The Effect of Diet Therapy on the Course of Acute Diarrheal Disease / 대한소아소화기영양학회지

PURPOSE: We studied to know the effect of early feeding on the course and the recovery of acute diarrheal disease. METHODS: The study was conducted on 76 patients who admitted to the Soonchunhyang university hospital for acute diarrhea. We divided 76 patients into 3 dietary groups (whole milk group (WMG): 35, diluted milk group (DMG): 29, breast milk group (BMG): 12). We compared three groups by numbers of diarrhea, numbers of vomiting, calory intake, weight increments, and duration of diarrhea. RESULTS: 1) The mean age was 16.45+/-18.20, 11.53+/-9.80, 5.38+/-5.01 months for WMG, DMG, and BMG, respectively. The mean weight was 9 kg and the mean duration of diarrhea was 2.29 days. 2) The numbers of diarrhea during admission was not significantly different in the three groups. 3) The calory intake during admission was significantly low in DMG. 4) The weight increments during admission was significantly low in DMG. 5) The duration of diarrhea during admission was not significantly different in the three gourps. CONCLUSION: Early refeeding with whole milk or breast milk did not prolong or worsen the course or symptoms of diarrhea compared with gradual reintroduction with diluted milk. But there were advantages of improved nutrition and weight increments. Futher study is necessary to demonstrate the effect of diet according to the causative organisms.

The Detection of Chlamydia trachomatis Using Nested PCR in Prematurity and Delivery of Low Birth Weight Infant

PURPOSE: Polymerase chain reaction(PCR) has generally been more sensitive than traditional tests for the detection of Chlamydia trachomatis which has been a leading cause of sexually transmitted disease. We performed this study to find out if there is an association between C. trachomatis infection and low birth weight(LBW) or prematurity. METHODS: The study included 98 premature or LBW infants admitted to the neonatal intensive care unit of Soonchunhyang Chunan hospital between January and July of 1999. Nasopharyngeal swab specimens were obtained from 98 neonates with a LBW or prematurity. Endotracheal secretions were obtained from 28 LBW or premature infants. Vaginal swabs were collected from 47 mothers who had given birth to LBW or premature infants. We performed the nested PCR with Chlamydia-CR kit(Bioneer, Korea). PCR products were resolved by electrophoresis on 2% agarose gel. These products were observed by their size which was 345 bp. RESULTS: C. trachomatis was not detected by the nested PCR from 98 nasopharyngeal swabs nor 28 endotracheal secretion specimens. But, C. trachomatis was detected in 2(4.2%) out of 47 vaginal swab specimens from mothers who had given birth to LBW or premature infants. CONCLUSION: The nested PCR is a relatively simple, fast and practical tool for the detection of C. trachomatis, but the positive rates of C. trachomatis were low in LBW or premature infants and also in mothers who had given birth to LBW or premature infants. We suggest two possible conclusions from our study. The first is that nasopharyngeal swabs and endotracheal secretions are improper specimens for C. trachomatis. The second is that C. trachomatis infection is lower in our study.

Clinical and Molecular-Biologic Study of Extended Spectrum beta-lactamase Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

PURPOSE: Extended spectrum beta-lactamase (ESBLs) producing Klebsiella pneumoniae has recently been increasingly responsible for infections. Considering the characteristics of the neonatal intensive care unit (NICU), the increase in such colonies is to be an important factor in the treatment and outcome of neonatal patients. Therefore, we performed this study in order to investigate the incidence of this colony and the clinical characteristics that are helpful in diagnosing these infections. METHODS: We performed a double disk synergy test and randomly amplified polymorphic DNA (RAPD) analysis of which 12 was resistant or intermediate to cefotaxime, and 4 colonies isolated from rectal swab taken in 14 patients between July and August, 1997. Also, we compared the annual isolation rate of K. pneumoniae, from those admitted to the Soonchunhyang University Chunan Hospital NICU from July, 1997 to June, 2000. We retrospectively studied the medical records and the clinical characteristics of those 79 cases from whom 110 colonies were isolated. RESULTS: From July to August, 1997, there was a K. pneumoniae outbreak in the NICU. Fifteen out of a total of sixteen isolates were positive in the double disk synergy test and turned out to be ESBL producing K. pneumoniae. Also the RAPD analysis of thirteen isolates which were from the NICU proved eleven isolates to have similar band pattern on RAPD typing. In those who were admitted to our NICU from July, 1997 to June, 2000, 110 colonies of K. pneumoniae resistant or intermediate to cefotaxime were isolated from 79 patients. Though patient group infected by the ESBLs producing K. pneumoniae had significantly no difference in gestational age or birth weight, they had a longer hospitalization period compared to the control group. CONCLUSION: It is possible that ESBLs producing K. pneumoniae be responsible for outbreaks in the NICU. The emerging of these can affect the morbidity in neonates and also can put great limits in the choice of antibiotics.

Endoscopic Findings of Upper GI Bleedings in Full Term Newborn Infants / 대한소아소화기영양학회지

PURPOSE: We are going to establish the efficacy of endoscopic examinations in diagnosing and treating upper GI bleeding in full term neonates. METHODS: We retrospectively reviewed newborns who underwent endoscopic examination because of hematemesis from July 1998 to April 2001. RESULTS: Gestational ages were between 38 and 41weeks, and birth weights were between 2,730 and 3,400 gm. Total of 9 patients were reviewed. Endoscopic examination revealed gastric ulcer in 6 cases, multiple erosions in 2 cases and negative finding in 1 case. All 6 gastric ulcers were multiple and among them 2 patients endoscopic hemostatic therapy. No complication due to the procedure was noticed. Five patients recieved transfusions. All 9 cases were cured through conservative and endoscopic therapy without recurrence. CONCLUSION: The common cause of upper GI hemorrhage in newborns with no preceding disease turns out to be multiple gastric ulcers and the prognosis is good. The endoscopic approach is useful in diagnosing and treating upper GI bleeding in newborns.

The Clinical Usefulness of Esophagogastreduodenoscopy in Neonates and Infants / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. METHODS: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. RESULTS: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/<), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. CONCLUSIONS: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication.

Hyperechogenicity of Renal Medulla and Urinary Bladder in Normal Neonates: Clinical Significance

PURPOSE: To evaluate the clinical significance of hyperechogenicity of the renal medulla and urinary bladder in normal neonates. MATERIALS AND METHODS: We investigated 31 clinically normal neonates, including one post-term, 16 pre-term, and 14 full-term babies, in whom hyperechogenicity of the renal medulla or urinary bladder was seen on ini-tial sonograms. All neonates underwent sonography while aged between 1 and 21 (mean: 2.5)days. For 14, fol-low-up sonography was performed 2-20 (mean : 6.8) days later. Eighteen neonates also underwent urinalysis, and two underwent a bacteriologic examination. RESULTS: Initial sonograms revealed (hyperechogenicity in the renal medulla (n=28) and urinary bladder (n=12). Twenty-five neonates were aged less than one week, four were aged 1-2 weeks, and two were aged 2-3 weeks. Urinalysis showed that six neonates were erythrocyte-positive (+/-:1, +1:4, +4:1), two were protein-pos-itive (+/-:2), and the others were negative. In all cases the results of bacteriologic study were negative. Follow-up sonography revealed that the hyperechogencity of renal medulla had regressed (n=12) or decreased (2), and that of the urinary bladder had regressed (n=4). CONCLUSION: In clinically normal neonates, hyperechogenicity of the renal medulla and urinary bladder was mostly visualized within the first week of life, and on follow-up sonography was seen to have regressed or decreased.

A Case of Virilizing Adrenal Cortical Tumor in Child

Adrenal cortical tumor is a rare disease both in adults and children. Most of these tumors are malignant and functional, especially in children, producing endocrine syndrome such as virilization, Cushing's syndrome, hyperaldosteronism or feminization. Recently, we experienced a case of adrenal cortical tumor in a 26 month-old boy who showed features of virilization. This case was diagnosed with typical hormonal findings and abdominal CT and confirmed by pathologic examinations. He was successfully treated with right adrenalectomy. We report a case of virilizing adrenal cortical tumor and review the literature.

A Case of Primary Jejunal Adenocarcinoma in Children / 대한소아소화기영양학회지

Primary adenocarcinoma of the jejunum which accounts for only approximately 3% of all gastrointestinal tract malignancies, is distinctly unusual. The rarity and the non-specific symptoms of this cancer, which are the major factors contributing to its poor prognosis, make the diagnosis difficult. As the prognosis of primary adenocarcinoma of the jejunum, once metastasized, is poor, a greater awareness of the possibility of a jejunal cancer must accompany aggressive diagnostic and surgical procedure. We report our experience of a child with primary adenocarcinoma of the jejunum with a brief review of the literature.

A case of laryngeal cleft

Laryngotracheoesophageal cleft is a rare congenital anomaly characterized by a midline defect of variable length between the posterior larynx and trachea and the anterior wall of the esophagus which was first reported by Richter in 1792. The male, birth weight 2780 gm, was born our hospital, After birth the infant breathed spontaneously, cried immediately but weak and did well initially but after minutes appeared moderate amount of mucus in the mouth, and sterile water was given but immediately vomited with chocking, cough and cyanosis. A nasogastric tube was inserted through the esophagus without resistance and kinking. Esophagogram was showed spillage of contrast media simultaneously into trachea and esophagus. In direct laryngoscopy, there appeared to be small laryngeal cleft posteriorly, to the level of vocal cord. But bronchoscopy could not be performed due to narrow tracheal orifice. So we confirmed the laryngeal cleft by means of CT and MRI of neck. CT and MRI scan of neck demonstrated a cleft in interarytenoid lesion and connection between esophagus and laryngeal lumen.

The change of anti-HBs titer after hepatitis B vaccination in newborn according to dosage and time

We studied anti-HBs titer, positive and effective rate in relation to dosages(5microgram, 10microgram) and time interval after third vaccination in 23 infants born to HBsAg negative mother. The babies were divided into two groups. In one group(n=12), 5microgram of Hepavax was administered intramusculary at 1 month, 2 months and 6 months of age, in other group (n=11), 10microgram of Hepavax at same time interval. And the anti-HBs was studied at 2 months and 3 year after third vaccination by radioimmunoassay. The results were as follows: 1) The anti-HBs positive rate was 100% in two groups at 2 months and 3 years after vaccination. 2) The geometric mean anti-HBs titer at 2 months after third vacciantion was 9418.3+/-13041.5 IU/L in 5microgram group and 12750.0+/-12750.5 IU/L in 10microgram group, and 3 year after vaccination, 949.4+/-1404.0 IU/L in 5microgram group, 1067.4+/-1067.7 IU/L in 10microgram group. There were no significant difference between two groups, although mean anti-HBs titer decreased significantly after 3 years. 3) The effective rate at 3 years after vaccination was 66.7% in 5 microgram group and 72.8% in 10microgram group. There was no statistical significant difference between two groups.

A study of screening for anemia in 9 month old infants in well baby clinic

Iron deficiency remains the most common cause of anemia in infants and chidren despite increasing availability of iron-fortified foods. We screened out anemia in 9-month old infants in well baby clinic to know the prevalence of anemia and the weaning status. The results were as follows: 1) Among 345 infants screened, 24 infants (7%) were found to have anemia. 2) The kind of anemia was microcytosis and 7 infants (2.2%) revealed hypochromia. 3) Among the remaining 311 non-anemic infants, 6 infants (1.9%) revealed microcytosis and 7 infants (2.2%) revealed hypochromia. 4) In anemic group the mean hemoglobin concentration was 8.75+/-1.03gm/dl, hematocrit was 27. 73+/-3.11%, MCV was 65.84+/-8.21 fL, MCHwas 20.95+/-2.93 pg and MCHC was 31.34+/-1.89 gm/dl. 5) In 9 anemic infants, weaning was delayed until 9 months of age.