Erratum: Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

The funding acknowledgment in this article was omitted as published.

Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.

Case Report of Pediatric Gastroenteritis Due to CTX-M-15 Extended-Spectrum beta-Lactamase-Producing Salmonella enterica Serotype Enteritidis / 대한진단검사의학회지

A clinical isolate of Salmonella enterica serotype Enteritidis in Korea was found to produce the extended-spectrum beta-lactamase CTX-M-15. The isolate was recovered in 2008 from the stool of a 3-yr-old boy with gastroenteritis. This isolate was found to be resistant to multiple drugs, including ampicillin, piperacillin, cefotaxime, ceftazidime, cefepime, and aztreonam. The resistance to cefotaxime was transferred by conjugation to recipient Escherichia coli J53. The patient was eventually successfully treated with trimethoprim-sulfamethoxazole. This is the first report of the bla (CTX-M-15) gene in S. enterica serotype Enteritidis in Korea.

Association of Breast-feeding and Allergic Diseases in Preschool Aged Children / 소아알레르기및호흡기학회지

PURPOSE: The effect of breastfeeding on the development of allergic disease has been assessed in many studies but remains controversial. Thus, we evaluated the prevalence of allergic disease and its association with breastfeeding among preschool children. METHODS: A questionnaire survey was conducted in 604 kindergarten children from 5 different kindergartens in Seoul between May and June, 2004. Parents or guardians were asked to answer the duration of breast-feeding and the time of weaning diet. RESULTS: For the question, "Have you been treated for allergic disease during the past 12 months?" showed 4.5% of in asthma, 11.3% and 19.0% were in allergic rhinitis and atopic dermatitis, respectively. Exclusive breast-feeding for the first 4 months was noted in 21.8% of the children, compared with 55%, partial breast-feeding or only formula milk feeding in 23.2%. The prevalence of wheezing during the past 12 months was significantly lower in children with prolonged breast-feeding than in those with short-term breast feeding infants. There was a significant reduction in risk for atopic dermatitis in breastfeeding compared with formula milk feeding. CONCLUSION: Breastfeeding seems to have a preventive effect on the development of atopic dermatitis. The risk for wheezing, during the past 12 months was higher for in children with formula milk feeding.

Association of Breast-feeding and Allergic Diseases in Preschool Aged Children / 소아알레르기및호흡기학회지

PURPOSE: The effect of breastfeeding on the development of allergic disease has been assessed in many studies but remains controversial. Thus, we evaluated the prevalence of allergic disease and its association with breastfeeding among preschool children. METHODS: A questionnaire survey was conducted in 604 kindergarten children from 5 different kindergartens in Seoul between May and June, 2004. Parents or guardians were asked to answer the duration of breast-feeding and the time of weaning diet. RESULTS: For the question, "Have you been treated for allergic disease during the past 12 months?" showed 4.5% of in asthma, 11.3% and 19.0% were in allergic rhinitis and atopic dermatitis, respectively. Exclusive breast-feeding for the first 4 months was noted in 21.8% of the children, compared with 55%, partial breast-feeding or only formula milk feeding in 23.2%. The prevalence of wheezing during the past 12 months was significantly lower in children with prolonged breast-feeding than in those with short-term breast feeding infants. There was a significant reduction in risk for atopic dermatitis in breastfeeding compared with formula milk feeding. CONCLUSION: Breastfeeding seems to have a preventive effect on the development of atopic dermatitis. The risk for wheezing, during the past 12 months was higher for in children with formula milk feeding.

Correlation between the Diagnostic Validity of Enzymeimmunoassay and the Hyperreactivity of the Respiratory Tract for the Diagnosis of Mycoplasma pneumoniae / 소아알레르기및호흡기학회지

PURPOSE:Mycoplasma pneumoniae (M. pneumoniae) is one of the common causes of lower respiratory tract diseases. Several studies have suggested that respiratory infection by M. pneumoniae may be associated with a reactive airway disease and asthma. In order to find such relationships, we compared the particle agglutination test with enzyme immunoassay (EIA) which were checked on the 1st, and at 1 and 5 or 7 days of follow-up. We also evaluated EIA in association with bronchial hypersensitivity. METHODS:One hundred eleven children who were out patients or hospitalized with pneumonia at Inje University and Hallym University Hospitals were included in the study. Patients were grouped according to the M. pneumoniae antibody titer. Patients who showed initial M. pneumoniae antibody titer and EIA Immunoglobulin (Ig) G/IgM greater than 1:320 were designated as group 1 (n=46). In group 2 (n=33), patients showed initial M. pneumoniae antibody titer lower than 1:320 but it increased more than fourfold between acute and convalescent stages. Group 3 (n=32) was a control group. We measured eosinophil counts, the total IgE, and the eosinophil cationic protein (ECP). Thirty-five children were checked with the methacholine test 3 or 4 months, after the first visit. Bronchial hypersensitiveness was defined positive if the concentration of methacholine was less than the lower limit (8 mg/mL methacholine). RESULTS:All 111 patients participated in the particle agglutination test at the initial and convalescent stages. The sensitivity and specificity for EIA were obtained from the results of the particle agglutination test. The sensitivity and specificity of acute and convalescent EIA IgG were 44.3% and 90.6%, and 67.1% and 96.9%, respectively. The sensitivity and specificity of acute and convalescent EIA IgM were 60.8% and 100%, and 92.4% and 100%, respectively. The M. pneumoniae antibody titer was associated with hospitalized days and improvement of chest X-rays. Only in group 3, the M. pneumoniae antibody titer correlated with the ECP level, but there was no significant difference between the methacholine test and eosinophil counts. CONCLUSION:The results of this study suggest that EIA may be a useful diagnostic method for detecting early phase of M. pneumoniae infection.

Effect of cytokines in breast milk on infant during the first two-years of life / 소아과

PURPOSE: Breast milk contains several components that provide specific immunity and affect the maturation of the infant's immune system. Allergic disease (AD), including atopic eczema, asthma, allergic rhinitis, and food allergy is characterized by an imbalance between cytokines produced by distinct T-helper cell subtypes. The aim of the study was to investigate the concentrations of cytokines and chemokines that were involved in allergic reactions in breast milk from allergic and non- allergic mothers and then analyse the effect of breastfeeding duration on the prevalence of allergic disease in the age of two. METHODS: The breast milk samples were collected from mothers with AD (n=88) and without AD (n=47). Breast milk was collected at the second day (colostrum) and four weeks later (mature milk). The level of Interlukine (IL)-4, IL-5, IL-6, IL-8, IL-10, IL-13, TGF-beta1, TGF-beta2, RANTES in breast milk were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer's instructions. RESULTS: Mothers with AD had a higher concentration of IL-8 in colostrum compared with those without AD (P=0.021). But, TGF-beta1 and TGF-beta2 were higher concentrated in colostrum of mother without AD (P=0.013, P=0.001). Whereas concentrations of other cytokines were not significantly different between the two groups. There was no association between levels of cytokines and chemokines in the breast milk and allergic development during the first 2 years of life in the infants. CONCLUSION: The higher concentration of TGF-beta1 and TGF-beta2 in colostrum from non-allergic mothers may explain the protective effect. But, the higher concentrations of IL-8 in colostrum from allergic mothers may in part explain the controversial results on the protective effect of breastfeeding against allergic diseases. We conclude that there is no convincing evidence form a relation between cytokines in breast milk and allergic diseases in infants. Longer follow-up are necessary to evaluate the effects of breast milk components on AD.

A Role of Sepsis in Bronchopulmonary Dysplasia of Premature Infants

PURPOSE:The aim of this study was to determine whether postnatal sepsis is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature infants. METHODS:Premature infants of less than 32 weeks of gestation or birth weight under 1,500 g who admitted at Kangnam Sacred Heart Hospital of Hallym University during 1997-2005 were investigated. Among them, infants born at other hospitals or died within 4 weeks of life and infants who got sepsis after neonatal period were all excluded. Total 268 cases were included in this study. They were divided into those with respiratory distress syndrome (RDS) (n=77) and without RDS (n=191) and each was subdivided into groups with sepsis and without sepsis. Based on the medical records, the incidence of BPD and its correlation with sepsis were analyzed. RESULTS:Incidence of typical BPD was 63.0% in group with sepsis and 26% in group without sepsis. In case of atypical BPD, incidence was 20.5% in group with sepsis and 1.3% in group without sepsis. When logistic regression analysis was performed for correcting the confounding factors, sepsis was found to be statistically significant for BPD de development (OR 3.159, 95% CI=1.241-8.039, P<0.05). RDS, birth weight were also independently significant. Other perinatal factors such as gestational age, 1 min & 5 min Apgar score, total duration of assisted ventilation, total duration of O2 administration, PDA, ROP, and IVH were found to be significant risk factors for developing BPD. We could not find any statistically significant maternal risk factors for BPD occurrence. CONCLUSION:For premature infants under 1,500 g of birth weight or 32 week of gestational age and less, sepsis during the first 4 weeks of age was a significant risk factor for developing both typical and atypical BPD.

Clinical Features of GEFS+ and its Neurological Outcome / 대한소아신경학회지

PURPOSE:The aim of this study was to characterize the clinical and electroencephalographic features as well as the neurologic outcomes of GEFS+(Genenralized Epilepsy with Febrile Seizures Plus). METHODS:We evaluated 55 children with GEFS+ who admitted at the Department of Peditrics, Kangnam Sacred Heart Hospital from 1993 to 2004. We formed them into two groups by age of first febrile seizure; Group A( or = 6 years). We analyzed the clinical features, electroencephalographic findings and the neurological outcomes of the subjects. RESULTS:The mean age of the initial febrile seizures of 55 subjects was 3 years and 9 months. 41 subjects had their initial febrile seizures under 6 years of age while 14 subjects after 6 years of age. 17 subjects had family history of seizures. The mean frequency of seizure is 4.4 times and the types of convulsions were mainly generalized. Nineteen(37.3%) showed abnormal finding on EEG and twenty three(41%) were treated with antiepileptic drug(AED) for long-term prophylaxis. Never the less, there was no subject with abnormalities in the neurological outcomes. The group with the initial seizures occurred under 6 years of age had more family history of seizures, higher frequency of total seizures, febrile seizures, and was administered with AEDs longer than the other group. CONCLUSION:In our study of GEFS+, the clinical features and the results of the electroencephalograms were various. While there were cases with a need of long term administration of AEDs, few cases of neurological abnormalities or developmental delay were seen. The group of the initial febrile seizures under 6 years of age revealed more family history of seizures, higher frequency of seizures than the other group.

A Case of Pneumococcal Meningitis Associated with Posttraumatic Cerebrospinal Fluid Rhinorrhea / 대한소아신경학회지

Bacterial meningitis after head trauma is a rare complication, but the cerebrospinal fluid(CSF) leakage after head trauma greatly increases the risk of bacterial meningitis. Most of the infections passes through the defects in the basal skull fracture, and Streptococcus pneumoniae is the most common organism. MRI, coronal thin sections of cranial CT and radioiosotope cisternography are considered to diagnose the CSF fistulae. We report a case of a 14-year-old girl with pneumococcal meningitis complicated by CSF rhinorrhea following an asymptomatic period of 3 years after head trauma. We found a bone defect of the cribrium of the skull base by means of paranasal sinus CT scanning and MRI.

Epidemiology and Clincal Analysis of Acute Viral Respiratory Tract Infections in Children(September, 1998-May, 2003) / 소아과

PURPOSE: Acute respiratory tract infections are the most common illnesses in children. The great majority of these infections involving lower respiratory tracts infections(LRTIs) are caused by respiratory viruses such as respiratory syncytial virus(RSV), parainfluenza virus(PIV), influenza virus (Flu), and adenovirus(ADV), etc. Our purpose was to determine seasonal epidemiology and clinical characteristic features of each viral infection. METHODS: Nasopharyngeal aspirate(NPA)s were collected from 4,554 hospitalized children diagnosed as LRTIs on the first day of admission. The study period was from September 1998(Autumn) through May 2003(Spring). Respiratory viruses were detected in 881(19 percent) cases by isolation of the virus or by antigen detection method using indirect immunofluorescent staining. We reviewed the medical records of 837 cases retrospectively. RESULTS: The identified pathogens were RSV in 485 cases(55 percent), PIV in 152 cases(17 percent), FluA in 114 cases(13 percent), ADV in 79 cases(9 percent) and FluB in 51 cases(6 percent). Outbreaks of RSV occurred every year, mostly in the November through December period and of PIV in the April through June period. LRTIs by FluA reached the highest level in January, 2002. FluB infection showed an outbreak in April, 2002. The clinical diagnoses of viral LRTIs were bronchiolitis in 395 cases(47 percent), pneumonia in 305 cases(36 percent), croup in 73 cases(9 percent) and tracheobronchitis in 64 cases(8 percent). CONCLUSION: Viruses are one of the major etiologic agents of acute LRTIs in chidren. Therefore, we must continue to study their seasonal occurrence and clinical features to focus on management, and also for reasons of prevention.

The Optimal Time for Retinopathy of Prematurity (ROP) Screening and Preventable Risk Factors Related to the Progression of Threshold ROP

PURPOSE: The aim of this study was to evaluate the optimal time for ROP screening and to find any preventive risk factors related to the progression to threshold ROP. METHODS: A retrospective analysis of ROP-diagnosed inborn neonates with gestational age of less than 32 weeks and birth weight of less than 1, 500 g who were admitted to Kangnam Sacred Heart Hospital from January 1997 to December 2003 were done. ROP infants were classified into two groups: PreT-ROP (prethreshold ROP, n=28) and T-ROP (threshold ROP, n=23). First ophthalmic examination time, time of onset ROP, time of threshold disease requiring cryotherapy or laser therapy, and risk factors were compared between two groups. RESULTS: Among all 220 infants, 51 (23.2%) patients were found to have ROP and 23 progressed to threshold ROP (10.5%). First ophthalmic examination time was significantly earlier in T-ROP for chronologic age. T-ROP was diagnosed at even 32+3 gestational weeks. Factors contributed to progression of ROP were gestational age, birth weight, Apgar score at 1 minute, duration of hospitalization, duration of TPN, duration of ventilator and oxygen supply, and number of transfusion. With logistic regression analysis, only birth weight (OR=1.001, 95% CI=1.001-1.016), duration of ventilation supply (OR=0.697, 95% CI=0.501-0.973), number of transfusions after the diagnosis of ROP (OR= 0.090, 95% CI=0.014-0.678) were relate to progression of ROP. CONCLUSION: For premature infants under 1, 500 g or 32 weeks and below should receive first ophthalmologic examination at least before 33 postconceptional age. The progression to threshold ROP after the diagnosis of ROP could be prevented by minimizing the duration of ventilator apply and number of transfusion after diagnosis of ROP.

Prevalence of Allergic Disease in Kindergarten Age Children in Korea / 소아알레르기및호흡기학회지

PURPOSE: Whereas allergic disease has the high morbidity during preschool age, there have not been sufficient surveys among the children in that age group. Thus we evaluated the prevalence of allergic disease among pre-school age children and risk factors which could cause or aggravate the disease. METHODS: A questionnaire survey was conducted among 593 kindergarten children, from 5 different kindergartens in Seoul between May and June, 2004. The standard for prevalence was whether one had been treated for allergic disease in past 12 months. Parents or guardians were surveyed to answer for each risk factor. RESULTS: For a question, "Have you been treated for allergic disease during past 12 months?", asthma showed 3.9% prevalence. For allergic rhinitis and atopic dermatitis were 11.1% and 20.1% respectively. Children with at least one of three diseases were 29.7%. Among children with asthma, risk factors were past history of bronchiolitis and paternal history of allergic disease. For allergic rhinitis, they were past history of bronchiolitis, mother's high education, and maternal history of allergic disease. For atopic dermatitis, risk factors were history of allergic disease of mother and father only. Other possible risk factors were statistically insignificant. CONCLUSION: Compared to the prevalence of primary school children (1995, 2000), asthma showed no difference but allergic rhinitis was lower and atopic dermatitis was higher. Among pre-school children, risk for allergic disease was higher with parental history of allergic disease. Especially the risk for respiratory allergy was even higher for those children with history of bronchiolitis.

Clinical Study of Benign Convulsion with Acute Gastroenteritis / 소아과

PURPOSE: This study was performed to characterize clinical features of benign convulsions with acute gastroenteritis(CwG) in infants. METHODS: We reviewed 83 consecutive seizures in 42 patients with CwG between January 1995 and December 2003. CwG was defined as convulsions having the following two characteristics : (a) seizures accompanied with symptoms of gastroenteritis without clinical signs of dehydration or electrolyte derangement; and (b) the body temperature remained less than 37.5 before and after the seizures. The clinical characteristics were compared between rotavirus positive and negative groups. RESULTS: Their ages ranged from 6 to 37 months(mean, 18.1 months). The average interval between the onset of astroenteritis and that of seizures was 56.4 hours. The seizure episodes ranged from one to seven times in cluster. Two or more seizures occurred in 23 patients(54.8%) within one episode of gastroenteritis. The seizure types constituted of generalized tonic-clonic(89.2%), generalized tonic(9.6%), or generalized clonic(1.2%). Only four of 42 patients showed abnormal electroencephalogram(EEG) findings, which reverted to normal during the follow-up period. All patients displayed normal psychomotor development without recurrent seizures, except two patients who had febrile seizures and a recurrence of CwG. Comparing the rotavirus positive group with the rotavirus negative group, the rotavirus positive group had more females, older patients and longer durations of seizure, significantly(P<0.05). CONCLUSION: The prognosis of afebrile seizures following acute gastroenteritis was benign.

A Case of Kikuchi-Fujimoto Disease, Subsequently Evolving to Systemic Lupus Eyrthematosus / 소아과

Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is a self-limited systemic illness and it has the pathognomonic histological appearance of lymph nodes. KFD is rarely associated with systemic lupus erythematosus (SLE). The diagnosis of KFD can precede, postdate or coincide with the diagnosis of SLE. Our case describes a young woman, originally diagnosed as having Kikuchi's disease by lymph node histology, who subsequently developed SLE with constitutional symptoms, skin rash, hematologic and immunologic disorder and high titer of antinuclear antibody. This raises consideration for the proposal that KFD may reflect a SLE-like auto-immune condition. Patients with KFD should be kept under observation for several years for the development of SLE. And KFD should be ruled out in SLE flare-up accompanied by lymphadenopathy.

A Case of Rhizomelic Chondrodysplasia Punctata Occurring in Siblings / 소아과

Chondrodysplasia punctata is a group of heterogeneous bone dysplasia characterized by punctate calcifications of the cartilage, frequently associated with a shortening of the limbs, cataracts, icthyosis and alopecia, alterations of the nervous system, and mental and growth deficiencies. Our case presented findings of the rhizomelic chodrodysplasia punctata : a characteristic face, a sucking difficulty and a short neck. Skeletal radiographies showed punctate calcification and stippling on femurs, lumbar vertebral bodies and vertebral coronal cleft. According to his family history, his brother, who had the same characteristic face and punctate calcification at the neonatal period, died at the age of six months due to respiratory failure. The rhizomelic form of chondrodysplasia puntata is rare, the prognosis is bad and death usually occurs within the first year of age. We report a case of rhizomelic chondrodysplasia punctata occurring in siblings diagnosed by clinical and radiological criteria.

A Case of Minicore Myopathy / 대한소아신경학회지

Minicore myopathy, an uncommon condition, is one of congenital myopathies. It is characterized by multifocal areas of degeneration in muscle fibers. The minicores consist of numerous small areas of decreased oxidative enzyme activity. The axis of the lesion is perpendicular or parallel to the long axis of the muscle fiber. The phenotype has been described as predominantly proximal, static or only slowly progressive muscle weakness. We report a 4 year-old-girl with respiratory failure, thoracic scoliosis, hypotonia and facial weakness, who was diagnosed as minicore myopathy by muscle biopsy. The laboratory investigations, such as creatine phosphokinase and lactic dehydrogenase levels, and the nerve conduction velocity were normal. The muscle biopsy showed marked size variations of myofibers, marked endomyseal and perimyseal fibrosis, and moderate fatty changes in myofibers. The histochemical studies showed multiple focal losses of mitochondria. These findings are consistent with minicore type congenital myopathy.

Assessment of Eosinophils and Eosinophil Cationic Protein in Induced Sputum in Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: Airway inflammation is a characteristic feature of asthma. Sputum analysis can be used as a non-invasive tool to assess severity of the airway inflammation. This study was performed to compare relationships between sputum eosinophils to other parameters of airway inflammation and to evaluate the clinical utility of sputum eosinophils and ECP in childhood asthma. METHODS: Twenty one ashtmatic children and age matched control subjects without history of allergy were enrolled in this study. Their age was from 21 months to 15 years old. The study was performed from January to April of 2001. Ultrasonically nebulized hypertonic saline was used to induce sputum from children. The children were pre-treated with bronchodilator and peak expiratory flow rate (PEFR) was monitored thought-out the procedure. Sample were analysed for total cell count, differential cell count and for concentrations of eosinophil cationic protein (ECP). RESULTS: Asthmatic subjects had a significantly higher proportion of blood eosinophils than the control subjects (279.8+/-187.7/mm3 and 26.5+/-18.5/mm3, P<0.01). Correspondingly, percentages of eosinophil and concentration of ECP were 5.10+/-8.79% and 99.85+/-70.10 microL/L in asthmatic and 0.20+/-0.42% and 1.02+/-2.54 microL/L in control subjects (P<0.01 and P<0.01). Serum eosinophils have no correlation with sputum eosinophils or sputum ECP. There was no correlation between sputum eosinophils and ECP either. CONCLUSION: This study suggests that the proportion of eosinophils and the level of ECP in induced sputum may be sensitive and accurate means of assessing the airway inflammation in childhood asthma, and their relationships with serum eosinophils or serum ECP are to be studied further.

Clinical Analysis of Acute Respiratory Tract Infections by Influenza Virus in Children

PURPOSE: Although influenza virus is one of the most important causes of acute respiratory tract infections(ARTIs) in children, virus isolation is not popular and there are only a few clinical studies on influenza in Korea. We evaluated the epidemiologic and clinical features of ARTIs by influenza virus in children. METHODS: From February 1995 to August 2001, nasopharyngeal aspirations were obtained and cultured for the isolation of influenza virus in children admitted with ARTIs. The medical records of patients with influenza virus infection were reviewed retrospectively. RESULTS: Respiratory viruses were isolated in 997(22.0%) out of 4,533 patients examined, and influenza virus was isolated in 164 cases(3.6%). Influenza virus was isolated year after year mainly from December to April of next year. The ratio of male and female was 1.9 : 1 with a median age of 15 months. The most common clinical diagnosis of influenza virus infection was pneumonia, and fever and cough developed in most patients. There was no difference between influenza A and B infection in clinical diagnoses and symptoms. All patients recovered without receiving antiviral treatment except for one patient diagnosed with pneumonia who had underlying disease of Down syndrome with ventricular septal defect. CONCLUSIONS: ARTIs caused by influenza virus developed every winter and spring during the period of study. Because fatal complication can develop in the high risk group, prevention, early diagnosis and proper management of influenza should be emphasized.

Variable Factors in Clinical Management of Childhood Asthma / 소아알레르기및호흡기학회지

No abstract available.