Clinical Study of Treatment of Group B Streptococcal Meningitis in Neonates / 대한소아신경학회지

PURPOSE: Penicillin or ampicillin with aminoglycoside is the drug of choice for Group B streptococcal(GBS) meningitis in neonates. Some GBS meningitis, however, does not respond well to the treatment. The purpose of this study was to evaluate the efficacy of early penicillin treatment for the GBS meningitis in neonates. METHODS: Nineteen cases of GBS meningitis which was proven by CSF culture(13 cases) or latex agglutination test(17 cases) from 1999 to 2007 were retrospectively reviewed. In all cases 3rd-generation cephalosporin was initially given with ampicillin or aminoglycoside. Penicillin was added on the initial regimen according to the CSF results. Seven cases with penicillin given within 3 days of admission(early group) were clinically compared to the other cases(late or non-penicillin group). RESULTS: Fever continued for 3 to 23 days in the early penicillin group, for 2 to 23 days in the late penicillin group, and persisted in the non-penicillin group. Time needed for negative conversion of CSF bactigen or culture, however, revealed no statistical differences in those 3 groups. Vancomycin was effective in cases with poor responses to other antibiotics. CONCLUSION: Early penicillin treatment in combination with other antibiotics seemed to shorten the fever duration in the neonatal GBS meningitis.

Predictors of Transient Hypothyroidism in Neonatal Screening Test / 대한소아내분비학회지

PURPOSE: Congenital hypothyroidism is detected through the neonatal screening test and treated early from neonatal period. Among these patients, however, transient hypothyroidism is included. In this study, we aimed to evaluate the predicting factors of transient hypothyroidism in neonatal screening test. METHODS: We retrospectively reviewed medical records of 40 male and 31 female neonates diagnosed as congenital hypothyroidism by newborn screening from 1996 to 2003. The untreated cases that revealed slightly decreased levels of thyroid hormone on repeated examination and the cases who showed normalized hormone after 2 years of treatment were regarded as transient hypothyroidism. The results of neonatal screening tests and other clinical features of children with transient hypothyroidism were compared to those of children with permanent form. The time to normalization of thyroid hormone levels in the transient hypothyroidism were also reviewed. RESULTS: Among 71 cases of congenital hypothyroidism, 39 cases (54.9%) were transient and 32 cases (45.1%) were permanent hypothyroidism. There were no significant differences in clinical features between two groups, except lower birth weight in the transient group (transient 2.80+/-0.75 kg, permanent 3.22+/-0.57 kg, P=0.02). Free T4 levels were significantly lower and TSH levels were significantly higher in the permanent form than the transient ones (P<0.01). The estimated cut-off point for distinguishing transient hypothyroidism from permanent form was 2.05 ng/dL (sensitivity 54%, specificity 93%) for free T4 and 34 microIU/mL (sensitivity 72%, specificity 87%) for TSH. CONLCUSION: In this study, transient hypothyroidism could be differentiated from permanent hypothyroidism by TSH and free T4 levels of neonatal screening test. Repeated thyroid function tests are thought to be essential to make a diagnosis of not only transient but also permanent hypothyroidism.

A Clinical Study of Benign Convulsions Associated with Acute Gastroenteritis / 대한소아신경학회지

PURPOSE: The aim of this study was to reveal detailed clinical features of benign childhood convulsions associated with acute gastroenteritis(BCAGE). METHODS: The medical records of 28 patients with BCAGE, who were admitted to the department of pediatrics, Chonnam National University Hospital between March 2000 and October 2004, were reviewed on the aspects of clinical symptoms, diagnostic tests and treatment. RESULTS: The ages of the subjects cases ranged from one to 96 months old and most of them had BCAGE in late autumn and winter seasons. Seizures were developed mostly 2 to 4 days after the symptoms of gastroenteritis appeared. Most of them showed generalized seizures which occurred repetitively during the episode of acute gastroenteritis (mean 2.7+/-0.9 times of the seizures attack), mostly 2-4 times. The duration of seizure was largely below 5 minutes, but in 2 cases it was prolonged over 15 minutes. The Rotazyme tests of stool were positive only in 3 cases(16.7%), and the cerebrospinal fluid and blood examinations revealed normal results. Either brain CT or MRI was performed in 17 patients and variable results were demonstrated. Most of them showed normal or mild brain swelling, but one showed cortical dysplasia of the frontal and parietal lobes, while another one showed cerebrospinal fluid collection in the posterior fossa. 17 patients were treated with diazepam, 12 of whom were prescribed additional phenbarbital or phenytoin. 2 patients who did not take diazepam were administered antiepileptics. Antiepileptic drugs were continuously given to 4 patients for up to one year after discharged from hospital. During follow-up periods, there occurred no further seizures in all the patients. CONCLUSION: BCAGE can be considered as a situation related seizure which does not need any long-term antiepileptic medications.

Frequency and clinical characteristics of prenatally diagnosed congenital hydronephrosis and outcomes of ureteropelvic junction stenosis / 소아과

PURPOSE: Popular use of fetal ultrasonography has increased to detect congenital hydronephrosis(CH) which is the most common anomaly prenatally detected. We'd like to determine the frequency and clinical characteristics of prenatally diagnosed CH and outcome of ureteropelvic junction stenosis(UPJS). METHODS: The records of births between January 1994 and June 2003 in Chonnam National University Hospital(CNUH), and the records of children who were diagnosed with CH in the Department of Pediatrics of CNUH during the above period, were retrospectively analyzed. In the patients with UPJS, the initial anterior posterior diameters of renal pelvis(APD) were compared between the spontaneous regression (SR) and operation group(OP). In the SR group, sequential regression rates of APD were estimated. RESULTS: Among a total 9,076 births, 231(2.54 percent) patients with 293 renal units were diagnosed as CH and 19(6.78 percent) renal units spontaneously regressed 3 days after birth. In 228 children(56 bilateral; 172 unilateral; total 284 renal units) diagnosed with CH in the department of pediatrics of CNUH, male(71.9 percent) and left kidney(69.2 percent) predilection were found and 78.1 percent of CH were caused by UPJS. The initial APD of the SR group(121 units) in UPJS was 7.8+/-6.28 mm, which was significantly smaller than the APD(26.8+/-12.14 mm) of the OP group(25 unit)(P<0.05). In the SR group, 81 percent spontaneously regressed within one year. CONCLUSIONS: In CH, male and left kidney predilection were found. UPJS was the most common cause of CH and initial APD in UPJS at 3 days of age was a good prognostic indicator. Close monitoring should be done for at least one year because most SR in UPJS regressed spontaneously within one year.

Clinical Use and Complications of Percutaneous Central Venous Catheterization in Very Low Birth Weight Infants / 소아과

PURPOSE: The administration of total parenteral nutrition (TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization (PCVC) in very low birth weight infants. METHODS: A total of 56 very low birth weight infants below 1, 500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group (n=32) included the babies who had undergone PCVC and a control group (n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. RESULTS: There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2, 000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1, 000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1, 000 to 1, 500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2, 000 g. CONCLUSION: Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

A Case of Neonatal Hypoxic Ischemic Encephalopathy caused by Amniotic Fluid Embolism / 대한주산의학회잡지

Amniotic fluid embolism, one of the leading causes of maternal death, is a rare event, however, it can cause maternal death and neonatal morbidity when it unrecognized and untreated effectively. Its pathogenesis is unclear and clinical presentations are variable without standardized means of confirming diagnosis. We experienced one case of neonatal hypoxic ischemic encephalopathy possibly due to maternal amniotic fluid embolism, which was diagnosed by brain MRI, EEG and maternal uterine pathology. We report this case with a brief review of literatures.

Changes in Incidence, Survival Rate and Morbidity of Very Low Birth Weight Infants

PURPOSE: The survival rate of very low birth weight infants(VLBWI) has improved by virtue of specialized neonatal care. This study was performed to analyze the changes in incidence, survival rate and morbidity of VLBWI who admitted to Chonnam National University Hospital from 1996 to 2001. METHODS: We enrolled 565 VLBWI, and compared the incidence and the survival rate according to the birth weight or gestational weeks between period I(1996 to 1998) and period II(1999 to 2001). The mortality rate according to the postnatal age, cause of death, morbidity and days of hospital stay were also compared. Morbidity is categorized into 'short term' which is curable until discharge, and 'long term' causing any types of sequelae after discharge. RESULTS: Incidence of VLBWI significantly increased in period II over period I(6.0% vs. 11.0%, P<0.001). The survival rate also increased in period II(71.8% vs. 80.1%, P<0.05), especially in 1,000 to 1,249 gm of birth weight(P<0.001) and in 28 to 30 weeks of gestation(P<0.001). The most common cause of death was respiratory distress syndrome in period I; however it was sepsis in period II. Although overall and short term morbidity rate increased, long term morbidity and days of hospital stay didn't increase in period II. CONCLUSION: Although the incidence of VLBWI significantly increased and the survival improved in period II compared to period I, especially in 1,000 to 1,249 gm of birth weight and 28 to 30 weeks of gestation, 'long term' morbidity rate and hospital days didn't increase.

Surgical Outcomes in Children with Intractable Temporal Lobe Epilespy:Electroencephalographic and Pathologic Findings / 대한소아신경학회지

PURPOSE: Epilepsy surgery has become increasingly available in children with medically intractable epilepsy including temporal lobe epilepsy(TLE). TLE in children, however, has many different clinical and electrophysiologic characteristics which make presurgical evaluation difficult. The aim of this study is to evaluate the electroencephalographic(EEG) features which might be one of the predictors of postsurgical seizure outcomes in TLE. METHODS: Standard EEG, video-EEG, subdural or depth EEG were investigated in 12 children who underwent anterior temporal lobectomy, and their seizure semiology, MRI, and pathologic findings were also reviewed. Postsurgical seizure outcomes were divided into favorable(class I, II) and unfavorable(class III, IV) groups by using the Engel's classification. RESULTS: Half of the patients showed favorable outcomes, whose pathologic findings revealed hippocampal sclerosis or gliosis. Such pathologic findings were not demonstrated in MRI. Interictal epileptiform discharges were concordant with the location of the ictal onset in only 2 cases of the favorable outcomes. For the other 4 cases in the favorable group, focal ictal onset patterns were clearly evident in video-EEG monitorings or invasive EEG studies. Six cases in the unfavorable group showed unlocalized or multifocal interictal or ictal discharges -extratemporal, bitemporal or generalized epileptic activities- even in the invasive EEG studies. Five of them revealed cortical dysplasia in the pathology. CONCLUSION: The postsurgical seizure outcomes of hippocampal sclerosis or gliosis were more favorable than those of cortical dysplasia. Invasive EEG recordings should be considered for the localization of epileptic foci in the presurgical evaluation of children with intractable TLE.