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산전 Dexamethasone과 Ambroxol 투여의 호흡곤란증 예방효과 및 신생아 이환률에 대한 비교연구
김은정,전성숙,서손상 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.1
Purpose : Antenatal dexamethasone administration is associated with a significant lowering respiratory distress syndrome(RDS) incidence, but can increase neonatal infection. Ambroxol has been accepted as an alternative treatment to dexamethasone and is of at least equal efficacy but without adverse reaction. The aim of this study was to evaluate the effectiveness of ambroxol versus dexamethasone in RDS incidence and neonatal infection. Methods : In this study, 30 infants, who received prenatal dexamethasone therapy, were compared retrospectively to 19 infants who received prenatal ambroxol therapy and 45 infants who received placebo during 28 to 34 weeks’ of gestation. Results : RDS incidence was comparable in both the dexamethasone(10.0%) and ambroxol(10.5%) groups but higer in the control group(26.6%). The puerperal infection rate in the mothers of these infants was 33.3% in the dexamethasone group, 10.5% in the ambroxol group and 20.0% in the control group. Neonatal infection in the 28 days following delivery was 56.6% in the dexamethasone group, 26.3% in the ambroxol group and 26.6% in the control group. Neonatal infection rate of the dexamethasone group was higher than ambroxol and control groups(P<0.05). When premature rupture of membrane was controlled, the sepsis rate(<28 days) was significantly lower in the ambroxol group than in the dexamethasone group(P<0.05), but puerperal infection and sepsis(<7 days) were not significantly different. Conclusion : Ambroxol was as effective as the dexamethasone in reducing the RDS incidence. Neonatal and puerperal infection were significantly higher in the dexamethasone group than in the ambroxol group. 목 적 : 조기 분만시 산전 dexamethasone 투여가 신생아 호흡곤란증을 의미있게 감소시키지만 신생아 감염의 위험성을 증가시킨다는 보고가 있다. 따라서 부작용을 줄일수 있는 약물의 연구가 계속되고 있는데 그중 하나가 ambroxol이다. 본 연구에서는 산모에게 dexamethasone과 ambroxol을 투여한 후 태어난 미숙아들에서 호흡곤란증의 빈도 및 신생아 이환률을 대조군과 비교 연구하였다.방 법 : 1998년 3월부터 1998년 3월까지 일신기독병원에서 재태기간 28주에서 34주 사이에 조산된 미숙아에서 산전 dexamethasone을 투여받은 산모에게서 태어난 미숙아 30례, ambroxol을 투여받은 산모에게서 태어난 미숙아 19례와, 아무것도 투여받지 않은 대조군 45례를 후향적으로 조사하였다.결 과 : 세 군에서의 평균 재태기간, 출생 체중, 1분, 5분 Apgar 점수, 분만 형태는 통계학적으로 차이가 없었다. 호흡곤란증은 dexamethasone군에서 3명(10.0%), ambroxol군에서 2명(10.5%) 발생하여 빈도의 차이가 없었으며 대조군에서는 12명(26.6%)이 발생하여 다른 두 군에서보다 발생률이 높았으나 통계학적인 의의는 없었다. 생후 28일 이내의 신생아 감염이 dexamethasone군에서 17명(56.6%), ambroxol군에서 5명(26.3%), 대조군에서 12명(26.6%) 발생하여 dexamethasone군에서 다른 두 군에 비해 감염률이 높았다(P<0.05). 약물 투여후 산모에서의 산욕기 감염은 dexamethasone군에서 10명(33.3%), ambroxol 군에서 2명(10.5%), 대조군에서 9명(20.0%) 발생하여 ambroxol군에서 다른 두 군에 비해 감염률이 낮았다(P<0.05). 생후 28일 이내의 패혈증은 dexamethasone군에서 14명(46.7%), ambroxol 군에서 3명(15.8 %), 대조군에서 7명(15.6%) 발생하여 다른 두 군에 비해 dexamethasone군에서 발생률이 높았다(P<0.05).
탠덤매스 신생아 스크리닝 검사로 발견된Isolated 3-Methylcrotonyl CoA Carboxylase 결핍증 1례
곽주영,박준영,남경아,손상희,서손상 대한소아청소년과학회 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.5
Isolated deficiency of 3-methylcrotonyl CoA carboxylase is a rare disorder of the catabolic pathway for leucine and many patients have mild symptoms or no symptom. However, the introduction of tandem mass spectrometry in newborn screening has revealed an unexpectedly high incidence of this disorder. We report an asymptomatic premature infant with isolated 3-methylcrotonyl CoA carboxylase deficiency detected by newborn screening program using tandem mass spectrometry. She was born at preterm, 36 weeks of gestation and her birth weight was 1,912 gm. She was delivered by Cesarian section due to maternal preeclampsia and oligohydramnios. An elevation of 3-hydroxyisovalerylcarnitine in a blood sample obtained at Seven days was detected by tandem mass screening. Massively elevated excretion of 3-hydroxyisovalerate and 3-methylcrotonylglycine was detected in the urine collected at 15 days. L-carnitine(100 mg/kg/day) was administrated orally to correct sencondary carnitine deficiency. Carnitine is conjugated with metabolites, to decrease the potential toxic effects. She is asymptomatic to date, and her growth and development are within normal limits. 저자들은 탠덤매스를 이용한 신생아 대사질환 스크리닝 검사로 우연히 발견된 무증상의 isolated 3-methylcrotonyl CoA carboxylase 결핍증 1례를 경험하여 이를 보고하는 바이다.