Neonatal Outcomes of Near-term Infants / 대한주산의학회잡지

OBJECTIVE: To document the common medical problems and clinical outcomes of near-term infants who were delivered between 35(+0) and 36(+6) weeks of gestation, in order to promote optimal health outcomes for these infants. METHODS: We performed a retrospective review of medical records of 113 near-term infants and 138 term infants as control, who were born at Chungbuk national university hospital in 2003~2004. RESULTS: When compared with term infants, near-term infants had a significantly lower Apgar scores (7.7 vs. 8.7 at 1 minute) and higher frequency of prolonged rupture of membrane (19.8% vs. 6.7%), preeclampsia (20.9% vs. 4.4%), jaundice (46.0% vs. 11.6%), respiratory distress (20.4% vs. 10.9%), feeding problems (19.5% vs. 5.8%), intravenous fluid infusion (63.7% vs. 24.6%), diagnostic work-up for possible sepsis (68.1% vs. 26.1%), and use of antibiotics (58.4% vs. 22.5%). There were no differences in frequency of cesarean section, hypoglycemia, hypothermia and clinical sepsis. More near-term infants were admitted to the neonatal intensive care unit (68% vs. 28%) and delayed in discharge home (60% vs. 27%) with longer hospital stay (7.77+/-5.63 days vs. 4.67+/-3.17 days). CONCLUSION: Near-term infants showed significantly more neonatal problems and longer and repeated hospital stays than full-term infants. Optimal care guidelines for near-term infants including scrupulous monitoring for the development of early complications and meticulous follow-up after discharge need to be developed.

Accelerated Idioventricular Rhythm in Children with Normal Heart

Accelerated idioventricular rhythm(AIVR) describes ventricular rates slower than usual tachycardia rates but faster than the ventricular escape rhythm. Ventricular rates of 40- 120 beats/min are usual. Accelerated idioventricular rhythm probably represents enhanced automaticity in the ventricles and manifests itself when sinus rates slow. This arrhythmia has been reported in association with acute myocardial infarction, digitalis excess, cardiomyopathy, and rheumatic heart disease. Only rare case of AIVR without underlying heart disease has been described. It is transient and intermittent, with episodes lasting a few seconds to a minute, and does not appear to seriously affect the patient's clinical course or the prognosis. Suppressive therapy is rarely necessary. Recently, we have experienced four cases of AIVR in children without underlying heart disease with benign clinical course.

Effects of Angiotensin II on Glomerular Epithelial Cells Permeability Model; Role of Oxidative Stress / 대한신장학회잡지

BACKGROUND: Glomerular injury induced by angiotensin II (Ang II) may arise from its hemodynamic or non-hemodynamic actions including oxidative stress, or from such effects of Ang II acting in concert. The release of reactive oxygen species from podocytes may play a role in the pathogenesis of glomerular damage and proteinuria. METHODS: To investigate whether Ang II induces oxidative stress in vitro in glomerular epithelial cells (GEpC) and whether such oxidant stress may increase in vitro glomerular permeability model using cultured GEpC, we studied GEpC culture exposed to Ang II and antioxidant, probucol. For oxidative system assay, we measured the production of superoxide anion and hydrogen peroxide and the activity of superoxide dismutase (SOD). Scanning electron microscopy was performed on cells grown for one week on chamber slides. RESULTS: We found that in vitro permeability, which was prevented from probucol, increased significantly in media with 10-4 and 10-5 M of Ang II by 15.9% and 13%, respectively. Administration of the 10-5 M of Ang II significantly increased the superoxide anion productions by 39%, 61% and 30% at 1, 2 and 6 hours exposure time, respectively, compared to those of control and suppressed by probucol to control levels. At high concentration (10-5 M) Ang II suppressed the activity of SOD without affecting the production of hydrogen peroxide on the other hand, at low concentration (less than 10-5 M) Ang II showed reverse results. On ultrastructural examination, we could see the shortened and fused microvilli on GEpC surface by 10-5 M of Ang II, which change could be prevented by probucol. CONCLUSION: We could suggest that Ang II induces the generation of superoxide anion and the suppression of the activity of SOD, and subsequent oxidative stress leading to increase glomerular permeability by disruption of glomerular filtration barrier.

Hemolytic Uremic Syndrome Associated with Amoebic Dysentery

The hemolytic uremic syndrome(HUS), a heterogenous group of disorders characterized by micorangiopathic hemolytic anemia, thrombocytopenia, and azotemia, is the most frequent cause of acute renal failure in children. The association of the HUS with E. coli O157:H7 has been well-described, but the other intestinal infection have been relatively less reported to date. We report a 18-month-old boy presenting with typical clinical characteristics of HUS associated with amoebic dysentery with a brief review of literatures.

Two Cases Suggesting the Relationship of IgA Nephropathy and Henoch-Sch nlein Purpura

There are a considerable number of reports suggesting a common pathogenesis of IgA nephritis(IgAN) and Henoch-Sch nlein purpura(HSP). In previous reports, a patient develops IgAN after kidney transplantation for HSP nephritis, one of Identical twin boys, developed IgAN and the other HSP, and a boy with IgAN later developed HSP. We report two cases, one with IgAN who later developed HSP and the other with HSP who later developed IgAN, suggesting that IgAN and HSP have a common pathogenesis.