• Journal of Chest Surgery
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• 제20권4호
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• pp.780-785
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• 1987

Pulmonary atresia with VSD is uncommon congenital anomaly with high mortality in neonatal period. Recently we experienced surgical correction of 2 cases of pulmonary atresia with VSD. The first case was 7-year old female patient and diagnosed as pulmonary atresia with VSD combined PDA. So, total correction was undertaken which consisted of PDA ligation, patch repair of VSD, transannular enlargement of RVOT with woven Dacron vascular graft, and closure of PFO. Postoperative systemic Rt. ventricular and radial artery pressure ratio was 0.44 and her postoperative course was uneventful. The second case was 6-year old male patient diagnosed as pulmonary atresia with VSD and large systemic-pulmonary collateral arteries. There were two large systemic-pulmonary collaterals, one was simply controlled by ligation, but the other was considered to supply Rt. upper lung. So end to side anastomosis was performed to the RVOT patch. Postoperative systolic Rt. ventricular and radial artery pressure ratio was 0.54. During the follow up period he showed clinical picture of Rt. heart failure, which is relatively well controlled with anticongestive therapy.

• Advances in pediatric surgery
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• 제12권1호
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• pp.99-106
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• 2006

Anorectal malformations comprise a spectrum of disease and the majority of patients have one or more abnormalities that affect other systems. In evaluating a newborn with anorectal malformation, the decision regarding the need for a colostomy and detection and management of any life threatening associated anomalies are thetwo most important considerations. Perineal inspection provides the clue to the surgical approach in about 80-90 % of male and 90 % of female newborn baby. The remaining patients who do not show any clinical evidence need radiologic evaluation to decide whether a colostomy should be performed. In most cases the decision to make a colostomy should not be made until the baby is 20 to 24 hours old and evaluation to rule out the presence of associated anomalies completed. A divided colostomy at the junction of the descending and sigmoid colon is recommended for anorectal malformations.

• Journal of Chest Surgery
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• 제21권1호
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• pp.191-195
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• 1988

Chylothorax in the neonatal period is a rare cause of respiratory distress. Surgical ligation of the thoracic duct is rarely necessary in congenital chylothorax. A 3 day-old newborn delivered by the cesarean section showed signs of respiratory distress suddenly and diagnosed as chylothorax on the right hemithorax. Conservative management such as multiple thoracenteses and tube thoracostomy drainage with nutritional support failed to close the leakage. At age of 60 days, we performed a supradiaphragmatic mass ligature of the thoracic duct visualized after injection of methylene blue into the thigh subcutaneously. Postoperatively, chylous effusion occurred in the left hemithorax and successfully treated with chest tube drainage for several days.

• Perinatology
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• 제29권4호
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• pp.175-179
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• 2018

Pneumatocele (PC) is a thin-walled cyst of the lung that can occur at all ages and with various etiologies. However, there is no fully accepted consensus for the management of PC in a neonatal intensive care unit. Although the management of PC is generally expectant, it is difficult to decide how long conservative management should be maintained, especially under Korea's medical care environment and the parents' worry and anxiety. We report a male neonate, born at $27^{+5}weeks$ gestation, weighing 1,000 g, who had a post infectious PC caused by methicillin-resistant Staphylococcus aureus sepsis. We treated conservatively for about 100 days (roughly 14 weeks), but unfortunately after a few days of chest retraction, acute exacerbation occurred, video assisted thoracoscopic surgery (VATS) was deemed necessary and performed. The purpose of this publication is to describe the clinical course, aggravation and relief after VATS management with a review of the literature.

• Advances in pediatric surgery
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• 제14권2호
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• pp.144-152
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• 2008

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal population. The aim of this study is to evaluate surgical indication and prognostic factors of NEC. Clinical data of seventy patients, diagnosed as NEC between January 2000 & January 2007, were reviewed retrospectively. Fifty-seven patients had medical treatment and 7 of them died. Thirteen patients who presented with pneumoperitoneum on plain abdominal film or were refractory to medical treatment received surgical treatment, and 5 of them died. All the expired 12 patients weighed less than 2500 g. Twenty out of seventy patients showed thrombocytopenia, and 11 patients of them died. The finding of pneumoperitoneum and thrombocytopenia could be the most important surgical indication. Prematurity, low birth weight and thrombocytopenia were related to a bad prognosis. NEC patients who presents with these findings must be considered for close observation and intensive care.

• Journal of Chest Surgery
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• 제50권4호
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• pp.242-246
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• 2017

Background: Patent ductus arteriosus (PDA) ligation is usually performed by congenital cardiac surgeons. However, due to the uneven distribution of congenital cardiac surgeons in South Korea, many institutions depend solely on adult cardiac surgeons for congenital cardiac diseases. We report the outcomes of PDA ligations performed by adult cardiac surgeons at our institution. Methods: The electronic medical records of 852 neonates at Chung-Ang University Hospital, Seoul, South Korea from November 2010 to May 2014 were reviewed to identify patients with PDA. Results: Of the 111 neonates with a diagnosis of PDA, 26 (23%) underwent PDA ligation. PDAs were ligated within 28 days of birth (mean, $14.5{\pm}7.8days$), and the mean gestational age of these patients was $30.3{\pm}4.6weeks$ (range, 26 to 40 weeks) with a mean birth weight of $1,292.5{\pm}703.5g$ (range, 480 to 3,020 g). No residual shunts through the PDA were found on postoperative echocardiography. There was 1 case of 30-day mortality (3.8%) due to pneumonia, and 6 cases of in-hospital mortality (23.1%) after 30 days, which is comparable to results from other centers with congenital cardiac surgery programs. Conclusion: Although our outcomes may not be generalizable to all hospital settings without a congenital cardiac surgery program, in select centers, PDA ligations can be performed safely by adult cardiac surgeons if no congenital cardiac surgery program is available.

• Advances in pediatric surgery
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• 제4권1호
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• pp.16-26
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• 1998

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery who are unable to tolerate enteral feeding for long periods during the postoperative period. However, TPN via central venous catheters(central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins(peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery. Operations consisted of procedures for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele. Surgery was performed at the Division of Pediatric Surgery, Department of Surgery, Hanyang University Hospitall, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range; 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during subsequent oral feeding. The mean urine output was maintained at 3.5 ml/kg/ hour during TPN and at 3.6 ml/kg/hour during subsequent oral feeding. The increment of body weight observed during TPN was 132 g in TEF, 53 g in gastroschisis and 3 g in omphalocele patients, while loss of body weight was not observed. The mortality rate was 5.7 %(3/53) and was related to the underlying congenital anomalies, not the TPN. The most common complication of peripheral TPN observed was laboratory findings suggestive of liver dysfunction in 23 cases(43.4 %) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. None of the major complications usually expected associated with central TPN were observed. The result of this study suggest that peripheral TPN can be used for adeguate postoperative nutritional support in neonates requiring 2 to 3 weeks of TPN.

• Neonatal Medicine
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• 제17권1호
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• pp.109-115
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• 2010

신생아의 지속성 폐동맥 고혈압증(PPHN)은 출생 후 폐동맥의 저항이 낮아지고 전신 혈관 저항이 올라가면서 폐로 가는 혈류가 증가하고 난원공과 동맥관을 통한 폐와 전신의 평행 순환에서 연속 순환인 신생아 순환으로 바뀌게 되는 과정에 문제가 있는 것이다. 저자들은 태변흡인이 있었던 두 명의 만삭아에서 고빈도 환기 요법과 흡인성 일산화질소 가스를 이용하여 PPHN을 치료하였으나 치료에 반응하지 않고 전신 장기에 산소화가 문제가되어 정맥-정맥도관체외막형산소섭취(V-V ECMO)를 시행하였고 두 증례 모두 체외막형 산소 섭취를 이탈하여 생존할 수 있었다. 현재까지 태변 흡인 증후군에 의해 생긴 PPHN 환아들에서 ECMO를 적용하여 치료한 국내 보고가 없고, 특히 V-V ECMO 적용으로 신생아를 치료한 보고 또한 없다. 이에 저자들은 태변 흡입 증후군에 의해 생긴 PPHN 환아들에서 V-V ECMO로 생존한 2례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Advances in pediatric surgery
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• 제10권1호
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• pp.17-21
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• 2004

Improvement in prenatal ultrasonography is leading to diagnose choledochal cyst before birth and before onset of classical symptom more frequently. But, there is a controversy about optimal timing for Cyst excision of prenatally diagnosed asymptomatic choledochal cyst. To identify the most appropriate timing for surgery in prenatally diagnosed choledochal Cysts, we analyzed 6 patients who had operation for choledochal cysts within 30days after birth at the division of Pediatric Surgery, Samsung Medical Center and Inha University School of Medicine, from June 1995 to June 2002. Males were four and females 2, the mean age at operation was 11.2 days, and the median age 8.0 days. The range of gestational ages of the antenatal diagnosis of bile duct dilatation was 24 weeks to 32 weeks, mean was 38.3 weeks, and mean birth weight was 3,298.3 g. After birth, abdominal ultrasonography, hepatobiliary scintigraphy, and magnetic resonance cholangiopancratography (MRCP) were performed. Mean age at operation was 11.2 days. All patients had the cyst excision and Rouxen-Y hepaticojejunostomy. Immediate postoperative complication was not found. During the median follow-up period of 41 months, one patient was admitted due to cholangitis, and the other due to variceal bleeding. Early operative treatment of asymptomatic newborn is safe and effective to prevent developing complications later in life.

• Advances in pediatric surgery
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• 제12권1호
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• pp.1-10
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• 2006

Recent advances in neonatal management have resulted in a dramatic increase in survival of very low birth weight infants. These critically ill infants, however, continue to pose significant challenges in management and ethics. There is little information on the outcome of the micropremie (birth weight less than 800 g) that require surgery. The records of 171 micropremies treated over a 15 year period (beginning in 1989) at Asan Medical Center was reviewed retrospectively. Forty-one (24.0 %) infants required surgical interventions by pediatric surgeons. There were 90 boys and 81 girls. The smallest infant, weighed 396g at birth, had esophageal atresia and died before surgery. The smallest survivor, birth weight 645 g, received anenterostomy for necrotizing enterocolitis at the weight of 590 g. The gestational age of the group rangedfrom 21 to 36 weeks. The most common surgical problem was inguinal hernia. There were 20 inguinal hernias, and repairs were performed on17 infants. Excluding 2 cases, hernia repair was performed at the time of discharge. There was only one recurrence of adirect inguinal hernia. Necrotizing enterocolitis developed in 17 patients, 11 were operated upon, two had peritoneal drainages, and 9 had enterostomies. Five of 11 surgical infants died after operation and three of the nonsurgical infants died of various complications. Although micropremies have potentially high risks of serious complications and death, the outcome can improve with careful surgical observation and judgment.