Newly Developed Sex-Specific Z Score Model for Coronary Artery Diameter in a Pediatric Population

Background@#This study aimed to generate a Z score calculation model for coronary artery diameter of normal children and adolescents to be adopted as the standard calculation method with consensus in clinical practice. @*Methods@#This study was a retrospective, multicenter study that collected data from multiple institutions across South Korea. Data were analyzed to determine the model that best fit the relationship between the diameter of coronary arteries and independent demographic parameters. Linear, power, logarithmic, exponential, and square root polynomial models were tested for best fit. @*Results@#Data of 2,030 subjects were collected from 16 institutions. Separate calculation models for each sex were developed because the impact of demographic variables on the diameter of coronary arteries differs according to sex. The final model was the polynomial formula with an exponential relationship between the diameter of coronary arteries and body surface area using the DuBois formula. @*Conclusion@#A new coronary artery diameter Z score model was developed and is anticipated to be applicable in clinical practice. The new model will help establish a consensus-based Z score model.

Primary Cardiac Hemangioendothelioma in an Infant: A Case Report / 임상소아혈액종양

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.

Depression and Fear about Maturation in Girls with Precocious Puberty and Depression and Anxiety in Their Mothers

PURPOSE: This study investigated depression and anxiety in girls with precocious puberty and in their mothers. METHOD: This study recruited 75 girls treated with a gonadotropin-releasing hormone agonist (GnRHa) and their mothers from October 2017 to April 2018. The girls completed the Korean Children's Depression Inventory (K-CDI) and Maturity Fear Scale (MFS), and their mothers were surveyed with the Korean Beck Depression Inventory (K-BDI) and Korean Beck Anxiety Inventory (K-BAI). RESULTS: The K-BDI scores showed statistically significant differences according to girl's age (p < 0.016) and household income (p < 0.037). The anxiety scores showed statistically significant differences according to girls' Body Mass Index (BMI) (p < 0.029) and household income (p < 0.005). There was a positive correlation between depression in girls and mothers (r=0.264, p < 0.050). CONCLUSION: Our findings suggest a need for understanding and counseling for depression in both girls??and their mothers during the process of diagnosis and treatment for precocious puberty.

Risk Factors of Readmission to Hospital for Pneumonia in Children

PURPOSE: We analyzed the risk factors affecting readmission of children with pneumonia. METHODS: We retrospectively analyzed the medical records of pediatric patients admitted to the Department of Pediatrics at the Jeonju Presbyterian Medical Center from January 2007 to August 2016. We classified patients who were readmitted with pneumonia within 30 days of discharge as the readmission group and patients who were admitted with pneumonia for the first time as the first admission group. RESULTS: Among 158 patients, the study (readmission) group included 82 patients and the control (first admission) group included 76 patients. Age, the percentage of segmented neutrophils and lymphocytes, the number of admissions in the last 12 months, the associated diseases (respiratory diseases such as asthma), and the affection of the right upper lung were analyzed as risk factors for readmission. However, based on a regression analysis, only age and associated diseases were found to be significant risk factors. The rate of readmission increased with younger age. When there were associated diseases, the rate of readmission also increased. CONCLUSIONS: Young age and associated diseases were significant risk factors for readmission for patients with pediatric pneumonia. When pediatric patients are admitted with pneumonia, if they are young and/or have associated diseases, a comprehensive approach is needed to reduce the rate of readmission with careful consideration of precise examination, treatment, timing of discharge, and follow-up.

Risk Factors of Readmission to Hospital for Pneumonia in Children

PURPOSE: We analyzed the risk factors affecting readmission of children with pneumonia. METHODS: We retrospectively analyzed the medical records of pediatric patients admitted to the Department of Pediatrics at the Jeonju Presbyterian Medical Center from January 2007 to August 2016. We classified patients who were readmitted with pneumonia within 30 days of discharge as the readmission group and patients who were admitted with pneumonia for the first time as the first admission group. RESULTS: Among 158 patients, the study (readmission) group included 82 patients and the control (first admission) group included 76 patients. Age, the percentage of segmented neutrophils and lymphocytes, the number of admissions in the last 12 months, the associated diseases (respiratory diseases such as asthma), and the affection of the right upper lung were analyzed as risk factors for readmission. However, based on a regression analysis, only age and associated diseases were found to be significant risk factors. The rate of readmission increased with younger age. When there were associated diseases, the rate of readmission also increased. CONCLUSIONS: Young age and associated diseases were significant risk factors for readmission for patients with pediatric pneumonia. When pediatric patients are admitted with pneumonia, if they are young and/or have associated diseases, a comprehensive approach is needed to reduce the rate of readmission with careful consideration of precise examination, treatment, timing of discharge, and follow-up.

Predictors of High-grade Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections

PURPOSE: This study aimed to investigate clinical and radiological factors that may predict high-grade vesicoureteral reflux (VUR) in patients with febrile urinary tract infection (UTI). METHODS: We retrospectively analyzed medical records of 446 patients diagnosed with febrile UTI from March 2008 to February 2017. All patients underwent renal-bladder ultrasonography (RBUS), 99mTc dimercaptosuccinic acid (DMSA) renal scan, and voiding cystourethrography (VCUG), and were divided in to 3 groups: a high-grade VUR group (n=53), a low-grade VUR group (n=28), and a group without VUR (n=365). RESULTS: The recurrence and non-Escherichia coli infection rates in febrile UTI were significantly higher in the high-grade VUR group than in the other two groups (P<0.05). RBUS showed that hydronephrosis and ureter dilatation were more frequent in the high-grade VUR group than in the other groups (P<0.05). In the high-grade VUR group, a renal cortical defect was more likely to appear as multiple defects, and the difference in bilateral renal scan uptake between both kidneys was larger than in the other two groups (P<0.001). CONCLUSION: Recurrent UTI, non-E. coli UTI, abnormal findings on RBUS such as hydronephrosis and ureter dilatation, and abnormal findings in the DMSA renal scan such as multiple renal cortical defects and greater uptake difference were associated with high-grade VUR. VCUG should be selectively performed when RBUS and/or DMSA renal scan reveal significant abnormalities.

Predictors of High-grade Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections

PURPOSE: This study aimed to investigate clinical and radiological factors that may predict high-grade vesicoureteral reflux (VUR) in patients with febrile urinary tract infection (UTI). METHODS: We retrospectively analyzed medical records of 446 patients diagnosed with febrile UTI from March 2008 to February 2017. All patients underwent renal-bladder ultrasonography (RBUS), 99mTc dimercaptosuccinic acid (DMSA) renal scan, and voiding cystourethrography (VCUG), and were divided in to 3 groups: a high-grade VUR group (n=53), a low-grade VUR group (n=28), and a group without VUR (n=365). RESULTS: The recurrence and non-Escherichia coli infection rates in febrile UTI were significantly higher in the high-grade VUR group than in the other two groups (P<0.05). RBUS showed that hydronephrosis and ureter dilatation were more frequent in the high-grade VUR group than in the other groups (P<0.05). In the high-grade VUR group, a renal cortical defect was more likely to appear as multiple defects, and the difference in bilateral renal scan uptake between both kidneys was larger than in the other two groups (P<0.001). CONCLUSION: Recurrent UTI, non-E. coli UTI, abnormal findings on RBUS such as hydronephrosis and ureter dilatation, and abnormal findings in the DMSA renal scan such as multiple renal cortical defects and greater uptake difference were associated with high-grade VUR. VCUG should be selectively performed when RBUS and/or DMSA renal scan reveal significant abnormalities.

Long Term Follow-up Study of Patients with Kawasaki Disease

PURPOSE: To investigate the long-term prognosis of patients with Kawasaki disease in Korea, and discuss the need for long-term follow-up. METHODS: The subjects were 48 patients among 354 who had been hospitalized due to Kawasaki disease, and who consented to echocardiography and exercise challenge testing. The mean duration from the onset of disease to follow-up testing after rehospitalization was 11.6 years (8.2-17.0). Patients without coronary artery aneurysms at the initial presentation of the disease were classified in group 1, and patients with small aneurysms were in group 2. Test abnormalities and differences between the two groups were analyzed. RESULT: There were no significant differences in the results of follow-up echocardiography and exercise challenge testing between the two groups. Although no abnormal findings were noted at follow-up in most patients, a 9-year-old boy in group 2 showed coronary artery dilation. The exercise test indicated normal results in both groups, and echocardiography results were also normal in 100% of cases in group 1 and 93.3% of cases in group 2. CONCLUSIONS: As some patients with coronary aneurysms showed coronary artery dilation, we believe that long-term follow-up may be selectively required in patients with coronary artery complications.

A 3-year-old girl with Graves' disease with literature review

Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3) and free thyroxine (free T4) were normal, whereas that of thyroid-stimulating hormone (TSH) was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.

A Case of Neonatal Dual Ectopic Thyroid Glands with Congenital Hypothyroidism

An ectopic thyroid occurs when thyroid tissue has not properly migrated from the foramen cecum to the fourth tracheal ring along the midline of the ventral portion of the neck, but instead is located elsewhere. There are some cases of dual-site ectopic thyroid glands, usually involving adolescents or adults. Cases of neonatal dual ectopic thyroid glands are even rarer. We report a case of a dual ectopic thyroid with congenital hypothyroidism found during a neonatal screening of the lingual and upper cervical regions of a patient . The patient had no airway obstruction symptoms, such as dysphagia or grunting. The thyroxine (T4) level was 2.49 microg/dL (normal value: 6.2-22.0 microg/dL) and the thyroid-stimulating hormone (TSH) level was 217.85 microIU/mL (normal value: 1.7-9.1 microIU/mL). A dual ectopic thyroid was diagnosed based on a Tc-99m thyroid scan. After receiving thyroid hormone replacement therapy, the child has developed normally.

Thyroid Dysfunction in Obese Children in Jeonju, Korea

PURPOSE: The aim of this study was to evaluate thyroid dysfunction in obese children in Korea. METHOD: We measured body mass index and thyroid hormone in obese, overweight, and normal weight children who visited a pediatric clinic in Jeonju, Korea, from January 2009 to September 2012. RESULTS: The free thyroxoine (FT4) level of the obese group (16.35 +/- 2.79 pmol/L) was lower than levels of the overweight (17.65 +/- 2.31 pmol/L) and normal weight (17.28 +/- 2.35 pmol/L; P=0.012) groups. The average value of FT4 in severely obese children (15.71 +/- 1.68 pmol/L) was lower than those of mildly and moderately obese children (16.40 +/- 2.88 pmol/L). We found no significant difference in thyroid stimulating hormone level between the obese group and normal weight group. CONCLUSION: The FT4 level is lower in obese children than in normal weight children.

Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program

BACKGROUND: Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes. METHODS: Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program ( or =3 years [> or =3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint. RESULTS: The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the or =3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol). CONCLUSION: Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

Associated Symptoms of Kawasaki Disease

BACKGROUND AND OBJECTIVES: In addition to diagnostic criteria, a broad range of nonspecific clinical features can be found in patients with Kawasaki disease. This lack of specificity may cause confusion with other febrile illnesses and delay the diagnosis of Kawasaki disease. The purpose of this study is to describe common associated symptoms and their clinical significances in children affected with Kawasaki disease. SUBJECTS AND METHODS: As a retrospective study, we reviewed the medical records of 121 children who were treated for Kawasaki disease at Presbyterian medical center from January 2005 to June 2010. All clinical symptoms, laboratory data and echocardiographic findings in patients with KD were collected and analyzed. RESULTS: We found that there are 9 associated symptoms, namely cough, rhinorrhea, sputum, abdominal pain, vomiting, diarrhea, arthralgia, headache and seizure, which occur in patients with Kawasaki disease. Among the study group, there were only 32 children with no associated symptoms (26.4%). Patients with abdominal pain and headache had an older mean age than those without such symptoms. The incidence of seizure was significantly higher in incomplete Kawasaki disease patients compared with those with complete Kawasaki disease. Vomiting was highly associated with IVIG non-responder group. CONCLUSION: To decrease the incidence of serious coronary complications due to delayed diagnosis, physicians need to be aware of the manifestations of Kawasaki disease and the possibility of associated symptoms, which, being unspecific, may otherwise not raise any red flags.

A Case of Esophageal Candidiasis in a Healthy Child / 대한소아소화기영양학회지

Esophageal candidiasis is an opportunistic infection, often reported in patients who have acquired immune deficiency syndrome (AIDS), a neoplastic disease, or undergoing protracted antibiotic therapy. Impaired cell mediated immunity was often considered as the major predisposing factor in patients of esophageal mucosal colonization of Candida spp. However, it is increasingly reported that the occurrence of esophageal candidiasis with no underlying disease or immune suppression. We have experienced a case of esophageal candidiasis in a 15-year-old girl who was immunologically normal and have no underlying disease and whose main symptoms were epigastric and retrosternal pain with dysphagia. This case suggests the possibilities of candidal infections in children without predisposing factors such as immune compromised conditions, so it will be needed to differentiate the esophageal candidiasis among healthy children with symptoms of odynophagia and dysphagia.

Risk Factors of Nosocomial Rotavirus Infections in Children / 소아과

PURPOSE: Rotavirus is one of the most important causes of nosocomial infections among children. The aim of this study is to determine the risk of nosocomial rotavirus infections and to evaluate the effectiveness of breast-feeding and probiotics in the prevention of nosocomial rotavirus infections. METHODS: This study was carried out on admitted children without diarrhea between March 1, 2003 and February 29, 2004. Three hundred ninety patients aged 4 days to 13 years during this study were available. We examined the feces of all children for rotavirus by latex agglutination on admission, during hospital, and after discharge, to see whether they developed diarrhea or not. RESULTS: Nosocomial rotavirus infections was significantly increased with children under 12 months of age(P=0.008). The monthly attack rate was great between December and March(P=0.046). Prolonged hospital stay was associated with an increased attack rate of nosocomial rotavirus infections (P=0.003). The risk of nosocomial rotavirus infections was not associated with the number of roommates and whether or not they were breast-fed or fed on probiotics. CONCLUSION: Nosocomial rotavirus infections are significantly more likely to occur in children under 12 months of age, admitted between December and March, and with prolonged hospital stays. Prompt identification and isolation of children with nosocomial rotavirus infections, even without diarrhea, may decrease rates of nosocomial rotavirus infections.

Spontaneously Resolved Neonatal Hemochromatosis

Neonatal hemochromatosis is a very rare disorder with an unclear etiology with an extremely poor outcome. We report a case of female newborn who presented with direct hyperbilirubinemia without any evidence of congenital infection, immune related hemolysis or exogenous iron uptake. Diagnostic studies revealed highly elevated ferritin level. T2 weighted image of abdominal Magnetic Resonance Imaging (MRI) showed decreased signal intensity of entire left lobe and a part of right lobe of liver with normal spleen. Liver biopsy showed a large amount of hemosiderin in the hepatocytes and Kupffer cells. All the biochemical and excretory liver functions normalized with conservative managements.

The Clinical Usefulness of Serum Aminotransferase Activities for Predicting Fatty Liver in Obese Children / 대한소아소화기영양학회지

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) has been recognized as an important childhood liver disease, especially where the prevalence of childhood obesity is increasing. The purpose of this study is to clarify the usefulness of elevated serum aminotransferase activities and their ratio for predicting the presence of fatty liver and its severity in obese children. METHODS: Forty-four children (M/F 29/15, age 4 to 16 years) with obesity (weight excess>20%) were analyzed retrospectively with medical records based on degree of obesity, bioelectrical impedence, serum aminotransferase activities, lipid profiles and ultrasonography. RESULTS: 1) Ultrasonography was carried out in 34 cases. Elevated serum ALT was found in 89.7% (26/29) of the patients diagnosed as fatty liver by ultrasonography and decreased AST/ALT ratio (45 IU/L) or decreased AST/ALT ratio (0.05). 3) There was a significant correlation between total cholesterol, triglyceride and fatty liver (p<0.05). CONCLUSION: Serum ALT activity and AST/ALT ratio were useful to predict the presence of fatty liver diagnosed by ultrasonography in obese children, whereas they were not useful to predict the degree of fatty liver. Therefore, to prevent fatty liver progressing to advanced liver disease, it is necessary to manage and monitor the obese children continuously, especially those who have predicting factors of fatty liver.