PURPOSE: Factors affecting the response to surfactant replacement therapy are considered as types of surfactant, and strategies of treatment including prophylactic vs rescue therapy, single vs multiple doses, methods of mechanical ventilation, and modes of surfactant delivery. Among those factors, response to surfactant replacement therapy according to the modes of surfactant delivery was rarely studied in the world. In preterm infants with RDS, we studied the efficacy and adverse effects of surfactant replacernent therapy according to the differences in the modes of surfactant delivery. METHOD: Preterm infant weighing 500-2,500g with RDS who required assisted ventilation were divided into two groups. One group is as follows five fractional doses with five positional changes after removal from ventilator by feeding tube technique. The other group is as follows; two fractional doses with two positional changes by side-port adaptor technique. Of the 30 infants enrolled, 15 were randomly assigned to each group. We compared the respiratory indices, chest radiologic response, clinical outcome after surfactant replacement, and adverse effects during dosing procedure. RESULT: There were no diffrences of patient profile between two groups. There were significant improvernent in FiO2, a/APO2, MAP, OI, and chest radiologic response following surfactant replacement therapy in both groups. No significant differences were noted in the adverse effects during dosing procedure and incidence of complication. CONCLUSION: In initial phase of RDS treatment with surfactant replacement therapy, two fractional doses with two positional changes by side-port adaptor technique improve respiratory indices, radiologic response without dernonstrable harmful effects as five fractional doses with five positional changes after removal from ventilator by feeding tube technique, however two fractional dosing procedure is more recommendable because of #more simple and convenient procedure.
Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Respiration, Artificial ; Thorax ; Ventilation ; Ventilators, Mechanical

We analyzed neurodevelopmental outcome data of 36 selected studies. Data of individual studies were pooled by birth weight group: <800g, <1.000g, <1.500g and by time period of birth year: Period I (pre-intensive care era), 1960-67:Period II (beginning period of intensive care), 1968-76: and Period III (established period of intensive care), 1977-87. In all weight groups, survival and intact outcome rates based on live birth have progressively improved over the three period. The major neurodevelopmental handicap rate of the <1,500g decreased in Period III vs. Period I and Period II (66,70, and 45 per 1,000 live births in I, II, and III, respectively). However, the major handicap rate in the <800g and the <1,000g live births increased: in the <800g, from 48 per 1,000 live births in Period II to 101 in Period III and, in the <1000g, from 28 per 1,000 live births in Period I to 67 in Period II and 73 in Period III. Increases in major handicap rate in two lower weight groups were predominantly the effect of increasing number of survivors over these periods and had little to do with the change in handicap rates in the survivors. In the <1,500g, the magnitude of reduction in handicap rate in the survivors was sufficient to overwhelm the effect of increased survival, resulting in a reduction in the number of major handicapped children. We conclude that based on the currently avaiable reports, neonatal intensive care has provided very low birth weight infants with a reduction in mortality, an increase in intact outcome, and decrease in the number of major neurodevelopmentally handicapped children. We try to estimate the trend of major neurodevelopmental handicap and intactoutcome of infants with birth weights <1,500g in Korea and speculate that major handicap rate have progressively increased over the three period in spite of increase in intact outcome.
Birth Weight ; Disabled Children ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal* ; Korea ; Live Birth ; Mortality ; Parturition ; Survivors

PURPOSE: High flow rate (FR) and pressure limit (PL) strategy with time-cycled pressure-limited (TCPL) ventilator is employed routinely in the neonates. Theoretical basis of this strategy is the two-compartment theory that the lung with acute respiratory failure consists of units with different compliance and resistance. But such constant pressure strategy has the risk of ventilator induced lung injury. We compared the ventilatory indices and clinical outcomes of two different strategies, high FR-constant pressure and low FR-constant FR in the ventilator care of the neonates with acute respiratory failure. METHODS: For the neonates born in our hospital and treated with mechanical ventilation from March to August in 1997, two different ventilator strategies were employed randomly with flow control ventilator. In the high-FR group, the FR was fixed at 10 L/ min and the PL was adjusted according to the arterial blood gas analysis (ABGA) results. In the low-FR group, the FR was adjusted to 10 mL/kg of tidal volume. Sixty neonates were enrolled, 32 in high-FR and 28 in low-FR group. Ventilatory indices and clinical outcomes were statistically cornpared in the two groups. RESULTS: Perinatal factors were not different in the two groups. Initial ventilator settings, ABGA results and ventilatory indices were not different. The tidal volume, fraction of inspired oxygen, peak inspired pressure and oxygenation index were higher and dynamic compliance was lower in the high-FR group compared to the low-FR group after 3 to 72 hours of ventilator care. In clinical outcomes, incidences of pulmonary interstitial emphysema, pneumothorax and chronic lung disease were significantly lower in the low-FR group. CONCLUSION: Low-FR with constant FR strategy resulted in better clinical outcomes in the ventilator care of neonates. We conclude that constant FR strategy prevents damage of the better compliant lung units and decreases the incidence of acute and chronic complications of ventilator care.
Blood Gas Analysis ; Compliance ; Emphysema ; Humans ; Incidence ; Infant, Newborn* ; Lung ; Lung Diseases ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency* ; Tidal Volume ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical

No abstract available.
Humans ; Infant, Newborn*

No abstract available.
Female ; Humans

No abstract available.
Animals ; Extracellular Matrix* ; Hyaluronic Acid* ; Hyperoxia* ; Lung Injury* ; Lung* ; Rats*

We studied the effects of chronic hyperoxia (>95% oxygen for 14 days) in change of body weight, wet to dry lung weight ratio, and morphologic changes of lung tissue compared with that of room air (21% oxygen for 14 days) in Sprague-Dawley neonatal rat pups. The results were as follows: 1) In neonatal rat pups exposed to room air (normoxia group), body weight of initial 3 days of neonatal rat pups was 9.18 0.18g, and body weights of developing rat pups exposed to room air for 7, 10, 14 days were 14.07 1.90, 17.00 2.09, 23.07 1.93g respectively. In neonatal rat pups exposed to hyperoxia (hyperoxia group), body weight of initial 3 days of neonatal rat pups was 9.35 0.80 g, and body weights of developing rat pups exposed to hyperoxia for 7, 10, 14 days were 11.06 1.31, 12.64 1.77, 15,41 1.65 g respectively. These results suggest that changes of body weight in developing rat pups were stunted significantly in the hyperoxia group compared with normoxia group during 14days-experiment (p<0.01). 2) No appreciable difference of wet to dry lung weight ratio was noted at initial 3 days of neonatal rat pups between normoxia group and hyperoxia group, but considerably increased wet to dry lung weight ratio was noted significantly at 7 days of exposure in the hyperoxia group compared with the normoxia group (p<0.05). The difference of wet to dry lung weight ratio was not significant at 10, 14 days of exposure between normoxia group and hyperoxia group. These results suggested that relative water content of wet lung was at a peak at 7 days of exposure in hyperoxia group. 3) The lung from developing rat pups exposed to room air for 7 days had many small alveoli and numerous septal buds. However, in the lung from developing rat pups exposed to hyperoxia for 7 days, presence of pink staining material within the lumen of the air spaces (proteinaceous edema fluid) and increased interstitial cellularity due to infiltration by macrophages and neutrophils was observed, and these findings suggested acute exudative lung injury. 4) In most lungs from developing rat pups exposed to room air for 14 days, much increased alveolarization including the secondary septal bud formation was observed. However, in most lungs from developing rat pups exposed to hypeoxia for 14 days, increased septal and interstitial cellularity and thickness and interstitial fibrosis were observed significantly compared with normoxia group (p<0.01). In conclusion we could make a experimental animal model which had similar histopathologic finding of bronchopulmonary dysplasia in human infant and this model will be useful for research of pathogenesis of bronchopulmonary dysplasia.
Animals ; Body Weight ; Bronchopulmonary Dysplasia ; Edema ; Fibrosis ; Humans ; Hyperoxia* ; Infant ; Infant, Newborn ; Lung Injury ; Lung* ; Macrophages ; Models, Animal ; Neutrophils ; Oxygen ; Pulmonary Edema ; Rats* ; Rats, Sprague-Dawley

We found an error in this article. The author's affiliation.

BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins ; Medical Records ; Motor Activity ; Pneumothorax ; Retrospective Studies ; Subclavian Vein ; Vascular Access Devices ; Vena Cava, Superior ; Venous Thrombosis

No abstract available.
Nevus*