Kim, Jeong-Eun
(Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
,
Lee, Chul
(Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
,
Park, Kook-In
(Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
,
Park, Min-Soo
(Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
,
NamGung, Ran
(Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
,
Park, In-Kyu
(Department of Thoracic and Cardiovascular Surgery, Severance Children's Hospital, Yonsei University College of Medicine)
OK-432 (picibanil) is an inactivated preparation of $Streptococcus$ pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intra...
OK-432 (picibanil) is an inactivated preparation of $Streptococcus$ pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.
OK-432 (picibanil) is an inactivated preparation of $Streptococcus$ pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.
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대상 데이터
A female preterm infant (case 2, gestation 29 weeks and 6 days weeks, birth weight 1,790 g) was born by C-section with bilateral pleural effusion, diagnosed at 27 weeks of gestation. APGAR score was 2 at 1 minute, 6 at 5 minutes.
A male preterm infant (gestation 33 weeks, birth weight 2,720 g) was born by C-section with hydrops fetalis. A fetal sonogram showed generalized edema, bilateral pleural effusion (right, 2.
성능/효과
The infant had been treated with thoracentesis and intrapleural instillation of OK-432 during the fetal period at 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion after seven days of instillation of OK-432 and progressed into hydrops fetalis at 29 weeks and 6 days of gestation. Analysis of fetal pleural fluid demonstrated the presence of more than 99% lymphocytes suggesting congenital chylothorax, while culture of the fluid was sterile. Fetal karyotype and viral studies were all negative.
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