Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea

Background@#Endoscopy is used for diagnosing and treating various digestive diseases in children as well as in adults. However, in pediatric patients, it is recommended that sufficient sedation should be ensured before conducting endoscopy, since insufficient sedation may cause serious complications. However, in Korea, no studies have yet described the types of sedation drugs, effects of sedation, and efficiency of endoscopy with respect to the sedation instructor. Thus, we investigated the effectiveness of sedative procedures performed by anesthesiologists. @*Methods@#We retrospectively reviewed the medical records of patients aged < 18 years who underwent endoscopy during March 2014–July 2019. Data of sedation instructors, sedation drugs and their doses, complications, and the recovery after sedation were evaluated. @*Results@#Of 257 patients, 217 underwent esophagogastroduodenoscopy (EGD) and 40 underwent colonoscopies. Before EGD, 29 patients (13.4%) underwent sedation by the pediatric endoscopist and 188 (86.6%) were sedated by the anesthesiologist. The anesthesiologist performed the sedation for all 40 patients who underwent colonoscopy. Endoscopic examinations performed by the anesthesiologist were relatively more time-consuming (401.0 ± 135.1 seconds vs. 274.9 ± 106.1 seconds, P < 0.001). We observed that in patients who underwent EGD, there was a difference in the dose of midazolam administered (P = 0.000). When comparing EGD and colonoscopy in patients undergoing sedation by the anesthesiologist, there were no significant differences in the doses of midazolam and ketamine, but the dose of propofol increased for colonoscopy (2.50 ± 0.95 mg/kg vs. 4.71 ± 1.66 mg/kg, P = 0.000). The cognitive recovery time according to drug dose was associated with propofol only in EGD with a shorter endoscopy time. The longer cognitive recovery time in colonoscopy and the discharge time of EGD and colonoscopies were not associated with propofol use. @*Conclusion@#When sedation is performed by an anesthesiologist, various drugs are used with sufficient doses and complications are reduced, but the discharge time does not change. For performing pediatric endoscopy in Korea, anesthesiologists should be considered for inducing anesthesia.

Influence of proton pump inhibitor therapy on intestinal inflammation assessed by fecal calprotectin in pediatric patients / 소아과

BACKGROUND: An increase in the numbers of patients with gastrointestinal symptoms has recently been observed. PURPOSE: To investigate the effects of proton pump inhibitor (PPI) therapy on intestinal inflammation in children and adolescents as confirmed by clinical manifestations and objectively assessed by fecal calprotectin (FC) level measurement. METHODS: Consecutive children (aged 3–18 years) who presented with gastrointestinal symptoms and were treated with or without PPI for at least 1 month were enrolled. Patients were divided into PPI and non-PPI groups. The PPI group was further subdivided by treatment duration and type of PPI used. Stool samples were collected for FC evaluation at baseline and after treatment and clinical data and FC levels were compared between the groups. RESULTS: Fifty-one patients (15 boys, 36 girls) were enrolled in the study. The PPI group included 37 patients, while the non-PPI group included 14 patients. Clinical symptoms were not significantly different. FC levels and laboratory results, including C-reactive protein levels, white blood cell count, and absolute neutrophil count, were not statistically different before versus after PPI treatment. After treatment, FC levels decreased to 8.1 mg/kg (-575.4 to 340.3 mg/kg) in the PPI group and increased to 5.6 mg/kg (-460.0 to 186.9 mg/kg) in the non-PPI group compared to those before treatment (P=0.841). The number of patients with increased FC levels was not significantly different between the 2 groups (48.6% vs. 64.3%, P=0.363), similar to that observed in patients with an FC level > 50 mg/kg (24.3% and 7.1%, P=0.250). PPI therapy type and duration did not affect the FC levels (P=0.811 and P=0.502, respectively). CONCLUSION: Although we aimed to confirm the evidence of intestinal inflammation due to PPI use in children and adolescents through clinical symptoms and FC measurement, no significant changes were observed.

Central Venous Catheter-related Cardiac Tamponade in Premature Infants: A Report of Two Cases and a Literature Review / 대한주산의학회잡지

Although central catheter-related complications are frequently reported and are inevitable in the neonatal care unit, the incidence of pericardiac tamponade is low but may be fatal. Index of suspicion, prompt diagnosis, and urgent pericardiocentesis are crucial for lifesaving. We encountered two premature cases of central venous catheter-related pericardial tamponade. The first case was a 4-day-old male premature infant (gestational age [GA], 33(+5) weeks; birth weight [BW], 1,864 g), and the second case was a 4-day-old female premature infant (GA, 28(+6) week; BW, 1,050 g). Each infant had an indwelling central venous catheter since birth and at the third day of hospitalization. The conditions of the babies suddenly deteriorated, but both babies were successfully resuscitated with urgent echocardiography and prompt pericardiocentesis.

Aggressively Progressed MRSA Sepsis Accompanied by Endophthalmitis and Endocarditis in Preterm Infant / 대한주산의학회잡지

Methicillin-resistant Staphylococcus aureus (MRSA) is a critical source of infections in neonatal intensive care units. Early diagnosis and treatment are important due to the significant morbidity of MRSA infection. MRSA sepsis can be disseminated despite antibiotics, therefore the extent of the infection should be evaluated. Common complications of MRSA sepsis include infective endocarditis, pneumonia, osteomyelitis, meningitis, septic shock.Urgent evaluation of other possible suppurative complications in neoate are necessary. Therefore echocardiogram, chest X-ray, ophthalmic examination, brain sonography and spinal tapping are needed. In this study, we present a case of MRSA sepsis in a preterm infant, accompanied by endophthalmitis and endocarditis in spite of the early diagnosis and treatment.

Efficacy of Erythromycin and Metoclopramide in Neonates with Feeding Intolerance

PURPOSE: Feeding intolerance is common in premature infants. It may extend the parenteral nutrition period and increase the risk of complications. We evaluated the efficacy of erythromycin and metoclopramide in neonates with feeding intolerance. METHODS: Between December 2006 to August 2011, 114 neonates with feeding intolerance were divided into two groups treated with either erythromycin or metoclopramide in the neonatal intensive care unit of Chung-ang University Hospital, a tertiary care center. We defined neonates with feeding intolerance as those who either could not be fully fed enterally (120 mL/kg/day) within 7 days or who skipped feeding more than twice per day because the gastric residual volume was >20% of each feed or more than 50% once. The time taken to achieve 50%, 75%, and 100% enteral feeding was estimated retrospectively. RESULTS: The erythromycin group achieved 50% feeding (P=0.047), 75% feeding (P=0.042), and 100% feeding (P=0.039) earlier than the metoclopramide group. The erythromycin group achieved 100% feeding earlier than the metoclopramide group among infants with birth weight > or =1,500 g (P=0.036) and those with gestational age > or =34 weeks (P=0.008). CONCLUSION: Compared with metoclopramide, erythromycin improves feeding in neonates with feeding intolerance, especially in infants with birth weight > or =1,500 g and in those with gestational age > or =34 weeks.

Congenital Chloride Diarrhea in Dizygotic Twins / 대한소아소화기영양학회지

Congenital chloride diarrhea (CLD) is a rare inherited autosomal recessive disorder. Mutations of the solute carrier family 26 member 3 gene cause profuse, chloride ion rich diarrhea, which results in hypochloremia, hyponatremia and metabolic alkalosis with dehydration. If a fetal ultrasound shows bowel dilatation suggestive of bowel obstruction, or if a neonate shows persistent diarrhea and metabolic alkalosis, CLD should be considered in the differential diagnosis. The severity of CLD varies, but early detection and early therapy can prevent complications including growth failure. We report a case of dizygotic twins affected by CLD who had been born to non-consanguineous parents. Both of them showed growth failure, but one of the twins experienced worse clinical course. He showed developmental delay, along with dehydration and severe electrolyte imbalance. He was diagnosed with CLD first at 6-month age, and then the other one was also diagnosed with CLD.

Glomerular Filtration Rate Measurements Using 99mTechnetium-mercaptoacetyltriglycine Dynamic Renal Scintigraphy in Children with Renal Disease

PURPOSE: In children, 24-hour urine collections are unreliable for evaluating glomerular filtration rate (GFR) because of the difficulty of regulating voiding and the daily variation of urinary creatinine up to 25%. Additionally, creatinine clearance (Ccr) based on urinary creatinine is considered inaccurate. The purpose of this study was to compare estimated GFR determined using Ccr, formulas with serum cystatin C and creatinine, and 99mTc-mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy. METHODS: This retrospective study included 101 patients (age, <18 years) who visited Chung-Ang University Hospital between July 2011 and August 2012. GFR was estimated using 24-hour urinary creatinine, five formulas with serum creatinine and cystatin C, and 99mTc-MAG3 renal scan. RESULTS: Of the 101 patients, glomerular renal diseases were present in 60 patients (59.4%) and non-glomerular diseases were present in 41 patients (40.6%). There was a significant correlation between estimated GFR determined using 99mTc-MAG3 renal scan and Ccr (r=0.389, P<0.001). The correlation values between estimated GFR determined using 99mTc-MAG3 renal scan and each formula of Schwartz, Counahan-Barratt, Cockcroft-Gault, Filler and Lepage, and Bokencamp were 0.265 (P=0.007), 0.128 (P=0.044), 0.230 (P=0.021), 0.356 (P<0.001), and 0.355 (P<0.001), respectively. 99mTc-MAG3 renal scan was correlated with estimated-GFR by all formulas in decreased renal function. CONCLUSION: Estimated GFRs determined using serum creatinine and cystatin C, and 99mTc-MAG3 renal scan correlated well with estimated GFR determined using Ccr. 99mTc-MAG3 renal scan may be replaced for evaluation of renal function with convenience in patients with renal disease and decreased renal function in childhood.

Comparison of Outcomes between Prophylactic and Rescue Therapy of Surfactant in Premature Infants

PURPOSE: To compare early and later surfactant instillation in neonates with a birth weight of <1,250 g and/or less than 30 weeks' gestation, following the changes in the National Health Insurance policy of the Republic of Korea. METHODS: Preterm infants diagnosed with respiratory distress syndrome and instilled with an exogenous surfactant from April 2006 to August 2012 were included in this study. The subjects were divided into the two groups: the prophylactic group (n=19) included neonates who were instilled with surfactant within 30 minutes after birth in the delivery or operating room, and the rescue group (n=27) included neonates who were treated with surfactant from 30 minutes to 10 hours after birth for the treatment of respiratory distress syndrome. We compared the two groups in terms of short- and long-term outcomes. RESULTS: The groups showed no significant difference in gestational age and birth weight. The prophylactic group had a shorter duration of mechanical ventilation of synchronized intermittent mandatory ventilation but longer parenteral nutrition and mechanical ventilation, including continuous positive airway pressure without synchronized intermittent mandatory ventilation. There are significant differences in the occurrence of long-term common complications such as patent ductus arteriosus and parenteral nutrition-associated cholestasis. The ventilation index, oxygenation index, mean airway pressure, and arterial-to-alveolar oxygen pressure ratio were lower in the prophylactic group than in the rescue group. CONCLUSION: In comparison with late instillation, early surfactant instillation can reduce the period and requirement of mechanical ventilation. It also reduces the occurrence of patent ductus arteriosus and parenteral nutrition-associated cholestasis in newborns.

The Indoor Level of House Dust Mite Allergen Is Associated with Severity of Atopic Dermatitis in Children

We attempted to investigate the correlation between the severity of atopic dermatitis (AD) in children and the indoor level of house dust mite (HDM) allergens. Ninety-five patients (31.1 +/- 19.5 months of age) with AD were enrolled in this study, and serum specific IgE against Dermatophagoides pteronyssinus and D. farinae was measured. The severity of AD was assessed using the visual analogue scale on the same day of house dust collection. Living rooms and mattresses where the child usually slept were vacuumed for 2 minutes and concentrations of Der f 1 were measured by enzyme-linked immunosorbent assay. The skin symptoms were more severe in patients with Der f 1 concentrations in living room > 2 microg/g dust than < or = 2 microg/g dust (P = 0.018). This difference was noted in AD patients without sensitization to HDM (P = 0.004), but not in patients with sensitization. There was no difference in symptom severity according to Der f 1 concentrations in mattresses (P = 0.062). The severity of skin symptoms is associated with indoor concentrations of HDM in children with AD, and it is likely to act as nonspecific irritants as well as allergens in AD skin lesions.

Etiology of Pediatric Healthcare-associated Infections in a Single Center (2007-2011) / 병원감염관리

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.

Effects of Postnatal Dexamethasone or Hydrocortisone in a Rat Model of Antenatal Lipopolysaccharide and Neonatal Hyperoxia Exposure

The aim of our study was to investigate the differential effects of dexamethasone (DXM) and hydrocortisone (HCS) on somatic growth and postnatal lung development in a rat model of bronchopulmonary dysplasia (BPD). A rat model of BPD was induced by administering intra-amniotic lipopolysaccharide (LPS) and postnatal hyperoxia. The rats were treated with a 6-day (D1-D6) tapering course of DXM (starting dose 0.5 mg/kg/day), HCS (starting dose 2 mg/kg/day), or an equivalent volume of normal saline. DXM treatment in a rat model of BPD induced by LPS and hyperoxia was also associated with a more profound weight loss compared to control and LPS + O2 groups not exposed to corticosteroid, whereas HCS treatment affected body weight only slightly. Examination of lung morphology showed worse mean cord length in both LPS + O2 + DXM and LPS + O2 + HCS groups as compared to the LPS + O2 alone group, and the LPS + O2 + DXM group had thicker alveolar walls than the LPS + O2 group at day 14. The HCS treatment was not significantly associated with aberrant alveolar wall thickening and retarded somatic growth. The use of postnatal DXM or HCS in a rat model of BPD induced by intra-amniotic LPS and postnatal hyperoxia appeared detrimental to lung growth, but there was less effect in the case of HCS. These findings suggest that effect of HCS on somatic growth and pulmonary outcome may be better tolerated in neonates for preventing and/or treating BPD.

Differences of the Clinical Manifestations and Laboratory Tests between Monosensitized and Polysensitized Children: A Single Center Study / 소아알레르기및호흡기학회지

PURPOSE: The objective of this study was to identify differences in the clinical manifestations and allergic indices between monosensitized and polysensitized children. METHODS: We reviewed retrospective data from the medical records of patients who had chronic or recurrent respiratory symptoms and visited the pediatric clinic at Chung-Ang University Hospital for an evaluation of allergic diseases from January 2003 to January 2011. The patients were categorized into nonsensitized (n=111), monosensitized (n=149), and polysensitized (n=205) groups according to skin prick tests (as classified by five allergen groups). We compared gender, age, family history, admission history, food sensitization, total immunoglobulin E (IgE), peripheral eosinophil counts, eosinophil cationic protein (ECP) levels, forced expiratory volume in 1 second (FEV1), and methacholine provocation tests among the three groups. RESULTS: The frequency of food sensitivity was highest in the polysensitized group (n=101, 49.3%), followed by the monosensitized (n=8, 5.4%) and nonsensitized groups (n=0) (P<0.001). The FEV1 was significantly lower in the polysensitized group than that in the monosensitized and nonsensitized groups (79.4+/-20.2% vs. 87.2+/-16.0% vs. 87.6+/-17.1%, respectively) (P=0.013). The total IgE and ECP levels were significantly higher in the polysensitized patients than those in the other patients (P<0.001 and <0.001, respectively). Differences in gender, age, peripheral eosinophil count, and bronchial hyper-responsiveness were not identified between the monosensitized and polysensitized groups. CONCLUSION: The polysensitized group showed more frequent food hypersensitivity, lower FEV1 values, and higher allergic indices such as total IgE and ECP, suggesting a different atopic phenotype compared with those in the monosensitized group.

The First Case of X-linked Alpha-thalassemia/Mental Retardation (ATR-X) Syndrome in Korea

Mutation of the ATRX gene leads to X-linked alpha-thalassemia/mental retardation (ATR-X) syndrome and several other X-linked mental retardation syndromes. We report the first case of ATR-X syndrome documented here in Korea. A 32-month-old boy came in with irritability and fever. He showed dysmorphic features, mental retardation and epilepsy, so ATR-X syndrome was considered. Hemoglobin H inclusions in red blood cells supported the diagnosis and genetic studies confirmed it. Mutation analysis for our patient showed a point mutation of thymine to cytosine on the 9th exon in the ATRX gene, indicating that Trp(C), the 220th amino acid, was replaced by Ser(R). Furthermore, we investigated the same mutation in family members, and his mother and two sisters were found to be carriers.

Clinical significance of matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 and 2 in Kawasaki disease / 소아과

PURPOSE: Kawasaki disease (KD) is a systemic vasculitis, a leading cause of pediatric acquired heart disease. Histopathological findings of coronary artery lesion (CAL) in KD indicate destruction of the coronary artery wall with diffuse vasculitis. Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) might play central roles in this process. Special attention to MMP-9 has recently been emerging. This study was performed to investigate the clinical significance of MMP-9 and its inhibitors, TIMP-1 and TIMP-2, in KD. METHODS: We compared 47 KD patients with 14 febrile controls. Serum MMP-9 and TIMP-1, TIMP-2 were measured by ELISA and compared according to clinical stages and coronary involvement. RESULTS: In acute stage, MMP-9 and TIMP-1 were significantly higher, whereas TIMP-2 was lower, in KD than those in febrile controls (p<0.05). The elevated MMP-9 levels in acute phase significantly decreased during the subacute and convalescent phases (p<0.05). During acute phase, the MMP-9, TIMP-1, and MMP-9/TIMP-2 levels in the CAL group were lower than those in the non-CAL group, but they increased significantly in the subacute phase (p<0.05). MMP-9 has a positive correlation with TIMP-1 in the acute and subacute phases, and negative correlation with TIMP-2 in the subacute and convalescent phases (p<0.05). CONCLUSION: These results suggest that MMP-9, TIMP-1, and the imbalance in MMP-9 and TIMP-2 might play important roles on the pathophysiology of KD and especially on the development of CAL. However, further larger studies are needed.

Changing Patterns of Low Birth Weight and Associated Risk Factors in Korea, 1995-2007 / 대한주산의학회잡지

OBJECTIVE: Low birth weight (LBW) infants are known to be at the risk of increased morbidity and mortality, and also of developing adult or metabolic diseases later in their life. Recently, the number of LBW infants has increased in Korea. Therefore, we examined the changing patterns of LBW infants and associated risk factors. METHODS: Data from the Korean National Statistical Office during 13 years (1995-2007) were used. We analyzed the changing mean gestational age, mean birth weight, mean maternal age, and the changing incidence of premature infant, LBW infant, multiple births, the proportion of first baby, and sex of the baby. Also, we analyzed the incidence of unmarried mother, old aged mother (>35 years), young aged mother (<20 years), high school graduated mother. In addition, we analyzed the relationship between LBW infants and risk factors. RESULTS: The incidence of LBW infants was 2.99% in 1995, and 4.66% in 2007. The proportion of premature infant, multiple birth, first baby, unmarried mother, old aged mother, female baby increased. The increase in premature infant, multiple birth, old aged mother, unmarried mother, and female infant were found to be the important factors regarding increase in LBW infants in Korea. CONCLUSION: In Korea, an increase in the prevalence of LBW infants and prematurity from 1995 to 2007 was observed. The increase in premature infants, multiple birth, old aged mother, unmarried mother, and female infant are associated with the increase in LBW infants.

A Case of Severe Hyponatremia Induced by Radiographic Contrast Agent

Hyponatremia which is a very common electrolyte abnormality in hospitalized patients is defined as a plasma sodium concentration less than 135 mEq/L. Hyponatremia is generally caused by intravascular volume depletion, excessive salt loss and hypotonic fluid overload. It also can be caused by intravascular osmotic agent. Although most cases are mild and asymptomatic, acute severe hyponatremia can cause severe neurologic symptoms, such as seizures and coma. We report a rare case of severe hyponatremia induced by radiographic contrast agent.

Clinical Analysis of the Pediatric Patients with Neurological Disorders Seen in the Emergency Department / 대한소아신경학회지

PURPOSE: Pediatric emergencies with seizure and decreased mental status or loss of consciouseness may cause severe complications without early proper management. Distribution of neurological disorders may differ according to various demographics, it would be valuable to evaluate recent data in Korea. METHODS: Patients who had neurological problems and below 18 years old were defined as case. 1,058(5.6%) cases who visited the emergency department of Chung-Ang University Hospital from January 2005 to December 2008 were analyzed. The patients were also divided into four age groups: age 1 year or younger, preschool children(2-5 years), middle childhood group(6-10 years), and adolescent group(11-18 years). RESULTS: The male to female ratio was 1.5:1. Most children were between 2 to 5 years old(mean age=3 years). Febrile convulsion is the most common neurological disorders among infant and preschooler, meningitis is the most common among middle childhood, epilepsy and headache is the most common among adolescent. Main initial presentations were seizure followed by fever, headache and vomiting. Febrile convulsion was the most common neurological disorders followed by epilepsy and meningitis. Final dispositions of patients were admission, discharge, against medical device, and transfer to other hospital. Admission rate of patients with neurological disorders was higher than those of total patients. CONCLUSION: Neurological disorders are increasing in pediatric emergencies and have highest admission rate, mostly because of the parent's anxiety and severity of disease itself. Therefore, not only detect and treat neurological disorder in early stage, but also reassuring parent is important.

Epidemiologic and clinical features in children with acute lower respiratory tract infection caused by human metapneumovirus in 2006-2007 / 소아과

PURPOSE: The causes of acute lower respiratory tract infection (ALRTI) are mostly attributable to viral infection, including respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus A/ B (IFV A/ B), or adenovirus (ADV). Several Korean studies reported human metapneumovirus (hMPV) as a common pathogen of ALRTI. However, studies on seasonal distribution and clinical differences relative to other viruses are insufficient, prompting us to perform this study. METHODS: From November 2006 to October 2007, we tested nasopharyngeal aspiration specimens in children hospitalized with ALRTI with the multiplex reverse transcriptase-polymerase chain reaction to identify 6 kinds of common pathogen (hMPV, RSV, PIV, IFV A/ B, and ADV). We analyzed positive rates and clinical features by retrospective chart review. RESULTS: We detected 38 (8.4%) hMPV-positive cases out of 193 (41.8%) virus-positive specimens among 462 patients. HMPV infection prevailed from March to June with incidence peaking in April. HMPV-positive patients were aged 1-5 years (76.3%), and the ratio of boys to girls was 1.2:1. The median age was 27 months. HMPV primarily caused pneumonia (76.3%) (P=0.018). Average hospitalization of HMPV-associated ALRTI patients was 5.8 days. In addition, they showed parahilar peribronchial infiltration (100%) on chest X-ray, normal white blood cell count (73.7%), and negative C-reactive protein (86.8%) (P>0.05). All hMPV-positive patients recovered without complication. CONCLUSION: HMPV is a common pathogen of ALRTI in Korean children, especially in 1-5 year olds, from March to May. Immunocompetent children diagnosed with hMPV-associated ALRTI may have a good prognosis.

A case of herpes zoster in a 4-month-old infant / 소아과

Herpes zoster in infancy is very rare but can be developed following intrauterine or postnatal exposure to varicella zoster virus. We report a case of herpes zoster in a 4-month-old male infant. He had no prior history of primary varicella or varicella vaccination. His mother had no history of varicella infection and no contact history with varicella during pregnancy. He had a history of exposure to his father with herpes zoster 3 months ago, and to his cousin with convalescent chickenpox 2 months ago. Multinucleated, giant cells were shown on a Tzanck smear. He was treated with acyclovir and first generation cephalosporin for herpes zoster with Staphylococcal skin infection, with complete resolution without sequelae.

A case of epignathus tumor causing obstruction of upper airway immediately after birth / 대한주산의학회잡지

Teratoma originate from one or more germ cell layer and commonly arise from sacrococcygeal area in neonate. Teratoma arising from the oropharyngeal cavity is called "epignathus tumor" and is extremely rare in neonate. Clinical manifestation of epignathus tumor vary from asymptomatic to severe respiratory distress symptom. It is reported that most of the tumor are benign in nature. Large teratoma can be diagnosed by prenatal ultrasonography, but most cases were diagnosed with computed tomography or magnetic resonance image after birth. Prognosis is determined by the need for neonatal resuscitation for respiratory distress at the time of birth and the extent of tumor, involving large vessles, skull base or communication with the brain. We experienced a case of epignathus tumor in a neonate with severe respiratory distress immediately after birth, so that reported with review of the literature.