A partially hydrolyzed whey formula provides adequate nutrition in high-risk infants for allergy

BACKGROUND/OBJECTIVES@#Hydrolyzed formula is often fed to infants with gastrointestinal or immune issues, such as malabsorption or cow's milk allergy, because enzymatic treatment has rendered it more digestible and less allergenic than standard cow's milk formula (SF). Partially hydrolyzed formula (PHF) should be considered for those infants who are intolerant to extensively hydrolyzed formula. However, there are concerns about the nutritional insufficiencies of PHF. We aimed to evaluate the effects of PHF on the growth and health indicators in infants who were at high-risk of allergic disease and potential candidates for consuming PHF. @*SUBJECTS/METHODS@#A total of 83 infants aged 0–2 mon with a family history of allergies were assigned to consume either PHF or SF until 24 weeks of age. Anthropometric measures were obtained at baseline, 12 weeks, and 24 weeks; blood samples were drawn and evaluated at the end of the study. @*RESULTS@#No significant differences were observed in weight, height, and weight-for-height at any time point in each sex between the PHF and SF groups. At 24 weeks of age, the weightfor-age and height-for-age z-scores of the SF group were higher than those of the PHF group, but there was no significant difference in the weight-for-height z-score. There were no significant differences in levels of white blood cells, hemoglobin, ferritin, protein, albumin, aspartate aminotransferase, alanine aminotransferase, eosinophil cationic protein, and immunoglobulin E. @*CONCLUSIONS@#In this study, there were no differences in growth and blood panels between the infants consuming PHF or SF. Therefore, infants who are unable to tolerate SF can be fed PHF without nutritional concerns about growth.

Retinol, α-tocopherol, and selected minerals in breast milk of lactating women with full-term infants in South Korea

BACKGROUND/OBJECTIVES: This study was performed to measure fat-soluble vitamins and minerals in breast milk of Korean lactating mothers who exclusively breastfed their babies. SUBJECTS/METHODS: Breast milk samples were collected from 334 mothers. Concentrations of retinol and α-tocopherol were analyzed by high performance liquid chromatography ultraviolet spectrometry while concentrations of minerals were measured by inductively coupled plasma optical emission spectrometry. RESULTS: Retinol and α-tocopherol contents of breast milk were 39.58 ± 19.64 µg/dL and 0.23 ± 0.13 mg/dL, respectively. Average sodium, potassium, calcium, phosphorus, and magnesium levels in breast milk were 11.11 ± 5.16, 38.56 ± 9.01, 27.87 ± 6.10, 13.56 ± 3.30, and 3.05 ± 0.65 mg/dL, respectively. Contents of trace elements such as iron, zinc, copper, and manganese were 40.26 ± 46.21, 98.40 ± 62.47, 24.09 ± 9.03, and 0.90 ± 1.63 µg/dL, respectively. Fat-soluble vitamin concentration was positively correlated with total fat in milk samples, but no significant differences were observed in levels of retinol, α-tocopherol, or minerals based on whether or not lactating women were taking dietary supplements. CONCLUSIONS: Micronutrient contents of breast milk samples from Korean lactating women were comparable to those of other nations. Retinol and α-tocopherol levels were correlated and also with total fat in breast milk.

Comparison of transport media for the isolation and detection of Brachyspira hyodysenteriae / 대한수의학회지

Brachyspira (B.) hyodysenteriae is a causative agent of swine dysentery that is responsible for death and economic losses in the pig industry. It is imperative that clinical samples be delivered fresh for accurate diagnosis. The viability and DNA detection of B. hyodysenteriae using lab-made (phosphate buffered saline and modified tryptic soy broth) or commercial transport media (C, D, and E) were compared by culturing and real-time PCR at 4degrees C or room temperature (RT), respectively. B. hyodysenteriae grown in D (Anaerobe Systems, USA) and E (Starplex Scientific, Canada) media was viable for 4 days at 4degrees C and RT. However, B. hyodysenteriae in A, B, and C (culture swab; BD Biosciences, USA) media were not recovered after 2 days at RT. Ct values for real-time PCR at 4degrees C and RT ranged from 27.2 +/- 2.1 (C) to 29.6 +/- 0.5 (B), and 28.0 +/- 0.9 (E) to 30.2 +/- 1.5 (B), respectively. Considering the field conditions, it is important that transport media is used for specimen isolation and PCR to obtain an accurate diagnosis of swine dysentery.

Macronutrient composition of human milk from Korean mothers of full term infants born at 37-42 gestational weeks

BACKGROUND/OBJECTIVES: Breast milk is the best available food for optimum growth and development of infants and the breastfeeding rate is increasing in Korea. The purpose of this study is to measure the concentrations of macronutrients and to evaluate their changes according to lactation period in breast milk from lactating Korean women. SUBJECTS/METHODS: Milk samples were obtained from 2,632 healthy lactating women (mean age; 32.0 +/- 3.3 years), where the lactating period was up to a period of 8 months, who also volunteered to participate in the Human Milk Macronutrient Analysis Research. Lactose, protein, fat and water content in the breast milk samples were analyzed with infrared spectrometry using MilkoScan FT-2. RESULTS: The mean macronutrient composition per 100 mL of mature breast milk was 7.1 g for lactose, 1.4 g for protein and 3.0 g for fat, and energy content was 61.1 kcal. The protein concentration was significantly lower in milk samples at 1-2 weeks (2.0 g/dL) to 2-3 months (1.4 g/dL) than those at 0-1 week (2.2 g/dL), but it was similar among samples from 3-4 months to 7-8 months (1.3 g/dL). Mean lipid levels varied among different lactational period groups (2.7-3.2 g/dL), but presented no significant difference. Lactose concentration in the milk samples did not differ with lactation period. Maternal body mass index was positively related to protein and lipid breast milk contents, but was negatively related to lactose content. General linear models examining the associations between maternal variables and milk macronutrient content revealed that lactation period had a major impact on protein and lipid, but not on lactose content in breast milk. CONCLUSIONS: These results warrant future studies to explore factors that may be associated with changes in macronutrient content in human milk.

Breastfeeding Rate in Below 6 Months Infants during Recent 6-year in Korea Based on Childcare Database

PURPOSE: Breastfeeding is ideal diet for young infant and worldwidely recommended by many guidelines of authoritative centers. We investigated breastfeeding rate of young infant during recent 6-year in Korea and analyzed the tendency of it. METHODS: The subjectives were young infants whose mothers registered in childcare database of Mail dairies Co., Ltd. We surveyed exclusive breast feeding rate, mixed feeding rate, exclusive artificial milk feeding rate and ever breastfed rate at 1st week after birth and every months of age from the first to sixth months and assessed the changes of them during recent 6-year (2007-2012) in Korea. RESULTS: During the recent 6-year (2007-2012), the means of exclusive breastfeeding rates from the birth to 6th month in age were 34% for 1 week, 38% for 1 month, 42% for 2 months, 39% for 3 months, 33% for 4 months, 27% for 5 months and 25% for 6 months. The exclusive breastfeeding rate had been increased at 1 week, 1 month, 4 to 6 months aged infants during the recent 6-year. The mixed feeding rate had not been changed significantly and the exclusive artificial milk feeding rate had been decreased. Also, ever breastfed rate had been increased at 1 week to 2 months aged infants and had not been changed significantly at 4 to 6 months aged infants. CONCLUSION: The young infant's breastfeeding rate in Korea had been increased in recent 6-year from 2007 to 2012 and should be further increased.

Recent concepts on vitamin D in children and adolescents / 소아과

Vitamin D is an important fat-soluble vitamin that functions as a prohormone and affects bone mineralization and calcium homeostasis. Vitamin D deficiency causesboth musculoskeletal manifestations, including rickets, and extra-musculoskeletal symptoms. Because vitamin D is naturally present in only some foods, intake of daily foods cannot meet the dietary reference intake for vitamin D. Sunlight is the main source of vitamin D in humans therefore, the lack of sunlight can easily cause vitamin D deficiency in children and adolescents. Vitamin D deficiency can be diagnosed on the basis ofits typical clinical manifestation, laboratory tests, and radiologic findings. Detection of vitamin D deficiency in children or adolescents necessitates the simultaneous administration of vitamin D and calcium supplements. To prevent vitamin D deficiency, 200 IU of daily vitamin D intake is recommended in infants, and 400 IU of daily vitamin D intake is recommended in Korean children and adolescents.

Assessment of modifiable lifestyle factors for obese children and adolescents through questionnaires / 소아과

PURPOSE: The identification of specific behaviors conducive to overeating or inactivity is the cornerstone of obesity management. The Committee on Nutrition of the Korean Pediatric Society developed parent and self-reporting questionnaires about eating behavior and physical activity in 2006. The aim of this study was to evaluate the usefulness of the questionnaires in assessing modifiable lifestyle factors related to obesity. METHODS: A retrospective chart review was performed for 177 children (6-11 years old) and 134 adolescents (12-16 years old) from 10 hospitals between May 2006 and January 2007 who had completed parent or self-reporting questionnaires. Cases were divided into normal and overweight groups at or above the age-gender-specific 85th percentile based on 2007 Korean national growth charts. RESULTS: Compared to children, the adolescents tended to have a significantly more sedentary lifestvle and inappropriate dietary behaviors significantly (P<.05). Overweight mothers were significantly associated with overweight children and adolescents (P<.05). Being overweight was significantly associated with a family history of adult diseases for children and adolescents (P<.05). Inappropriate eating behaviors (strong appetite, eating fast, eating until they were full, binge eating, favoring greasy foods) were associated with being overweight in children and adolescents. Sedentary activity such as TV viewing and using a computer were significantly associated with overweight in children and adolescents (P<.05). CONCLUSION: Intervention to modify obesity-related lifestyle factors is needed before adolescence. These questionnaires are useful in identifying modifiable lifestyle factors and in individual counseling for overweight children and adolescents in pediatric clinics.

The usefulness of skin test in evaluation of immunity to varicella / 소아과

PURPOSE: The aim of this study is to assess the usefulness of skin test by an inactivated, 1/50 diluted solution of attenuated varicella vaccine in evaluating the immune status to varicella. METHODS: Total 41 subjects (22 males, 19 females, aged 1-32 years) were enrolled from July to August, 2005. Past medical history including varicella infection, varicella vaccination were investigated through questionnaires. The skin test solution was prepared from solution of attenuated varicella vaccine(Oka strain) which was inactivated by exposure to room temperature for 10 days and diluted at 1/50 with normal saline. Skin test was done by injecting 0.1 mL of the solution intradermally into the volar surface of the right forearm and sterile normal saline was used as a control on the left forearm. Positive reaction was defined when the transverse diameter of the induration was 5 mm or more. Serum varicella zoster virus specific IgG antibody test by ELISA (enzyme-linked immunosorbent assay) was done. RESULTS: In adults, the sensitivity of the varicella zoster virus skin test compared to ELISA was 94.7% and the positive predictive value was 100%. In children, both the positive predictive value and specificity were 100% but the sensitivity and the negative predictive value were 50% and 30.7% respectively. Children showed smaller skin test reactivity compared to adults. CONCLUSION: The varicella zoster virus skin test using inactivated, 1/50 diluted solution of attenuated varicella vaccine was proved as one of the useful tools for evaluating the immunity and susceptibility of the varicella zoster virus.

The Prevalence of Metabolic Syndrome in Children and Adolescents Born Small for Gestational Age / 대한소아내분비학회지

PURPOSE: Type 2 diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, called metabolic syndrome (MS), occur more frequently among individuals who were born small for gestational age (SGA). SGA children with catch-up growth in height and high BMI are the most insulin resistant. We investigated the prevalence of MS and evaluated the risk factors affecting the development of MS in children and adolescents born SGA. METHODS: The study population (n=65) were born less than 10th percentile in body weight for their gestational age and the body weights of the control group (n=34) were more than 10th percentile at birth. The SGA and control subjects divided into prepubertal and pubertal groups. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin glucose ratio and quantitative insulin sensitivity check index. RESULTS: Systolic blood pressure was significantly higher in the pubertal SGA group than in the control group (113.2+/-0.3 vs. 98.7+/-6.4, P=0.001). The prevalence of high triglyceride and high fasting glucose levels were significantly increased in pubertal SGA group than prepubertal SGA group (P<0.05). Insulin resistance was correlated to systolic blood pressure, triglyceride levels, HDL-cholesterol levels, fasting glucose, insulin levels at fasting and 2 hours after oral glucose tolerance test and body fat mass in SGA group (P<0.05). CONCLUSION: We suggest that the monitoring of these risk factors including systolic blood pressure, triglyceride, HDL-cholesterol levels and body fat mass is important for the prevention of MS in children and adolescents born SGA.

A Case of Intussusception Diagnosed by Exploratory Laparotomy in a Very Low Birth Weight Infant

Intussusception is the most common cause of intestinal obstruction between 5 month and 11 month of age. However, it is very rare in neonatal period and only 1% incidence was reported. It is exceedingly rare among preterm infants and the signs are similar to those of necrotizing enterocolitis (NEC). So the time from onset of symptoms to diagnosis may be prolonged. The authors report a case of intussusception in very low birth weight infant born at 28 weeks of gestation diagnosed after exploratory laparotomy.

Utility of Streptococcal Rapid Antigen Detection Test in Children with Acute Pharyngitis / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to evaluate the utility of rapid antigen detection test for group A streptococci in children with acute pharyngitis. METHODS: Seventy children with acute pharyngitis enrolled the study, who visited the Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym Medical Center from September 2004 to August 2005. The presence of clinical features such as tonsillar exudates, fever, scarletiniform rash and previous antibiotic use were evaluated and throat swab culture, rapid antigen detection test for group A Streptococci, CBC, ASO, and CRP were performed. RESULTS: Among 70 children with acute pharyngitis, the prevalence of group A beta-hemolytic Streptococcus by throat swab culture and rapid antigen detection test was 14(20.0 %) and 22(31.4%), respectively. The sensitivity of the rapid antigen detection test was 78.6 %, specificity was 80.4%, the positive predictive value was 50.0% and the negative predictive value was 93.8%. The positivity of the throat swab culture and rapid antigen detection test showed no signigicant differences according to the presence of the clinical symptoms except scarletiniform rash. Laboratory data such as CBC, ASO or CRP proved not valuable to predict the positivity of the throat swab culture and/or rapid antigen detection test for group A Streptococcus. There was a tendency of negative throat swab culture and positive rapid antigen detection test in cases of previous antibiotic use. CONCLUSION: The rapid antigen detection test can be a useful diagnostic tool for early detection of the group A Streptococcus in children with acute pharyngitis and can be helpful for the clinician to reduce the inappropriate use of antibiotics.

Successful Treatment of Candida albicans Endocarditis with Liposomal Amphotericin B (AmBisome(R)) in a Very Low Birth Weight Infant

Candida albicans endocarditis is an uncommon manifestation of systemic candidiasis in newborn infants who require intensive care and develops mostly in patients with congenital heart disease; open heart surgery is the majority of predisposing factor. Improvement of techniques managing premature infants leads to increased survival rates, which give much more chances to develop fungal infections and its complications. We report a case of very low birth weight infant who had candidemia and Candida endocarditis, who was successfully treated with AmBisome(R) because of no response to conventional amphotericin B therapy.

The Changes of Intestinal Normal Flora in Neonates for Seven Days Postnatally / 대한소아소화기영양학회지

PURPOSE: Microbial colonization of the intestine begins just after birth and development of the normal flora is a gradual process. The first bacteria colonizing the intestine in newborns are Staphylococcus, Enterobacteriaceae and Streptococcus. For several days after birth, the number of Bifidobacterium spp. increase. The aim of this study was to investigate the changes of microflora for seven days postnatally in neonatal stool. METHODS: Fifteen neonates (breast : formula : mixed feeding 1 : 8 : 6, vaginal delivery : cesarean section 3 : 12) who were born at the Kangdong Sacred Heart Hospital, Hallym University were enrolled. First meconium and stools of postnatal 1-, 3-, and 7-day were innoculated. Blood agar plates for total aerobes, trypton bile X-glucuronide agar for E. coli, phenylethyl alcohol agar for gram positive anaerobes, MRS agar for Lactobacillus spp., bifidobacterium selective agar for Bifidobacterium spp. and cefoxitin-cycloserine-fructose agar for Clostridium difficile were used in the general incubator (CO2 free incubator), CO2 incubator or the anaerobic chamber for 48 or 72 hours at 37oC and then colony forming units were counted. RESULTS: No microflora was identified in the first meconium. Total aerobes, E. coli, and gram positive anaerobes were significantly increased with advancing postnatal days. In only one baby, Lactobacillus acidophilus was detected 2x105 CFU/g in the seven-day stool. Bifidobacterium spp. was detected in two babies. Clostridium difficile was not detected during the seven days. There were no significant differences in the bowel flora depending on the delivery pattern and feeding method. CONCLUSION: This study shows many changes in the intestinal normal flora in neonatal stool during seven days postnatally. If these findings are confirmed with larger studies, the data may be preliminary findings to support use of probiotics in neonates.

A Case of Overlap Syndrome with Auoimmune Hepatitis and Cholangiopathy in a Child / 대한소아소화기영양학회지

Although autoimmune liver diseases are common in Western countries, only sporadic cases have been reported in Korean children. Autoimmune hepatitis, primary biliary cirrhosis, autoimmune cholangiopathy and primary sclerosing cholangitis are major classes of liver diseases currently considered autoimmune. The overlap syndrome has features associated with both autoimmune hepatitis and other liver diseases. We treated a case of the overlap syndrome that included auoimmune hepatitis and cholangiopathy in a 12 year-old boy. Considering that these entities, autoimmune liver diseases or overlap syndromes, are potentially treatable diseases in children, a high index of suspicion is needed for the appropriate diagnosis.

Chromosome 7q Deletion Syndrome 46, XX, del(7)(q34) with Hydronephrosis

Chromosome 7q deletion, relatively rare syndrome, was first described by de Grouchy in 1969. The most frequent clinical manifestations of a "7q deletion syndrome" include; low birth weight, postnatal growth retardation, mental retardation, developmental delay, microcephaly, congenital heart disease, hypotonia, bulbous nasal tip and abnormal ears. We report a case of 7q deletion syndrome with microcephaly, upslanting palpabral fissure, micrognathia, bulbous nasal tip, developmental delay and hydronephrosis.

Etiology and Management of Acute Diarrhea in Children / 소아과

No abstract available.

A Case of Adenomyoma of the Stomach in a Child Presenting Epigastric Pain / 대한소아소화기영양학회지

Adenomyomas of the stomach are rare tumors characterised by duct/gland-like structures embedded within a smooth muscle stroma. A 5-year-old female patient was admitted to the department of Pediatrics, Ewha Womans University MokDong Hospital with the history of severe epigastric pain and vomiting for 1 day. Esophagogastroduodenoscopy showed bridging fold with central dimpling on posterior wall of prepyloric antrum. Endoscopic biopsy was nondiagnostic. The patient complained epigastric pain continuously and underwent wedge resection. Pathologic examination showed an adenomyoma of the prepyloric antrum. After wedge resection, the patient did not complain epigastric pain during the postoperative follow-up. We report an unusual case of an adenomyoma of stomach.

The Utility of Serum Prealbumin as a Biochemical Marker for Nutritional Adequacy in Neonates

PURPOSE: The purpose of this study was to determine the utility of serum prealbumin as a biochemical marker for nutritional adequacy in neonates. METHODS: From March 1998 to May 1999, 71 fullterm (54 AGA, 9 LGA, 8 SGA) and 46 preterm neonates were enrolled. The correlations among prealbumin, albumin, birth weight and gestational age were obtained. Serum concentrations of albumin and prealbumin according to calory and protein intake were also serially measured in 30 fullterm and 29 preterm neonates on days 0, 3 and 7 of life. RESULTS: Serum prealbumin concentrations at birth were 10.2+/-2.6mg/dL in fullterm AGA, 12.1+/-3.3mg/dL in fullterm LGA, 8.3+/-1.2mg/dL in fullterm SGA and 8.8+/-2.4mg/dL in preterm neonates. Serum prealbumin concentration was significantly correlated with birth weight, gestational age and serum albumin level (P<0.01). In the neonates, prealbumin concentrations on day 3 of life were significantly lower than initial concentrations, and then they rised on the day 7 of life (P< 0.05). Serial serum prealbumin level was significantly correlated with body weight, calory intake and protein intake (P<0.01). When caloric and protein intakes were higher than 100kcal/kg/d and 2g/kg/d, respectively, there were significant differences in the changes of prealbumin concentrations on days 0, 3, and 7 of life, compared with those in neonates with lower intake. CONCLUSION: Serum prealbumin concentration could be used in the early recognition of changes in nutritional state in neonates.

A Case of Intestinal Tuberculosis Diagnosed by Colonoscopy / 대한소아소화기영양학회지

Childhood intestinal tuberculosis is difficult to diagnose for its protean clinical manifestations, especially in cases without pulmonary involvement. Differential diagnosis with Crohn's disease, inflammatory bowel disease and other malignancy is also important. Surgery has often been required for pathologic confirmation or therapy. Colonoscopy may be performed safely under consciousness sedation in children for bacteriologic and histopathologic confirmation of the biopsy specimen in addition to gross appearance of the lesion. We have experienced a case of intestinal tuberculosis presenting with chronic abdominal pain, diarrhea, weight loss and anemia in a 9 year old girl who was diagnosed by a colonoscopic examination and culture of the biopsy specimen from the ascending colon. The patient was managed with antituberculous drugs and recovered uneventfully.