A review of the contents about childhood health care in middle & high school textbooks / 소아과

PURPOSE: The purpose of this study is to investigate the material in middle school and high school textbooks covering child care and children's health for medically inaccurate content and to make sure that the correct information is given to students. METHODS: We have examined 47 kinds of textbooks on the subjects 'Home economics' and 'Technology and home economics' published in 2007 to find out how much importance is placed on children's health and childcare and to search for incorrect definitions, inaccurate facts or insufficient explanations. We have also analyzed the credentials of the writers of these textbooks. RESULTS: Textbooks of middle school cover psychological and physical changes during adolescence and nutrition, and those of high school cover marriage and childcare. These materials covering health made up 27.5%, 11.7% of middle & high school texts. Age definitions of neonate and infant were incorrect. Inaccurate facts were mostly about fontanelles, primitive reflexes, breastfeeding and weaning. There also were wrong informations on the umbilical cord care and developmental milestones during infancy. The childhood immunization schedules and the growth curves were not up to date. Most of the authors major in home economics and the others were school teachers. There was no evidence of any review by a medical society or an expert. CONCLUSIONS: When writing about children's health and childcare in textbooks, a board-certified pediatrician or The Korean Pediatric Society should be consulted to provide accurate medical information to middle and high school students.

Urinary Tract Infections in Febrile Infants under Three Months of Age

PURPOSE: To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis METHODS: Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of > or = 10(5) colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. RESULTS: The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. CONCLUSION: Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.

Endocrine Function and Growth in Children with Craniopharyngioma

PURPOSE: Craniopharyngiomas are often accompanied by severe endocrine disorders. Although there is universal growth hormone deficiency(GHD), the resulting growth pattern is very heterogeneous. We report the growth and endocrine outcome of 44 children with craniopharyngioma, with emphasis on initial symptoms, growth before and during growth hormone(GH) treatment and spontaneous growth in spite of GHD. METHODS: We performed a retrospective study of 44 children treated at our centre between 1984 and 2002. RESULTS: About 30% of patients had symptoms suggesting endocrine disorder at diagnosis. After surgery, multiple endocrinopathies were almost universal. Before GH therapy, height velocity was 8.00+/-2.71 cm/yr in the normal growth group(n=11) and 1.79+/-1.10 cm/yr in the subnormal growth group(n=7) during the first year and during the second year, 6.76+/-2.49 cm/yr and 2.29+/-1.33 cm/yr, respectively. There was no difference of body mass index(BMI) change between before and after surgery in the two groups. Height standard deviation score(SDS) was -1.46+/-0.74 in the normal growth group and -0.43+/-0.97 in the subnormal growth group. Before GH treatment height SDS was -1.31+/-1.25 and BMI was 20.46 & gt; or =3.60. During GH treatment, height SDS increased to -0.60+/-1.37 in the first, and to -0.41+/-1.54 in the second year(P & lt;0.05), but BMI did not change significantly. CONCLUSION: The endocrine morbidity could develop in most children with craniopharyngioma before and after the operation and should be managed properly. Although all treated patients benefit from GH therapy, further studies are necessary to find out the possible mechanism of growth regulation in normally growing children, despite GH deficient.

A Case of Systemic Capillary Leak Syndrome in a Child

Systemic capillary leak syndrome(SCLS) is a rare disorder of unknown etiology, which is characterized by recurrent attacks of hypotension, hemoconcentration, and hypoalbuminemia. Urinary or enteric loss of protein is not demonstrated. It is often associated with monoclonal gammopathy, but does not manifest multiple myeloma. Since Clarkson et al. described the first case in a 34- year-old woman, about 50 cases have been reported in the literature. However, most of the cases were of adult age, and the mean age of onset in the reported cases was 42.6 years. In literature review, we could refer only one pediatric case of SCLC by Foeldvari et al. in 1995. We report another pediatric case of SCLS.