Yuh-Jyh Lin

Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity

The efficacy of nasal intermittent positive pressure ventilation (NIPPV) in treating apnea of prematurity was evaluated. Apneic preterm infants were randomly assigned to receive either NIPPV or continuous positive airway pressure (NCPAP) for 4 hr when they failed to respond to conservative therapy. The amount of reduction in apneic spells and bradycardia in the two groups after treatment was compared. Thirty‐four infants (18 with NIPPV, 16 with NCPAP) were enrolled. Their birth weights ranged from 590–1,880 g (mean, 1,021 g) and gestational ages from 25–32 weeks (mean, 27.6 weeks). The baseline characteristics were comparable in the two groups. Frequency of apnea and bradycardia was reduced during both forms of treatments. However, the infants receiving NIPPV had a greater reduction of apneic spells (P = 0.02) and a tendency to greater decrease in bradycardia (P = 0.09) than those receiving NCPAP. We conclude that NIPPV is more effective than NCPAP in reducing apnea in preterm infants. NIPPV may reduce bradycardia; however, this needs to be validated by a larger number of observations. Pediatr Pulmonol. 1998; 26:349–353.

Early postnatal dexamethasone therapy may lessen lung inflammation in premature infants with respiratory distress syndrome on mechanical ventilation

Early postnatal use of dexamethasone has recently been shown to be effective in improving the pulmonary status in premature infants with respiratory distress syndrome (RDS). To study the effect of dexamethasone on pulmonary inflammatory responses, we studied ten infants treated with dexamethasone and ten infants without this treatment. Serial tracheal aspirates were obtained for cell counts, neutrophil counts, total protein concentrations, and leukotriene B4 (LTB4) and 6‐keto prostaglandin (PG)F1α levels before and after starting the study. Infants in the dexamethasone‐treated group required significantly lower mean airway pressures for ventilation and had lower PaCO2 values from day 3 to day 14 than infants in the control group, suggesting better pulmonary function. For infants in the dexamethasone group, the tracheal aspirates showed significantly lower cell and neutrophil counts, protein concentrations, and 6‐keto‐PGF1α and LTB4 levels than in the control group. We conclude that early postnatal dexamethasone therapy may lessen lung inflammation and improve pulmonary function in infants with RDS. Pediatr Pulmonol. 1997; 23:193–197.

EARLY POSTNATAL (<12 HRS) DEXAMETHASONE (D) THERAPY FOR PREVENTION OF BPD IN PRETERM INFANTS WITH RDS- A TWO YEAR FOLLOW-UP STUDY. • 1115

We followed 133 (70 control, C; 63 D) of 164 surviving infants who were enrolled in a double blind control trial of early D therapy for preventing BPD. All infants had severe RDS and required IMV shortly after birth. Saline or D (0.25 mg/kg/dose, 1-7 d; 0.12 mg/kg/dose, 8-14 d; 0.05 mg/kg/dose, 15-21 d; 0.02 mg/kg/dose, 22-28 d) was given i.v. bid. Gr. C and D was comparable in B.W. (mean±SD 1.36±0.35 vs 1.42±0.31 kg), G.A.(29.4±2.4 vs 30.3±2.2 wks), Apgar score, initial blood gases, pH, IMV set-up, and family social background. The corrected age at time examined was similar. (C: 25.4±5.4, D: 24.3±4.4 m). *p<0.05Table

Renal Effects and Urinary Excretion of Prostaglandin Following Indomethacin Therapy in Premature Infants with Patent Ductus Arteriosus

Renal side effects and urinary prostaglandin were evaluated in 10 premature infants (Mean +/- SD: BW 1245 +/- 290 gm, GA 32 +/- 2.2 wks, Postnatal age 7.7 +/- 3.8 days) with significant PDA who were given one dose of indomethacin (0.3 mg/kg intravenously). There was a significant decrease in urinary output, osmolal and free water clearance after therapy. The fractional excretion of sodium, chloride, potassium, glomerular filtration rate and urinary prostaglandin E2 also decreased but were not statistically different from the baseline values. In infants who responded to indomethacin with ductus closure, their renal functions appeared to be preserved even though they had higher plasma indomethacin levels than the non-responders in whom significant changes in renal function were observed following indomethacin therapy. This observation suggested that the improved renal hemodynamics following the closure of the ductus may minimize or attenuate the renal side effects of indomethacin.

Effects of early postnatal dexamethasone therapy on calcium homeostasis and bone growth in preterm infants with respiratory distress syndrome

The effects of dexamethasone therapy on calcium homeostasis and bone growth were evaluated in 49 infants (24 placebo and 25 dexamethasone) who participated in a double‐blind trial of early dexamethasone therapy for the prevention of chronic lung disease. Dexamethasone (0.25 mg kg‐1 b.i.d. on d 1–7; 0.12 mg kg‐1 b.i.d. on d 8‐14; 0.05mg kg‐1 b.i.d. on d 15‐21; 0.02mg kg‐1 b.i.d. on d 22‐28) or saline placebo was given i.v. Serum calcium (Ca), phosphorus (P) and parathyroid hormone (PTH), and the corresponding urinary excretion of calcium (FECa) and phosphorus (FEP) were measured on d 2, 3, 7, 10, 14, 21 and 28 after starting the study. Radiographic evaluations of bone growth were also evaluated. Infants in the dexamethasone group had significantly higher PTH on d 2 (p < 0:01), 7 and 14 (p < 0:05) than infants in the placebo group. The dexamethasone‐treated infants also had significantly higher FEP on d 2,7 and 14 (p < 0:05) and lower FECa on d 7 and 14 (p < 0:05) than control infants. There was no significant difference between the groups in bone growth during the study. It was concluded that early dexamethasone therapy causes a transient elevation in PTH without apparent change in bone growth. The long‐term effect remains to be evaluated further.

Congenital bilateral agenesis of diaphragm : report of a case

Abstract Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this defect rarely survive to have surgical intervention. We report a 32-week premature female infant who was born to a 36-year-old mother via vaginal delivery. The pregnancy course was complicated by hypertension and polyhydramnios. Cytogenetic study showed a normal 46 XX female karyotype. She had cyanosis, respiratory distress and scaphoid abdomen at birth. A roentgenograph confirmed the diagnosis of diaphragmatic hernia. Surgery was performed at 21 h of age. Bilateral agenesis of diaphragm, herniation of abdominal organs and oesophagus and pulmonary hypoplasia were noted. Furthermore, stomach and spleen were adherent to the mediastinum and vertebrae. The patient developed hypotension and persistent hypoxaemia and expired at age of 26 h. Autopsy revealed bilateral agenesis of diaphragm, hypoplasia of lungs, and pancreas fibrosis with mild hypoplasia of islets of Langerhans. Conclusion Bilateral agenesis of diaphragm associated with pancreas fibrosis is a rare entity, and its clinical significance needs further investigation.

Systemic fungal infection in very low-birth-weight infants.

This retrospective study was designed to investigate the related factors and outcome of systemic fungal infection in very low-birth-weight (VLBW) infants. Medical records of infants admitted to the neonatal intensive care unit of National Cheng Kung University Hospital between January 1990 and June 1994 were reviewed. Of the 262 VLBW infants, 15 (5.7%) had fungemia (14 Candida 1 Cryptococcus) during the study period. Among the fungemic infants, 60% also had urinary tract infection; 18% had central nervous system infection. Their mean birth weight was 1079 +/- 78 g (504-1474 g), and the gestational age was 28.6 +/- 0.6 weeks (23-32 weeks). Thirteen of them (87%) had respiratory distress syndrome and patent ductus arteriosus, while 60% had chronic lung disease. The percentage of antibiotic usage, parenteral hyperalimentation, endotracheal intubation, placement of central venous line and steroid therapy were 100%, 100%, 73%, 67% and 36% respectively. The mean age at diagnosis of fungemia was 40.5 +/- 4.8 days (10-76 days). Common clinical manifestations were respiratory deterioration (93%), poor feeding (58%) and fever (53%). The frequency of side effects of amphotericin B in decreasing order were: hypokalemia (54%), hyponatremia (31%) and decreased urine amount (23%). The mortality rate was 40%. It was concluded that systemic fungal infection in VLBW infants might result in high mortality and the side effects were high in the treated infants.

Novel exon nucleotide substitution at the splice junction causes a neonatal Marfan syndrome

Chao S‐C, Chen J‐S, Tsai C‐H, Lin JY‐M, Lin Y‐J, Sun HS. Novel exon nucleotide substitution at the splice junction causes a neonatal Marfan syndrome.

The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: A two-year follow-up study

Aim: To evaluate the pulmonary outcome at corrected age of 2 y on preterm infants who participated in a double‐blind trial of early postnatal dexamethasone therapy (5 12 h after birth) for the prevention of chronic lung disease. Methods: Clinical respiratory status, blood gases, acid‐base balance and pulmonary function were evaluated at corrected age of 2 y in 116 preterm infants (59 infants in the control group; 57 in the dexamethasone‐treated group). In the dexamethasone‐treated group, dexamethasone was administered intravenously every 12 h in tapering doses: 0.25 mg/kg on days 1 through 7, 0.12 mg/kg on days 8 through 14, 0.05 mg/kg on days 15 through 21, and 0.02 mg/kg on days 21 through 28. Results: The clinical and laboratory characteristics in the perinatal period were comparable between the groups. At the time of follow‐up (mean ± SD corrected age was 25.1 ± 4.8 mo for the control group and 24.6 ± 5.1 mo for the dexamethasone‐treated group), there was a slightly lower mean body weight and body length, and a lower psychomotor developmental index in the dexamethasone‐treated group than in the control group (10.9 ± 2.1 vs 11.5 ± 1.9 kg, 84.4 ± 6.1 vs 85.9 ± 5.8 cm, and 82 ± 24 vs 89 ± 26, respectively); however, these differences were not statistically significant. There were no significant differences between the control and dexamethasone‐treated groups in clinical respiratory status, blood gases, acid‐base balance or in lung mechanics (VT: 9.5 ± 2.0vs 9.4 ± 1.9 ml/kg; Vmin: 0.23 ± 0.04 vs 0.23 ± 0.03 l/min/kg; CRS: 13.1 ± 3.9 vs 12.6 ± 3.6 ml/kPa/kg; RRS: 1.56 ± 0.64 vs 1.62 ± 0.58 kPa/l/s, respectively).

Outcome and cost of intensive care for very low birth weight infants.

Very low birth weights (VLBW) remain the major factor contributing to neonatal mortality and morbidity. The development of Neonatal Intensive Care Units (NICU) has improved the outcome for the VLBW infants. However, outborn VLBW infants may have different outcomes, and different medical costs than those born intramurally. This study compared the mortality, morbidity and costs of inborn and outborn VLBW infants cared in the NICU of a tertiary care center. A total of 176 VLBW infants (inborn 83, outborn 93) were examined over the three years period June 1990 to May 1993. The birth weights (1131 +/- 244 g vs 1133 +/- 255 g) and gestational ages (29.0 +/- 4.0 wk vs 28.9 +/- 3.0 wk) were not different between the two groups. However, the age of admission to our wards was significantly different between the inborn infants (5.0 +/- 3.2 hr.) and outborn infants (53.6 +/- 26.8 hr.). There was no difference in mortality rates between the outborn infants (35.7%) and the inborn infants (32.9%), nor in the incidence of intraventricular hemorrhage, respiratory distress syndrome, sepsis, necrotizing enterocolitis, retinopathy of prematurity or abnormal auditory brainstem response. However the incidence of patent ductus arteriosus and chronic lung disease of the outborn infants was higher than those of the inborn (47% vs 32%, 51% vs 29% respectively). The mean duration of hospitalization and cost seemed to be longer and higher in the outborn VLBW infants. It was concluded that outborn VLBW infants have higher rates of morbidity, longer hospitalization and cost more than inborn infants.(ABSTRACT TRUNCATED AT 250 WORDS)