NT-proBNP as a useful tool in diagnosing incomplete Kawasaki disease / 소아과

PURPOSE: To determine the efficacy of the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) as a useful diagnostic method in children with incomplete Kawasaki disease (KD). METHODS: Ninety-six patients who were diagnosed as having KD between January 2008 and June 2009 were enrolled in the study. American Heart Association recommendations for diagnosis were used, and patients were divided into the complete KD and incomplete KD groups. Blood tests including NT-proBNP were performed on admission day. Nineteen patients who had other febrile diseases other than KD were enrolled as control. RESULTS: Thirty-three patients (34%) had incomplete KD. Change in the lips and oral cavity and conjunctivitis were the most common clinical features, but their frequency was lower than complete KD (76% vs 98%, 76% vs 90%). Patients with incomplete KD exhibited significantly higher NT-proBNP level than that of control (1,407.7+/-1633.5 pg/mL vs 126.2+/-135.5 pg/mL, p<0.001). An NT-proBNP cutoff value of 158 pg/mL provided a sensitivity of 81% and a specificity of 74% for diagnosis of incomplete KD. CONCLUSION: NT-proBNP assay can be clinically useful for the diagnosis of incomplete KD, if the patient has persistent fever, change in the lips and oral cavity, and conjunctivitis, and if the patient with those symptoms is suspected to have incomplete KD.

Clinical feature of neonatal pneumothorax induced by respiratory distress syndrome and pneumonia / 소아과

PURPOSE: Pneumothorax is an important factor responsible for increased mortality and morbidity in neonates. Here, we compared the clinical findings and prognosis for neonatal pneumothorax induced by respiratory distress syndrome (RDS) and pneumonia. METHODS: Between January 2001 and December 2005, 80 patients with neonatal pneumothorax induced by RDS and pneumonia and admitted to the NICU of Dongsan Medical Center, Keimyung University, were enrolled. They were assigned to the RDS group (30 cases) or the pneumonia group (50 cases). Admission records for gestational age, onset day of life, rate of ventilatory care and thoracostomy, and prognosis were retrospectively reviewed and statistically analyzed for both groups. RESULTS: The mean gestation age was significantly shorter in the RDS group (32.3 weeks) than in the pneumonia group (38.1 weeks) (P0.5) and the RDS group itself (OR 1.70, 95% CI: 0.52-5.54, P>0.3) did not increase mortality rates significantly. CONCLUSION: Our study suggests that neonatal pneumothorax in the RDS group tends to have a later onset, higher mortality rate, and needs a higher rate of thoracostomy than the pneumonia group. However, after logistic analysis, only preterm significantly and independently increased the mortality rate.

Clinical findings of severe amniotic fluid aspiration pneumonia and effects of surfactant replacement therapy / 소아과

PURPOSE: Severe aspiration of the amniotic fluid is known to cause fatal respiratory distress in neonates. We conducted this study to investigate the clinical findings of severe amniotic fluid aspiration pneumonia (AFAP) in neonates and the effect of pulmonary surfactant replacement therapy (SRT). METHODS: Retrospective analysis of medical records was conducted on 28 patients who received ventilator care due to severe AFAP in a neonatal intensive care unit over a 7-year period (2000-2006). Patients whose amniotic fluid was contaminated with meconium were excluded. RESULTS: A large number of cases were term infants (82.1%) and infants born by caesarean section (85.7%), and the 1- and 5-min Apgar scores of these patients were 6.5+/-1.2 and 7.5+/-1.3, respectively. Soon after birth, the amount of amniotic fluid sucked out from airway below the vocal cord was 16.0+/-10.1 mL. All patients received SRT with a modified bovine-derived surfactant (120 mg/kg/dose), and one dose was administered in most cases (75%). Compared with pre-SRT, the oxygenation index (8.0+/-9.6 vs. 18.9+/-7.3) according to ventilator care was a significant improvement at 12 h after SRT (P<0.001). Furthermore, most cases showed radiological improvement for aeration at 12 h post-treatment. Many cases (46.4%) had cardiorespiratory complications, but their final outcomes were excellent (survival rate, 96.4%). CONCLUSION: AFAP may be an important cause of serious respiratory distress in near-term and term infants, and SRT seems to be an effective adjuvant therapy in mechanically ventilated neonates with severe AFAP.

Changes in N-terminal pro-B-type natriuretic peptide in a neonate with symptomatic isolated left ventricular noncompaction / 소아과

We describe here our experience with a neonate presenting with cyanosis, grunting, and cardiome galy, who was diagnosed with isolated left ventricular noncompaction (IVNC) by echocardiography. The patient had high levels of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and symptoms of heart failure including poor feeding and tachypnea. During the period in which NT pro-BNP levels steadily increased, the patient suffered sudden cardiac arrest despite heart failure management. Following cardiopulmonary resuscitation, cardiac arrest was resolved, NT pro-BNP levels decreased, and all symptoms showed improvement. We consider that assessment of NT pro-BNP with cardiac functional analysis using echocardiography could help in the prediction of disease progress in IVNC.

Cardiovascular Malformation Diagnosed by Echocardiography in Neonates of Diabetic Mothers / 대한주산의학회잡지

PURPOSE: This study was undertaken to investigate the spectrum and the prognosis of neonate with cardiovascular malformation delivered from diabetic mothers. METHODS: From January 2004 to December 2008, 70 neonates born to diabetic mothers who were delivered at Dongsan Medical Center, Keimyung University, and received echocardiographic study between 3rd and 14th days of life to identify the presence of cardiac anomaly were included. Cases combined with chromosomal anomaly were excluded. And follow up results (rate of cardiac operation and mortality) were assessed. RESULTS: Among 67 neonates, 22 cases (32.8%) had combined cardiovascular malformation. They were interventricular septal hypertrophy (10 cases), atrial septal defect (7 cases), significant patent ductus arteriosus (5 cases), ventricular septal defect (2 cases) and tetralogy of Fallot (1 case). Among them, 20 neonates (29.9%) were preterm babies, and 21 neonates (31.3%) were large babies. On follow up echocardiograpic examination between 2 and 12 months of life, all but 2 infants (received cardiac operation due to VSD or Tetralogy of Fallot) was improved spontaneously. And combined extracardiac anomalies were tracheoesophageal fistula (2 cases), imperforated anus (1 case) and corpus callosum agenesis (1 case). Only one preterm baby was dead due to necrotizing enterocolitis, but did not have cardiac disease. CONCLUSION: Pre-existing maternal diabetes was associated with the development of neonatal cardiac anomalies, but the prognosis was good in this study.

Epidemiologic study of Kawasaki disease in 6 months old and younger infants / 소아과

PURPOSE: The aim of this study was to investigate the epidemiologic status of Kawasaki disease (KD) in infants 6 months of age. RESULTS: A total of 1,739 patients 6 months old with data from 1,739 KD patients < or =6 months old showed significantly higher incidences of CA abnormalities and CA aneurysms in the younger patients.

A Case of Non-immune Hydrops Fetalis due to Congenital Syphilis

Congenital syphilis is a rare cause of non-immune hydrops fetalis. We cared for a neonate with hydrops fetalis who was delivered by emergency Cesarean section due to prolonged fetal bradycardia and ascites at 34 weeks of gestation. He had anemia, purpura, and hepatosplenomegaly, and the serologic tests revealed congenital syphilis (high titers of serum VDRL and TPHA, and a positive serum FTA-ABS IgM). He survived after aspiration of ascitic fluid, ventilator care, and intravenous penicillin therapy. We report a case of non-immune hydrops fetalis due to congenital syphilis with a brief review of literature.

Supraventricular tachycardia in a neonate with cardiac rhabdomyoma and tuberous sclerosis / 소아과

Primary tumors of the heart are uncommon among pediatric patients. Rhabdomyoma is the most frequent cardiac tumor in infants and children, which is commonly associated with tuberous sclerosis. Tuberous sclerosis is a neurocutaneous syndrome affecting the brain, heart, skin, and other organs. Cardiac rhadomyomas are reported in 50-64% of infants with tuberous sclerosis. Tuberous sclerosis involves multiple locations in the atrium, ventricle and septum, and may induce mechanical obstruction of the outflow tract and heart failure depending on the location, number, size, and degree of invasion of tumors. Arrhythmias may also develop in infants with cardiac rhadomyomas, but only a few of these patients require prolonged anti-arrhythmic therapy because arrhythmia often disappears with spontaneous regression of the tumors, and the ultimate prognosis may be decided by the cerebral manifestations.

The outcome of surfactant replacement therapy in above nearterm neonates with severe pulmonary disease / 소아과

PURPOSE: We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). METHODS: 48 patients, gestational period 36 weeks, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. RESULTS: Among each groups, mean pre-SRT OI was higher in MAP group (213.2) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) CONCLUSION: Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.

A case of recurrent hepatoblastoma: lung, heart and brain metastasis / 소아과

Hepatoblastoma is a hepatic tumor predominantly occurring in children. The usual site of metastasis is the lung. There are only several reports worldwide on the distant metastasis of hepatoblastoma to the central nervous system in children. Only one reported case showed survival of a patient after multiple resections of a recurrent brain lesion. Involvement of the cardiovascular system has been reported in the medical literature. Lesions almost always involve the right-side of the heart. We report a case of recurrent hepatoblastoma at multiple sites, including brain, left atrium of the heart and lung in a 6-year-old girl who was partially treated in the past at the age of 1.5 years; the patient had been event-free for four and a half years.

A Case of Ileao-ileal Intrauterine Intussusception in a Preterm Neonate / 대한소아소화기영양학회지

Intussusception in a preterm neonate is a very rare disorder. We experienced a case of intrauterine intussusception presented with symptoms of the small bowel obstruction in a preterm infant whose gestational age was 28(+2) weeks. Urgent ultrasonography of abdomen revealed no definite intussuscepted segment. At emergent surgery performed on the 11th days of life under the diagnosis of distal small bowel obstruction, an ileo-ileal intussusception with distal ileal atresia without perforation was found.

Clinical Features of Neonatal Candida Meningitis and Usefulness of Ultrasound Examination

BACKGROUND: Candida species are becoming one of the most common pathogens associated with nosocomial infection in the neonatal intensive care units (NICU). This study was undertaken to investigate the clinical features and radiologic findings of meningitis complicating candida sepsis in the neonates. MATERIALS AND METHODS: Seventy-two neonates with Candida sepsis admitted to the NICU of Dongsan Medical Center, Keimyung University from Jan. 1997 to Dec. 2003 were enrolled. Medical records and serial radiologic images were reviewed retrospectively performed. RESULTS: Among a total of 72 patients with candida sepsis, meningitis developed in 12 cases (17%) and C. albicans was the only causative organism. Cerebrospinal fluid (CSF) analysis:showed pleocytosis in 9 cases (75%), protein elevation and candidal isolation in 7 cases (58%) each, and hypoglycorrhachia in 3 cases (25%). Of the 66 cases that underwent serial ultrasound examination, multiple cerebral microabscess was observed in 9 cases (14%); these lesions were also found on the brain MRI taken after the end of treatment in 7 cases (78%). In 2 cases (17%) without initial abnormal CSF findings, diagnosis was made through early ultrasound examination. In limited study of 49 neonates with C. albicans sepsis, demographic characteristics and risk factors between two groups (group 1:with meningitis, group 2:without meningitis) were similar, but fever or seizure at the onset of infection was more common in group 1 (P<0.05). The mortality rate was also higher in group 1, but it was not statistically significant. CONCLUSIONS: Candida meningitis is common in neonates with C. albicans sepsis and findings of CSF study were variable. Therefore, serial ultrasound examination may be of help in making correct diagnosis of central nervous system involvement.

Clinical Features of Neonatal Candida Meningitis and Usefulness of Ultrasound Examination

BACKGROUND: Candida species are becoming one of the most common pathogens associated with nosocomial infection in the neonatal intensive care units (NICU). This study was undertaken to investigate the clinical features and radiologic findings of meningitis complicating candida sepsis in the neonates. MATERIALS AND METHODS: Seventy-two neonates with Candida sepsis admitted to the NICU of Dongsan Medical Center, Keimyung University from Jan. 1997 to Dec. 2003 were enrolled. Medical records and serial radiologic images were reviewed retrospectively performed. RESULTS: Among a total of 72 patients with candida sepsis, meningitis developed in 12 cases (17%) and C. albicans was the only causative organism. Cerebrospinal fluid (CSF) analysis:showed pleocytosis in 9 cases (75%), protein elevation and candidal isolation in 7 cases (58%) each, and hypoglycorrhachia in 3 cases (25%). Of the 66 cases that underwent serial ultrasound examination, multiple cerebral microabscess was observed in 9 cases (14%); these lesions were also found on the brain MRI taken after the end of treatment in 7 cases (78%). In 2 cases (17%) without initial abnormal CSF findings, diagnosis was made through early ultrasound examination. In limited study of 49 neonates with C. albicans sepsis, demographic characteristics and risk factors between two groups (group 1:with meningitis, group 2:without meningitis) were similar, but fever or seizure at the onset of infection was more common in group 1 (P<0.05). The mortality rate was also higher in group 1, but it was not statistically significant. CONCLUSIONS: Candida meningitis is common in neonates with C. albicans sepsis and findings of CSF study were variable. Therefore, serial ultrasound examination may be of help in making correct diagnosis of central nervous system involvement.

Clinical and Epidemiologic Study of Kawasaki Disease in Children 8 Years of Age and Older / 소아과

PURPOSE: The aim of this study was to investigate the epidemiologic and clinical profiles of Kawasaki disease (KD) in children 8 years of age and older. METHODS: For the epidemiologic study of KD in Korea, data of total 15, 692 KD patients were collected from 1994 to 2002 on a 3 year basis, by the retrospective survey. Among them, data of 211 KD patients 8 years of age and older were analyzed and compared with those of the KD patients less than 8 years of age. RESULTS: 211 patients 8 years of age and older (1.3% of total KD patients) with the mean age of 9.8 years, included 142 cases aged 8-10 years, 42 cases aged 10-12 years, and 27 cases aged 12 years and older. The male-to-female ratio was 1.9: 1, the recurrence rate was 3.8%, and the prevalence of cases in sibling was zero. Coronary arterial (CA) abnormalities were detected by echocardiography in 25.4% of the cases, including 7.6% of CA aneurysm cases. There was 1 case complicated by myocardial infarction. CONCLUSION: Comparing with the data of the KD patients less than 8 years of age, data of 211 patients 8 years of age and older showed significantly higher incidences of CA abnormalities (25.4%: 19.8%) and CA aneurysms (7.6%: 4.0%).

A Case of Symptomatic Neonatal Trichomoniasis / 대한주산의학회잡지

Trichomoniasis is a sexually transmitted disease by Trichomonas vaginalis infection that may be associated with preterm delivery and low birth weight in the newborn infants. T. vaginalis may be transmitted to neonates during passage through an infected birth canal and neonatal infection is usually self-limiting course, but rare cases of symptomatic neonatal infection such as vaginitis, urinary tract infection and respiratory infection have been reported. We experienced a case of symptomatic neonatal trichomoniasis which was confirmed by wet mount examination of vaginal discharge and urine specimens in premature baby with intrauterine growth retardation. The patient had complete resolution of symptoms such as vaginal discharge and pyuria after treatment with ornidazole (tiberalR). We report this case with a brief review of the related literatures.

A Case of Neonatal Atrial Flutter with Tuberous Sclerosis / 대한주산의학회잡지

Atrial flutter is one of the rare diseases in neonatal period, and characterized by a regular sawtooth p waves. We experienced a case of neonatal atrial flutter who was delivered from mother with fetal tachyarrhythmia, and the neonate had multiple tuber lesions in brain and heart. Atrial flutter was successfully controlled with digoxin therapy without further relapse. Thus, we report a case neonatal atrial flutter accompanied to tuberous sclerosis with brief review of literature.

Clinical Observations of Gastrointestinal Cow Milk Allergy in Children According to a New Classification / 대한소아소화기영양학회지

PURPOSE: A new classification of gastrointestinal food allergy was published, but the changes of terminology between previously reported terms and the new ones were in a state of disorder. This has resulted in confusion between medical communication and diagnostic and therapeutic approaches. The clinical observations of infants presenting with gastrointestinal cow milk allergy (GI-CMA) were performed, and the changes in the terminology reviewed through the published Korean literature. METHODS: Between March 2003 and July 2003, data from 37 consecutive infants with GI-CMA, aged 2 weeks to 15 months, were reviewed. The challenge and elimination test of cow milk, and the endoscopic and histologic findings, were used for the seven subdivisions of GI-CMA according to a new classification on the basis of patients' ages, clinical manifestations and location of gastrointestinal lesions. RESULTS: The 37 patients had a mean age of 5.4+/-4.8 months, with those observed in 26 (70.3%) of patients being below 6 months of age. The seven final diagnoses were; cow milk protein-induced enterocolitis (CMPIE) in 12 (32.4%), cow milk protein proctitis (PROC) in 12 (32.4%), IgE-mediated (IGE) in 6 (16.2%), gastroesophageal reflux-associated cow milk allergy (GERA) in 5 (13.5%) and eosinophilic gastroenterocolitis in 2 (5.4%). CMPIE was revealed as the typical type in 7 (18.9%) and the atypical type in 5 (13.5%), and all of typical CMPIE revealed cow milk protein-induced enteropathy. The mean age at symptom onset was 4.3+/-0.8 months, and for those with typical and atypical CMPIE, and PROC and GERA were 3.8+/-4.6, 10.4+/-3.8, 3.4+/-3.9 and 7.8+/-5.7 months, respectively (p<0.05). The period from onset of symptom to diagnosis was 2.4+/-3.3 (0.5~12) months, with those observed in atypical CMPIE and GERA being over 3months. Although the birth weights in all patients were within the 10~90 percentile range, the body weights on diagnoses were below the 3 percentile in 48.6%; IGE 16.7%, EOS 0%, typical CMPIE 85.7%, atypical CMPIE 60.0%, PROC 25.0% and GERA 100% (p<0.05). Through the review of the Korean literature, 8 case reports and 14 original articles for GI-CMA were found. CONCLUSION: GI-CMA is not a rare clinical disorder and is subdivided into seven categories on the basis of the patient's age, clinical manifestations and location of the gastrointestinal lesions. The terms for GI-CMA are changing with new classifications, and careful approaches are necessary for medical communications.

Shock / 소아과

No abstract available.

Significance of Cytokine Levels in Neonates with Severe Fetal Distress

PURPOSE: To determine the relation between the initial plasma cytokine response and the neurological prognosis in term infants with severe fetal distress. METHODS: Infants with severe fetal distress at birth (n=23) were studied prospectively. Cytokine concentrations were measured from umbilical cord blood at 3 and 12 hours of life by enzyme-linked immunosorbent assays for interleukin (IL)-1beta, IL-6, and IL-18. The study groups were divided into good (n=14) or poor prognostic group (n=9) according to survival and presence of cerebral palsy (CP) later and correlations with afore mentioned cytokine levels were determined. RESULTS: Cord blood IL-1beta and IL-18 concentrations were similar in both groups. However, infants with poor prognosis had significantly higher median (range) IL-6 concentration than infants with good prognosis at 3 hours [323.6 (32.6-812.8) vs. 38.4 (6.3- 322.7) pg/mL] (P=0.001), and 12 hours of life [287.1 (16.4-769.1) vs. 66.2 (8.8-757.8) pg/mL] (P200 pg/mL) may be a useful indicator of poor neurological outcome in infants with severe fetal distress.

A Case of Weaver Syndrome / 소아과

Weaver syndrome is a very rare overgrowth syndrome with accelerated skeletal maturation, unusual facies and clinodactyly. We experienced an extremely rare case of Weaver syndrome in Korea. The clinical manifestations were macrocephaly, unusal facies, simian crease, clinodactyly, decreased muscle tone, accelerated bone age and congenital heart diseases. We report this with a brief review of related literature.