiodensity ratio decreased from 1.20 (0.30) to 0.96 (0.09) (P<0.01) after foreign body removal. In the group with a foreign body in the right bronchus, the radiodensity of the right lung [51.8 (12.8)] was lower than that of left lung [62.0 (11.7), P=0.03], and it also increased after foreign body removal [58.4 (9.6), P=0.03]. The change of radiodensity ratio in the foreign body group [15.7 (17.8)%] was higher than the control group [5.4 (4.3)%, P=0.01] and the cutoff value was 7.5%. Conclusion: Radiodensity from chest X-ray could be a useful tool for diagnosing foreign body aspiration in children.

Comparação de ibuprofeno via oral e indometacina intravenosa no tratamento da persistência do canal arterial em neonatos com extremo baixo peso ao nascer / Comparison of oral ibuprofen and intravenous indomethacin for the treatment of patent ductus arteriosus in extremely low birth weight infants

OBJETIVO: Existem poucos relatórios publicados com relação à eficácia do ibuprofeno via oral no tratamento da persistência do canal arterial (PCA) em neonatos com extremo baixo peso ao nascer (EBPN). Comparamos o ibuprofeno via oral à indometacina intravenosa no que diz respeito à eficácia e segurança no tratamento de PCA em neonatos com peso inferior a 1.000 g ao nascer. MÉTODO: Este foi um estudo retrospectivo em um único centro. Coletamos dados de neonatos com EBPN que tiveram PCA ecocardiograficamente confirmada. Os neonatos foram tratados tanto com indometacina intravenosa quanto com ibuprofeno via oral. A taxa de fechamento do canal, a necessidade de tratamentos adicionais, os efeitos colaterais ou as complicações relacionadas ao medicamento e a mortalidade foram comparados entre os dois grupos de tratamento. RESULTADO: Examinamos 26 neonatos que receberam indometacina e 22 que receberam ibuprofeno. A taxa geral de fechamento do canal foi semelhante nos dois tratamentos: o fechamento do canal ocorreu em 23 dos 26 neonatos (88,5%) no grupo indometacina, e em 18 dos 22 neonatos (81,8%) no grupo ibuprofeno (p = 0,40). A taxa de ligadura cirúrgica (11,5% em comparação a 18,2%; p = 0,40) não diferiu de forma significativa entre os dois grupos de tratamento. Após o tratamento, não foi encontrada nenhuma diferença significativa nas concentrações de creatinina sérica entre os dois grupos. Não houve diferenças significativas com relação a efeitos colaterais ou complicações adicionais. CONCLUSÃO: Em neonatos com EBPN, o ibuprofeno via oral é tão eficaz quanto a indometacina intravenosa no tratamento da PCA. Não há diferenças entre os medicamentos no que diz respeito à segurança. O ibuprofeno via oral poderia ser usado como um agente alternativo no tratamento da PCA em neonatos com EBPN.

OBJECTIVE: There are few published reports concerning the efficacy of oral ibuprofen for the treatment of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Oral ibuprofen was compared to intravenous indomethacin regarding efficacy and safety in the treatment of PDA in infants weighting less than 1,000 g at birth. METHOD: This was a retrospective study in a single center. Data on ELBW infants who had an echocardiographically confirmed PDA were collected. The infants were treated with either intravenous indomethacin or oral ibuprofen. Rate of ductal closure, need for additional treatment, drug-related side effects or complications, and mortality were compared between the two treatment groups. RESULT: 26 infants who received indomethacin and 22 infants who received ibuprofen were studied. The overall rate of ductal closure was similar between the two treatments: it occurred in 23 of 26 infants (88.5%) treated with indomethacin, and in 18 of 22 infants (81.8%) treated with ibuprofen (p = 0.40). The rate of surgical ligation (11.5% versus 18.2%; p = 0.40) did not differ significantly between the two treatment groups. No significant difference was found in post-treatment serum creatinine concentrations between the two groups. There were no significant differences regarding additional side effects or complications. CONCLUSION: In ELBW infants, oral ibuprofen is as efficacious as intravenous indomethacin for the treatment of PDA. There were no differences between the two drugs with respect to safety. Oral ibuprofen could be used as an alternative agent for the treatment of PDA in ELBW infants.

The Clinical Characteristics and Outcome of Neonates born to Systemic Lupus Erythematosus Mothers

PURPOSE: Neonatal lupus erythematosus (NLE) is a rare disorder caused by the transplacentally transmitted maternal autoantibodies. It is characterized by congenital complete atrioventricular block (CCAVB), skin lesion and less commonly hepatic and hematologic abnormalities. This study was designed to investigate the clinical characteristics and outcome of systemic lupus erythematosus (SLE) mothers and their neonates. METHODS: 29 neonates born to 25 SLE mothers were admitted to the Neonatal Intensive Care Unit of Chonnam University Hospital between January 1994 and June 2005. We investigate the medical records retrospectively. RESULTS: Among 25 SLE mothers, 32.4% had history of spontaneous abortion or stillbirth in previous pregnancy, and 7 (28.0%) of preeclampsia and 3 (12.0%) of premature rupture of membranes in present pregnancy. Among 29 newborns, 14 (48.2%) were premature, 4 (13.7%) were intrauterine growth retardation, and 11 (37.9%) were confirmed as NLE. Anti-SSA/Ro was positive in 13 (52.0%) of 25 examined neonates including 6 (85.7%) of 7 neonates with electrocardiographic abnormalities. Two cases of CCAVB were diagnosed during the pregnancy. One patient didn't show heart failure, he is on the followed up without medical treatment until 4 years of age. The other one showed heart failure, cardiac pacemaker was inserted at 7 days of age, dilated cardiomyopathy developed at 4 years of age. Five neonates with sinus bradycardia resolved spontaneously. One (3.4%) had typical lupus skin lesion with thrombocytopenia and elevated liver enzyme, one (3.4%) had leukopenia, and two (6.9%) had elevated liver enzymes only. CONCLUSIONS: With careful antenatal monitoring of SLE mothers and their fetuses, neonates should be monitored by autoantibody, EKG, and laboratory test.