The Impact of Fluid Therapy Strategies on Nonoliguric Hyperkalemia in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study was to characterize the changes in the incidence and clinical characteristics of nonoliguric hyperkalemia (NOHK), together with plasma potassium levels, according to the fluid therapy strategies for extremely low birth weight infants (ELBWIs) during the first few days of life. METHODS: This retrospective study enrolled ELBWIs. We analyzed the occurrence of NOHK, plasma potassium levels, other biochemical data, and fluid balances according to historically controlled strategies such as conventional limited-volume supply and low-dose calcium supplementation (P1), increased-volume supply and high-dose calcium supplementation (P2), and early aggressive nutrition (EAN) and high-dose calcium supplementation (P3). RESULTS: The incidence of NOHK and the plasma potassium levels in P2 (127 ELBWIs) were not different from those in P1 (39 ELBWIs). However, arrhythmia and fatality significantly decreased in P2 compared to those in P1. In P3 (68 ELBWIs), the incidence of NOHK after 24 h and the plasma potassium levels after 36 h of life were significantly reduced compared to those in P1 and P2. Neither arrhythmia nor fatality developed in P3. CONCLUSION: EAN combined with high-dose calcium supplementation could be a potential strategy for the prevention of NOHK along with consequent arrhythmia and fatality in ELBWIs.

Lupus Anticoagulant Titer Changes in Children with Prolonged In Vitro Coagulation Time by Lupus Anticoagulant / 임상소아혈액종양

BACKGROUND: This study was conducted in order to examine the duration of lupus anticoagulant (LA) presence in serum after it was first detected in children in association with infection. In addition, the effect of LA on coagulation time was evaluated.METHODS: We included 14 children who had an accompanying high titer of LA and prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). The titer of LA and PT/aPTT were examined until LA titer normalized serially after an interval of approximately 10 days.RESULTS: None of the subjects showed any evidence of bleeding or thrombosis during conduct of the study. LA titer had normalized in none of the subjects within approximately 10 days later, and only 28.6% within 20 days later. However, LA titer had normalized in 85.7% of subjects within approximately 30 days, and all subjects showed the normal range of LA titer at 40 days from the first examination. LA titer had a statistically significantly effect on the PT and aPTT (P<0.05, P<0.01, respectively).CONCLUSION: The prolongation of PT or aPTT observed in children with high titer of LA after infectious diseases was not related to any bleeding or thrombotic problem. The elevated titer of LA and prolonged aPTT normalized within approximately 40 days. However, the number of subjects in this study was too small; therefore, conduct of a larger cohort study will be required in order to clarify that elevated LA is related to clinical problems.

Vascular endothelial dysfunction after anthracyclines treatment in children with acute lymphoblastic leukemia / 소아과

PURPOSE: Anthracyclines have been utilized in the treatment of children with acute lymphoblastic leukemia (ALL). Recent studies have shown that anthracyclines may induce toxicity in the vascular endothelium. This study was performed using brachial artery reactivity (BAR) to evaluate vascular endothelial function in ALL patients who were treated with anthracycline chemotherapy. METHODS: We included 21 children with ALL who received anthracycline chemotherapy and 20 healthy children. The cumulative dose of anthracyclines in the ALL patients was 142.5+/-18.2/m2. The last anthracycline dose was administered to the patients 2 to 85 months prior to their examination using BAR. The diameter of the brachial artery was measured in both groups using echocardiography, and BAR was calculated as the percentage change in the arterial diameter after release of the cuff relative to the baseline vessel diameter. RESULTS: In the anthracycline-treated group, BAR was observed to be 3.4%+/-3.9%, which was significantly lower than that observed in the control group (12.1%+/-8.0%, P<0.05). The time elapsed after the last anthracycline treatment and the age at the time of treatment did not affect the change in BAR (P=0.06 and P=0.13, respectively). CONCLUSION: These results provided evidence that treatment of ALL patients with anthracycline results in endothelial dysfunction. A larger cohort study and a longer follow-up period will be required to clarify the relationship between endothelial dysfunction resulting from anthracycline treatment for childhood ALL and occurrence of cardiovascular diseases later in life.

Lupus Anticoagulant Titer Changes in Children with Prolonged In Vitro Coagulation Time by Lupus Anticoagulant / 임상소아혈액종양

BACKGROUND: This study was conducted in order to examine the duration of lupus anticoagulant (LA) presence in serum after it was first detected in children in association with infection. In addition, the effect of LA on coagulation time was evaluated. METHODS: We included 14 children who had an accompanying high titer of LA and prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). The titer of LA and PT/aPTT were examined until LA titer normalized serially after an interval of approximately 10 days. RESULTS: None of the subjects showed any evidence of bleeding or thrombosis during conduct of the study. LA titer had normalized in none of the subjects within approximately 10 days later, and only 28.6% within 20 days later. However, LA titer had normalized in 85.7% of subjects within approximately 30 days, and all subjects showed the normal range of LA titer at 40 days from the first examination. LA titer had a statistically significantly effect on the PT and aPTT (P<0.05, P<0.01, respectively). CONCLUSION: The prolongation of PT or aPTT observed in children with high titer of LA after infectious diseases was not related to any bleeding or thrombotic problem. The elevated titer of LA and prolonged aPTT normalized within approximately 40 days. However, the number of subjects in this study was too small; therefore, conduct of a larger cohort study will be required in order to clarify that elevated LA is related to clinical problems.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Initiation of Therapeutic Hypothermia with a Cooling Fan for an Asphyxiated Newborn

Induced hypothermia for newborns with hypoxic-ischemic encephalopathy results in a significant decrease in mortality and neurodevelopmental disability. For optimal neuroprotection following perinatal hypoxia-ischemia (HI), therapy should begin within 6 hrs of the insult and continue for > or =72 hrs. We report on a baby with HI who underwent therapeutic hypothermia that was initiated with a cooling fan, as the whole-body cooling machine was in use for another patient. Although overcooling occurred, the method was successful. For effective and safe brain hypothermic therapy (BHT), a purpose-built cooling machine is recommended. The adherence to standard protocol is required for every BHT, as clearly defined by protocols similar to those used in published trials.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Iatrogenic Esophageal Perforation: An Occurrence from Feeding Tube Placement in a Premature Infant with a Pneumothorax

Spontaneous neonatal esophageal perforation (EP) is a rare condition. However, iatrogenic EP due to a feeding tube is not uncommon, particularly in premature infants. Iatrogenic EP can result in serious complications, such as a pneumothorax, and can be fatal. Usually a pneumothorax develops as a result of EP. However, we experienced an EP in a patient with a pneumothorax. The EP occurred after inserting a feeding tube while the patient was suffering from a pneumothorax. Thus care is needed when inserting the feeding tube in a patient with a pneumothorax.