A Survey of Doctors' Awareness of Simultaneous Vaccination

PURPOSE: In this study, doctors were surveyed with a questionnaire to determine whether they performed simultaneous vaccination and whether there were any concerns about safety or anxiety. The purpose of this study was to determine any problems associated with doctors readily performing simultaneous vaccination. METHODS: A trained surveyor visited 241 doctors from every institution registered with the National Immunization Program (NIP) located within six districts (gu) in the City of Busan (Dongnae-gu, Geumjeong-gu, Yeonje-gu, Suyeong-gu, Busanjin-gu, Haeundae-gu); a total of 155 (64%) valid responses were obtained. RESULTS: Of the 155 respondents, 144 (93%) were already performing simultaneous immunizations and 141 (91%) had a positive view of the practice. However, among the 144 doctors performing simultaneous immunizations, 67 (47%) were not confident about its safety; side effects were seen after simultaneous immunization by 86 doctors, 35 (41%) of whom believed that the frequency or possibility of side effects in simultaneous immunizations was higher than that in sequential immunizations. CONCLUSIONS: The use of simultaneous immunization is expanding quickly. However, among the doctors performing simultaneous immunizations, a high percentage had concerns over its unproven safety and potential side effects, indicating the need for academic societies or government institutions to present evidence to address such concerns.

High Proportion of Nervous System Disease among Major Cause of Under-Five Death in Korea; Compared with OECD 14 Nations (2005-2010) / 고신대학교의과대학학술지

OBJECTIVES: To compare the mortality rate of children under ages five from different countries by their causes and to explore the cause of death that is relatively higher in South Korea and came up with measures for resolution. METHODS: The statistics were based from section ICD(International Classification of Diseases)-10 of WHO(World Health Organization) Mortality Database. Among the OECD(Organization for Economic Cooperation and Development) countries, 15 countries with higher GDP(Gross Domestic Product) than South Korea were studied by the mortality rate from 2005 to 2010 sorted into two groups: 0 year group and 1-4 years group. Then the cause of death investigated in detail. RESULTS: Among the 15 countries, average mortality of 0 year group in Korea ranked 8th and the average mortality of 1-4 years group ranked 4th out of 15. There were no significance in the mortality of 0 year group caused by any specific disease, but unnatural death was ranked 2nd after the United States. The natural death of 1-4 years group was ranked 6th, and the unnatural death was ranked 2nd after the Unites States. Among the natural deaths of 1-4 years group, the cause of death significantly higher was found to be disease G(nervous system disease). Among the subgroups of disease G, the orders went epilepsy, cerebral palsy, paralysis, and inflammatory disease. CONCLUSIONS: We have identified major causes of death of children under age 5. The highest proportion of cause of death in 1-4 years group was nervous system disease and we have proposed resolution. Henceforth, this data will be used as a foundational data for formulating policies relation to the Mother-Child Health.

The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase / 고신대학교의과대학학술지

OBJECTIVES: Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L). METHODS: The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD3), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results. RESULTS: Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD3 concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants. CONCLUSIONS: In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.

Cerebral Venous Sinus Thrombosis in an Adolescent Presenting with Headache / 대한소아신경학회지

Cerebral Venous Sinus Thrombosis (CVST) in children is rare and its cause is multifactorial. The clinical manifestations of CVST vary and may cause long-term neurological sequelae and even death on rare occasion. In this case, a 15 year old boy presented with severe headache and vomiting for 1 day. Brain MRI with venography revealed multiple lesions of CVST in superior sagittal sinus and the left transverse sinus. Anticoagulation therapy was performed for 3 months, which led to the complete resolution in superior sagittal sinus and partial resolution in left transverse sinus.

Clinical Review of Children Diagnosed as Specific Language Impairment / 대한소아신경학회지

PURPOSE: The purpose of this study was to evaluate the clinical characteristics of children who had been diagnosed as specific language impairment as outpatients. METHODS: One hundred twenty-five speech- or language-delayed patients were enrolled in Dae-Dong Hospital from July 2007 to June 2008. Fifty-one of 125 children were diagnosed as specific language impairment in whom clinical factors such as duration of therapy and progress after therapy were evaluated. Data were obtained from telephone or direct personal interviews. RESULTS: Among 51 children diagnosed as specific language impairment, 39 (76.5%) had mixed receptive-expressive-type language disorder and 12 (23.5%) had expressive-type language disorder. Thirty children in total were studied as ten children were unavailable for follow-up and eleven dropped out during treatment. The final 30 children consisting of 23 with mixed receptive-expressive type language disorder and seven children with expressive-type language disorder were treated after diagnosis. Total average treatment duration of children with mixed receptive-expressive-type and expressive-type language disorder were 18.1 months and 8.6 months, respectively, a statistically significant difference (P = 0.014). Thirteen (57%) of 23 children with mixed receptive-expressive-type language disorder and all (100%) seven children with expressive-type language disorder completed speech therapy with an average treatment duration of 12.2 and 8.6 months, respectively; however, this difference was not statistically significant(P = 0.287). CONCLUSION: Classifying patients with specific language impairments into mixed receptive-expressive-type and expressive-type language disorder in an outpatient department can be useful for predicting duration of and prognostic effects of language therapy, as our study and other previous articles have shown. More attention is needed from pediatricians to ensure the effective assessment and management of specific language impairment.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

Diurnal Variation in Serum Bilirubin Concentration of Normal Newborn Infant

PURPOSE: We investigated whether there are independent intradaily changes in bilirubin levels in normal neonates. METHODS: During the period of January 1996 till July 1996, 100 healthy newborn infants were studied for at least 3 consecutive days. Starting from the third day of life, consistent intradaily changes of bilirubin concentration were observed. And obstetric history, birth history, weight change at 3 days were recorded from chart review. A complete blood cell count was obtained from each subject at the beginning of the study. RESULTS: The mean bilirubin concentrations at morning were 10.4 +/- 1.8mg/dl (3rd day), 11.6 +/- 2.1mg/dl (4th day) and 11.2 +/- 2.7mg/dl (5th day). The mean bilirubin concentrations at evening were 11.1 +/- 2.1mg/dl (3rd day), 11.3 +/- 2.2mg/dl (4th day) and 10.8 +/- 2.8mg/dl (5th day). Interdaily changes of bilirubin levels were found: morning levels were higher compared with those of the evening. CONCLUSION: We showed a consistent diurnal rhythm in bilirubin levels, with higher levels in the morning than in the evening. This diurnal rhythm in serum bilirubin concentration affects endogenous factors as well as exogenous. Mechanism of diurnal variation was unknown.