To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.
Bronchopulmonary Dysplasia ; Catheters ; Continuous Positive Airway Pressure ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Methods ; Noninvasive Ventilation ; Parturition ; Respiration ; Respiration, Artificial

Autonomic dysreflexia is a syndrome characterized by severe hypertension, headache, sweating that is seen in spinal cord injury population. It can be a life-threatening problem if not promptly recognized and treated. Since the most common cause is bladder distention, it is essential that the urologist sh6fild be familiar with this syndrome. Two hundred ninety four patients with spinal cord injury were reviewed for the prevalence rate and clinical manifestations of autonomic dysreflexia. The time of onset post-injury, precipitating causes, presenting symptoms and management were analyzed. 42 patients (34.4%) of 122 patients with lesion above T6 level exhibited autonomic dysreflexia. The majority of patients (61.9%) had manifested signs and symptoms of autonomic dysreflexia within the first year. The precipitating causes were bladder distention (69.0%), bowel distention (23.8%) and urinary tract infection (7.1%). The presenting symptoms of autonomic dysreflexia were headache (88.1%), sweating (88.1%), hot flushing (28.6%), chest discomfort, hyperpnea and spasm. The management of autonomic dysreflexia include prompt bladder erupting, bed rest and appropriate bowel preparation. In conclusion, prompt recognition and appropriate management of autonomic dysreflexia are essential to prevent life-threatening sequelae.
Autonomic Dysreflexia* ; Bed Rest ; Flushing ; Headache ; Humans ; Hypertension ; Prevalence ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating ; Thorax ; Urinary Bladder ; Urinary Tract Infections

For many years preterm infants with respiratory distress syndrome have been managed with a combination of intubation and surfactant replacement therapy. It is now recognized that applying noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to early intubation after birth. Recently, nasal CPAP has shown a benefit with a small reduction in the risk of the combined outcome of death or bronchopulmonary dysplasia. There has been an upsurge in the use of NIV as primary therapy for preterm infants, bringing with it the dilemma of when and how to give exogenous surfactant. In an effort to overcome this problem, minimally invasive surfactant therapy (MIST) to spontaneously breathing infants, allows them to remain on CPAP in first days after birth. MIST has included administration of exogenous surfactant by brief tracheal catheterization, aerosolization, laryngeal mask, and intrapharyngeal instillation. In recent clinical trials, surfactant delivery via brief tracheal catheterization was found to reduce the need for subsequent intubation and mechanical ventilation and to improve short-term respiratory outcomes. In conclusion, MIST is gentle, safe, feasible and effective to perform in preterm infants and will also be used commonly in Korea.
Bronchopulmonary Dysplasia ; Catheterization ; Catheters ; Continuous Positive Airway Pressure ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intubation ; Korea ; Laryngeal Masks ; Noninvasive Ventilation ; Parturition ; Respiration ; Respiration, Artificial

Purpose: The study aimed to examine whether prophylactic surfactant replacement therapy (SRT) with less invasive surfactant administration (LISA) by tracheal catheterization in a group of spontaneously breathing preterm infants would improve clinical outcomes compared to prophylactic SRT with the INtubation-SURfactantExtubation (INSURE) method. Methods: We compared 20 spontaneously breathing preterm infants, 25 to 29 weeks of gestation or with a birth weight of less than 1,250 g, treated with prophylactic SRT using a gastric tube (LISA group), to the 20 spontaneously breathing preterm infants matched by gestational age and birth weight, managed with prophylactic SRT via the INSURE method (INSURE group, historical control). Results: The LISA group had lower rates of mechanical ventilation (MV) 72 hours after birth (P=0.019) and at any time (P=0.025), lower frequency of bradycardia during SRT (P=0.031), and lower median duration of MV than the INSURE group (P=0.038). In multivariate analysis, the LISA method was associated with a significantly lower likelihood of receiving invasive ventilation during hospitalization (odds ratio [OR], 0.029; 95% confidence interval [CI], 0.001 to 0.938; P=0.046) and a decreased frequency of bradycardia during SRT (OR, 0.020; 95% CI, 0.001 to 0.535; P=0.020) as compared to the INSURE method. Conclusion Prophylactic SRT using LISA via tracheal catheterization in preterm infants may significantly reduce exposure to MV during hospitalization and bradycardia during surfactant administration.

Purpose: We examined the factors associated with nasal intermittent positive pressure ventilation (NIPPV) failure in late preterm and term infants with respiratory distress after birth. Methods: A retrospective cohort study was conducted on late preterm and term infants with respiratory distress after birth from January 2015 to December 2020. The medical records of 132 infants, who received NIPPV as primary respiratory therapy before 6 hours of age, were retrospectively examined. We excluded five neonates who were either transferred to another hospital (n=2) or presented with congenital anomalies (n=3). Results: The remaining 127 neonates were divided into the NIPPV success group (n=82) and NIPPV failure group (n=45). NIPPV failure was associated with birth in a community hospital, the need for a surfactant, and a high maximum respiratory severity score (RSS ≥2.5) on the first day of life. In the subgroup analysis, NIPPV failure in late preterm infants was associated with a lower gestational age, birth in a community hospital, and an RSS ≥2.5 on the first day of life. In addition, NIPPV failure in term infants was associated with birth in a community hospital, the need for a surfactant, and an RSS ≥2.5 on the first day of life. Conclusion Birth in a community hospital, the need for a surfactant, and an RSS ≥2.5 on the first day of life were significant factors associated with NIPPV failure in late preterm and term infants.

PURPOSE: Persistent pulmonary hypertension (PPHN) is considered an important prognostic factor in meconium aspiration syndrome (MAS). The aim of this study was to determine the comorbid risk factors for PPHN in infants with MAS. METHODS: We retrospectively analyzed 60 infants diagnosed with MAS and admitted to the neonatal intensive care unit of the Sanggye Paik Hospital from January 2007 to April 2013. There were 28 infants (47%) with PPHN and 32 infants (53%) without PPHN. Clinical characteristics, laboratory findings within 24 hours after birth, and initial capillary blood gas analysis results were compared between infants with and without PPHN. RESULTS: Incidence of PPHN was associated with the severity of MAS (P<0.001). The PPHN group had a greater incidence of hypotension and hypoxic-ischemic encephalopathy within 24 hours of birth compared to the non-PPHN group. The PPHN group also had a lower initial pH. However, there was no significant difference for laboratory findings within 24 hours of birth and initial capillary blood gas analysis. In the multivariate analysis, hypotension within 24 hours of birth (P=0.046, odds ratio 11.494, 95% confidence interval 1.048-125.00) was found to be a significant comorbid factor for PPHN in infants with MAS. CONCLUSION: Infants with MAS who develop hypotension within 24 hours of birth should be closely monitored for development of PPHN.
Blood Gas Analysis ; Capillaries ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Hypoxia-Ischemia, Brain ; Incidence ; Infant* ; Infant, Newborn* ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome* ; Multivariate Analysis ; Odds Ratio ; Parturition ; Retrospective Studies ; Risk Factors*

PURPOSE: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. METHODS: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. RESULTS: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancy-induce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28(+0)-31(+6) weeks. CONCLUSION: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28(+0)-31(+6) weeks.
Enterocolitis, Necrotizing ; Gestational Age* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Medical Records ; Multivariate Analysis ; Neuroimaging ; Odds Ratio ; Oxygen ; Risk Factors* ; Sepsis

PURPOSE: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. METHODS: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. RESULTS: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancy-induce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28(+0)-31(+6) weeks. CONCLUSION: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28(+0)-31(+6) weeks.
Enterocolitis, Necrotizing ; Gestational Age* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Medical Records ; Multivariate Analysis ; Neuroimaging ; Odds Ratio ; Oxygen ; Risk Factors* ; Sepsis

BACKGROUND: To investigate the effects of nitroglycerin(NTG) and dipyridamoie(DIP) on the perfusion of ischemic myocardium during total occlusion of one coronary vessel and with 3 graded partial occlusion of its collateral supplying vessel, myocardial contrast echocardiography(MC-Echo) was performed on seven pentobarbital anesthetized open chest dogs. METHODS: After a left thoracotomy was done, the left anterior descending coronary artery(LAD) was dissected for ligation to produce total LAD occlusion and left circumflex coronary artery(LCX) was separated to place an electromagnetic flow probe and, distally, screw occluder to restrict LCX flow by 50% and 90% of the preocclusion value. MC-Echo images were made by bolus injections of a 5ml of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix) and normal saline(2 : 3 by volume) into the aortic root, and then the echocontrast defect area(EDA) with planimeter, peak echocontrast intensity(PEI) and the echocontrast washout halftime(WHT) with videodensitometer were measured. A 100microg of NTG was administered by bolus injection in the aortic root and was followed by 5mg of DIP after the hemodynamic effect of the NTG has been abolished. MC-Echo images were obtained after each infusion of NTG and DIP, first 60 minutes after total LAD occlusion with intact LCX flow, next with a 50% restriction of LCX flow, and third with a 90% restriction of LCX flow. RESULTS: 1) During total LAD occlusion with intact LCX flow : The EDA measured 60 minutes postocclusiom(PO) of LAD(14.2%) was smaller than that 3 minutes PO(20.5%, p<0.01). After NTG, systolic and diastolic blood pressure(BP) was decreased(p<0.01, p<0.05, respectively) and heart rate(HR) was not changed. The mean EDA(15.1%) was not changed, but an increase in EDA occurred in cases of which the diastolic BP fell by more than 20mmHg, and/or the systolic BP was less than 80mmHG after NTG, After DIP, BP and HR were unchanged. The PEI was increased and WHT was shortened in the nonischemic area, reflecting an increase in myocardial perfusion to a normal zone. However, the EDA(17.0%) was increased(p<0.05). The increase in EDA was more prominent in cases with good collaterals. This finding indicates that DIP cases coronary steal from the ischemic myocardium to the normal myocardium through the collaterals. 2) During total LAD occlusion with a 50% restriction of LCX flow : BP and HR were not altered. EDA, PEI and WHT were the same as those taken during intact LCX flow. After NTG, BP was decreased(p<0.01), but HR were not different from baseline values, After DIP, BP and HR remaince unchanged and EDA(16.2%) was increased(p<0.05). PEI was decreased(p<0.05) and WHT was delayed(p=0.054), indicating that DIP impaired any further increase of perfusion in ischemic myocardium. 3) During total LAD occlusion with a 90% restriction of LCX flow : Systolic and diastolic BP were decreased(p<0.05), but HR was unchanged. EDA(20.2%) was increased as compared to those during intact LCX flow(p<0.01). NTG decreased the EDA(17.6%, p<0.05) despite decrease in BP(p<0.01), while DIP did not alter the hemodynamics or EDA(20.7%). The PEI and WHT after infusion of both NTG and DIP were not different from baseline values. CONCLUSION: 1) Dipyridamole causes coronary steal from ischemic myocardium when the flow of collateral supplying vessel is intact or restricted by 50%, but not during 90% restriction of flow, suggesting the degree of stenosis of collateral supplying vessels is a determinant of coronary steal. 2) The beneficial effect of nitroglycerin to ischemic myocardium was largely determined by the extent of collateral flow and its effect on hemodynamics.
Animals ; Constriction, Pathologic ; Coronary Occlusion* ; Coronary Vessels ; Dipyridamole* ; Dogs* ; Echocardiography ; Heart ; Hemodynamics ; Ligation ; Magnets ; Meglumine ; Myocardial Ischemia ; Myocardium ; Nitroglycerin* ; Pentobarbital ; Perfusion* ; Sodium ; Thoracotomy ; Thorax*

Propylene glycol, which is capable of producing both primary irritant and allergic skin reaction, is a common used vehicle for numerous topical preparations. The topical imidazole antimycotics are widely used but an infrequent cause of contact allergy. A 20-year-old female presented with erythematous scaly patch on the lower leg. An erythematous pruritic papulovesicular eruption developed around the lesion after applying Nizoral cream and was aggravated after applying Travogen cream. Patch test with Korean standard series and the ingredients of both cream revealed positive reaction to the propylene glycol contained in Nizoral cream and isoconazole nitrate in Travogen cream.
Dermatitis, Allergic Contact* ; Female ; Humans ; Hypersensitivity ; Ketoconazole ; Leg ; Patch Tests ; Propylene Glycol ; Skin ; Young Adult