Purpose: To compare the effect of humidified high flow nasal cannula (HHFNC) with that of nasal continuous positive airway pressure (NCPAP) as the mode of extubation in very low birth weight infants (VLBWI). Methods: Medical records were retrospectively reviewed for 219 VLBWI who were admitted to the neonatal intensive care unit of Ajou University Hospital from January 2009 through December 2012; 87 were supported by noninvasive ventilation (NIV) after extubation (HHFNC n=47, NCPAP n=40). Extubation failure was defined as the need for reintubation within 1 week of extubation.
Results:(1) There were no significant differences between the groups in demographic data such as gestational age, birth weight, and age at extubation. (2) There were no significant differences in fraction of inspired oxygen (FiO 2 ) (HHFNC 0.23±0.03 vs. NCPAP 0.23±0.03, P-value .937) and peak inspiratory pressure (HHFNC 11±6.6 cmH 2 O vs. NCPAP 10.3±3.4 cmH 2 O, P-value .559) before extubation. (3) The rate of extubation failure and FiO 2 values after extubation were similar in the 2 groups (extubation failure, HHFNC 5/47 vs. NCPAP 5/40, P-value 1.000; FiO 2 , HHFNC 0.24±0.05 vs. NCPAP 0.25±0.04, P-value .399). (4) Among patients who received NIV after extubation once but did not receive further intubation, the duration of NIV or duration of oxygen supply were not significantly different between the groups (NIV, HHFNC 12.4±9.1 days vs. NCPAP 8.7±12.3 days, P-value .159, oxygen supply, HHFNC 49.0±40.3 days vs. NCPAP 50.9±41.3 days, P-value .844) or bronchopulmonary dysplasia rate (HHFNC 24.3% vs. NCPAP 34.4%,. Conclusion: HHFNC is as effective as NCPAP for weaning VLBWIs from invasive mechanical ventilation.
Renovascular hypertension is caused by narrowing of the arteries supplying the kidneys. There are several methods to treat renal artery stenosis, such as medications, percutaneous transluminal renal angioplasty, and atherosclerosis. A boy presented to our hospital with severe hypertension. Computed tomography angiogram revealed severe narrowing of the left renal artery and hypoplastic left kidney. Total renal artery embolizaton was performed to make a complete occlusion of the left renal artery. Follow-up renin and aldosterone levels were gradually decreased. The main advantage of renal artery embolization is that it is minimally invasive compared with extensive surgical procedures. Therefore, renal artery embolization should be considered as an alternative to surgical nephrectomy in pediatric patients with renovascular hypertension.
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