Outcome of pregnant mothers with systemic lupus erythematosus (focusing on congenital heart block) / 소아과

PURPOSE: Neonatal lupus is characterized by congenital complete heart block(CCHB), cutaneous rash, and laboratory abnormalities in infants born to mothers with systemic lupus erythematosus(SLE). This study aims to examine the incidence of CCHB and clinical outcome in neonates born to mothers with SLE. METHODS: The study group consisted of 49 neonates, born from 57 pregnancies of 55 women with SLE, diagnosed at Hanyang University Hospital for the period between January 1997 and January 2005. Clinical and laboratory data were retrospectively identified from medical record. RESULTS: There were 5(8.8 percent) spontaneous abortions and one(1.8 percent) still births among 57 pregnancies of 55 mothers. Of 49 live births, 15(26.3 percent) were premature and eight(12.3 percent) were small for their gestational age. There was one(1.8 percent) CCHB suspected during pregnancy on fetal echocardiograpy in a fetus of mother with systemic lupus erythematosus and the fetus was not born by artificial abortion because of mother. There was no CCHB among EKG findings of 49 newborns. Laboratory testing showed hematologic abnormalities among 25.6 percent(10/39) of the babies. 5.1 percent(2/39) and 7.7 percent(3/39) of them were diagnosed as neutropenia, and thrombocytopenia was seen respectively. Anti-SSA(Ro) and antiphospholipid antibodies were predictive factors for prematurity(P=0.003, P=0.049). Anticardiolipin antibodies were predictive factors for ventilatory care(P=0.018). CONCLUSION: The incidence of CCHB among neonates born to mothers with SLE, which was measured in this study, was lower than that in earlier studies. A high incidence of hematologic abnormalities was found in our study. It is suggested that careful examination should be made of skin for the diagnosis of neonatal lupus.

Lymphadenitis following intradermal BCG vaccination / 소아과

PURPOSE: Intradermal BCG vaccine has not well been accepted by pediatric practitioners due to BCG lymphadenitis. Therefore, this study was undertaken to find out the incidence of lymphadenitis following intradermal BCG vaccination and its clinical outcome. METHODS: One thousand and fifty infants, who received intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccination in the Well Baby Clinic of Hanyang University Hospital from July 2001 to January 2004, were included in the study. Severe local reactions at the injection site and any mass noted on surrounding areas were reported to, and evaluated by, pediatricians. Surgical procedures, either surgical resection or needle aspiration, were recommended when lymph nodes progressed to suppurate without regression. RESULTS: Twenty infants(1.9 percent) developed lymphadenitis 2 to 8 months following vaccination. The incidence of BCG lymphadenitis was significantly higher in infants born with intrauterine period of <38 weeks and birth weight of <2,700 g. The lymph nodes became suppurative in 7/17 infants (41.2 percent) and four infants required surgical procedures with which the rate for the requirement of surgical procedures among intradermal BCG vaccinnes approximated to be 0.45 percent. There was no correlation between the size of lymph nodes and suppuration, however surgical procedures were required significantly more often for lymph nodes of greater than 3 cm in diameter. CONCLUSION: The incidence of BCG lymphadenitis following intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccinations would be more than 1.9 percent, when considering cases of lymphadenits not reported. More efforts need to be paid to decrease the incidence of BCG lymphadenitis in order to promote intradermal BCG vaccination in Korea.

The Study of the Influenced Factors of Hyperkalemia in Low Birth Weight Infants

PURPOSE: The aim of this study is to evaluate the incidence of hyperkalemia and the contributing factors of nonoliguric hyperkalemia in low birth weight infants within 48 hours after birth. METHODS: The incidence of nonoliguric hyperkalemia and difference of clinical features between hyperkalemia (>6.7 mEq/L) and normokalemia (< or =6.7 mEq/L) groups were determined by reviewing medical records of 196 low birth weight infants who were born in Hanyang university hospital between Oct. 2001. and Jul. 2004. We analized the serum level of sodium, potassium, fluid intake, urine output, pH of blood gas and others. RESULTS: Among 196 infants, 17 infants was hyperkalemia developed in 48 hours after birth. In that cases, 10 infants were showed EKG abnormalities, such as ventricular tachycardia. In all cases, birth weight, gestational age, Apgar score, usage of surfactant, urine output, BUN and creatinine were significant. In A group gestational age, urine output, BUN, creatinin were significant, in B group BUN, creatinine were significant, in C group BUN were significant between hyperkalemia and normokalemia. Six infants with hyperkalemia died as a result of hyperkalemia induced cardiac arrhythmia. CONCLUSION: Hyperkalemia frequently occurred extremely premature infants. But hyperkalemia also be developed in low birth weight infants who were not suffered from asphyxia or tissue damage. Serum potassium level should be monitored to avoid life threatening cardiac arrhythmia in low birth weight infant.