, Se Hwan Ahn, Jong Han Kim, Su Yeong Kim, Ji-Eun Ban Although Atrial flutter (AFL) in newborn infant with normal cardiac anatomy has benign clinical course, an intractable AFL is associated with an increased risk of development of heart failure and sudden death, and is still difficult to manage. It requires multiple external electrical cardioversions, and it shows a poor response to antiarrhythmic drug therapy. We report a case of a premature infant with an intractable AFL, which we successfully treated with oral flecainide and propranolol in spite of recurred AFL. A 1-month-old, 34-week gestation, premature baby presented with an irregular heart beat and irritability. An AFL with 2:1 atrioventricular conduction was documented. Because of the intractable AFL, repeated electrical cardioversion and amiodarone were continued for 14 days. However, amiodarone was discontinued in favour of flecainide and propranolol because of the recurrent AFL and newly developed transient hypothyroidism. During 1-year follow-up period, in which oral flecainide and propranolol were continued, no AFL was observed.
We studied the postnatal development of the renal function and the incidence of the renal dysfunction in premature with reapiratory distress syndrome, admitted to NICU, E.W.U.H. from March, 1986 to August 1989.
The results were as follows.
1) Renal function in Group I, RDS premature without perinatal asphyxia, was not different from the control values.
2) Renal function in Group II, RDS premature with perinatal asphyxia was different from the control values. Serum creatinine concentration was 1.05mg% at postnatal age 3 day and decreased to 0.88mg% at P.A 7 day. But both values were significantly higher than control values(P<0.05)
Creatinine clearance, 10.8ml/min/1.73m at P.A. 3 day which was significantly lower than control, but increased to 17.4ml/min/1.73m at P.A. 7 day which was not different from control value. Urine Na excretion and FENa were 5.2lmEg/kg/d and 3.81% at P.A. 3 day and decreaed to 3.42mEg/kg/d and 1.86% at P.A. 7 day. But both values were significantly higher than control values.(P<0.05) The incidence of proteinuria, oliguria and azotemia were significantly higher than control.(P<0.05)
In conclusion, RDS per se did not compromise the renal function. But associated perinatal asphyxia delayed the postnatal development of the glomerular function and the tubular reabsorptive capacity which seemed to be transient.
Sepsis and its associated complication of disseminated intravascular coagulation (DIC) are considered to be a major cause of morbidity and mortality in the newborn infants. Antithrombin(AT) is a single chain glycoprotein in plasma and belongs to the family of the serpins. It is an important anticoagulant protein acting as a heparin cofactor. However, it's effects and action in preterm infants are not clearly defined. The objective of this study was to determine whether AT III was effective in treatment of DIC in the premature infants.
We studied 52 preterm infants with clinical and laboratory diagnosis of DIC from November 1998 to October 1999. We examined the AT III, platelet, prothrombin time(PT), activated partial thromboplastin time(aPTT), fibrinogen, fibrinogen degradation product(FDP), and D-dimer before and after the treatment with AT III.
1) AT III concentrates were administerd for a mean of 3.6 days. Plasma AT III concetrations were elevated significantly(
2) Hematologic data(PT, aPTT, Fibrinogen, FDP) was significantly improved in definitive DIC group after AT III treatment(
3) The incidence of complications of DIC patients were slightly higher in definitive DIC group than in suspected DIC group, but there was no statistically significant difference. And AT III concentrate were well tolerated in all patients.
This data suggested that AT III therapy was effective to improve the clinical and laboratory findings without significant side effects in the premature infants with DIC.
First
Prev
