Significance of Ligation of Patent Ductus Arteriosus in Premature Infant / 대한흉부외과학회지

BACKGROUND: Early surgical ligation of patent ductus arteriosus which has a significant hemodynamics and contraindications to the indomethacin therapy is a safe and effective therapeutic modality in premature infants. MATERIAL AND METHOD: From January 1995 to May 2000, 50 premature infants were diagnosed to have patent ductus arteriosus in Kosin University Hospital. There were 22 infants with asymptomatic PDA(Group I) and 28 infants with hemodynamically significant PDA which were treated with indomethacin(Group II, n=5) and surgical ligation(Group III, n=23). Group III had one or more contraindications to indomethacin therapy. Surgical ligation was done in the neonatal intensive care unit. This study is to compare the effects of surgical ligation and indomethacin therapy in premature infant with hemodynamically significant PDA. RESULT: Gestational age(week)and birth weight (g) were shorter and lesser in Group III(29.6 2.1, 1435 431.0) than in Group I(32.1 2.1, 1731 450.9), II(32 1.0, 1830 165.5) significantly(p<0.05), Age at the time of treatment (day) was not different in Group II(8.6 5.5) and III(7.3 4.4)(p<0.05), but body weight at the time of treatment(g) was lesser in Group III(1211 22.4) than Group II (1670 43.6) significantly(p<0.05). Survival rate(%) was higher in Group II(100) than Group III(73.9) significantly(p<0.05). The main causes of deaths were septicemia(5 cases), intracerebral hemorrhage(2), bronchopulmonary dysplasia(2), septic shock(1), and pneumothorax(1), which were not related to the operation. CONCLUSION: Early surgical ligation of hemodynamically significant PDA was a very effective therapeutic modality, and was thought to be safely applicable to the premature infant with contraindication to the indomethacin therapy and the extremely low birth weight.

Clinical Effects of Newfactan in the Treatment of Moderate to Severe Respiratory Distress Syndrome

PURPOSE: This study was designed to investigate the clinical effects of Newfactan in the treatment of moderate to severe respiratory distress syndrome. METHODS: There were enrolled 20 preterm infants who were diagnosed as grade III or grade IV respiratory distress syndrome at Kosin University Gospel Hospital from July 1997 to May 2000. All of these preterm infants were treated for rescue. To investigate the improvement of respiratory parameters we used FiO2, MAP, a/APO2 ratio, OI. RESULTS: Newfactan was administered to the patients at 7.2+/-7.4 hours (range 1.5- 32) after birth and 7 cases (35%) were administered one dose, 8 (40%) were administered two doses and 5 (25%) were administered three doses. The dose interval from first to second dose was 9.2+/-12.3 hours (range 5-46). The dose interval from second to third dose was 27.6+/-5.4 hours (range 21-35). The need of FiO2 showed decreased tendency especially between 4 to 6 hour after administration (P0.05). There were 41 complications and outcomes including PDA, sepsis, pneumothorax, intraventricular hemorrhage, BPD, ROP, and necrotizing enterocolitis. CONCLUSION: The clinical effects of Newfactan in the treatment of grade III or grade IV respiratory distress syndrome were significant in improving FiO2, PaCO2, a/APO2 ratio and OI.

Molecular Epidemiology of Vancomycin-resistant Enterococci Isolated from Patients in a Neonatal Intensive Care Unit / 대한임상병리학회지

BACKGROUND: Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE. METHODS: Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis. RESULTS: All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively. CONCLUSIONS: This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.

Intralipid Infusions Effect on Nutrophil Elastase Level in Newborns

PURPOSE: Parenteral nutrition is given to infants who tempararily cannot take oral feeding adequately. A lipid emulsion is added to the parenteral to supply essential fatty acids. In neonatal sepsis, elastase from azuropilic granules of the neutrophils is released and rapidly bound to alpha1-Proteinase Inhibitor(alpha1-PI). The lipid emulsion has been noted to markedly inhibit chemotaxis of neutrophils, so we to measured the levels of Elastase-alpha1-Proteinase Inhibitor(E-alpha1-PI) complex to evaluate the effect of intralipid infusions on the neutrophil in newborns with sepsis. METHODS: This study evaluated 8 patients with neonatal sepsis and 12 normal newborns. We measured E-alpha1-PI complex levels in the serum of these patients by ELISA methods. RESULTS: Before infusion with lipid solution, patients with neonatal sepsis had significantly increased levels of E-alpha1-PI complex in comparison with those of vaginally delivered normal newborns. E-alpha1-PI complex levels were significantly decreased after lipid infusions of 0.5g/kg per day, but there was no further significant decrease with higher doses of the infusate. CONCLUSION: We observed the suppression neutrophil elastase levels by lipid infusions in newborn with sepsis. These results suggest that there were no appropriate chemotatic effects of neutrophil in newborn with sepsis. Therefore, we considered whether the lipid infusion was stopped if the newborn with sepsis was infused parenteral nutrition with intralipid.