Antibiotic-Associated Diarrhea in 3 to 6 Month Old Infants with Febrile Urinary Tract Infections / 소아감염

PURPOSE: This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. METHODS: Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. RESULTS: Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin (3rd CS) single therapy was used for 102 patients (69.4%), the 3rd CS and non-3rd CS combination therapy for 24 (16.3%), and non-3rd CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the 3rd CS and non-3rd CS combination therapy subgroup with 9.25+/-5.30 times/day than the other two subgroups (7.58+/-2.97 times/day in 3rd CS single therapy subgroup, 6.75+/-4.40 times/day in non-3rd CS combination therapy subgroup), there was no statistical significance (P=0.078). CONCLUSION: AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.

The Relationship between Endometrial Thickness and Anemia, Iron Status in Adolescent Females with Dysfunctional Uterine Bleeding / 임상소아혈액종양

BACKGROUND: We performed this study to investigate the relationship between endometrial thickness and anemia in adolescent females with dysfunctional uterine bleeding (DUB).METHODS: We investigated retrospectively the endometrial thickness and initial complete blood count (CBC) profile in 42 girls with DUB or other gynecologic problems (non-DUB). The endometrial thickness was compared between DUB group and non DUB group. The relationship between endometrial thickness and hemoglobin was elucidated in both groups. In DUB group the relationship between endometrial thickness and the state of anemia was investigated. Besides, the status of body iron was compared with the endometrial thickness.RESULTS: At diagnosing time, each mean/median age was 15.1+/-0.4/15.0 years, 15.3+/-0.5/14.5 years in DUB and non-DUB groups. The endometrial thickness of DUB group was statistically significantly thicker than that of non DUB group (p=0.013). A statistically significant correlation was observed between the increase of endometrial thickness and the decrease of hemoglobin level in all the subjects (P=0.007). However, in the comparison of the DUB group only, the relationship between the endometrial thickness and the hemoglobin, hematocrit were not statistically significant (P=0.337, 0.213). In addition, the level of iron, total iron binding capacity, and ferritin were not statistically significantly related to the endometrial thickness (P=0.604, 0.459, 0.139).CONCLUSION: The endometrium was thicker in adolescent females with DUB than those with other gynecologic problems. The anemia was proportionate to the endometrial thickness in all subjects of this study. However, in the DUB group only, the anemia and body iron status were not affected by the endometrial thickness.

Pattern of Hospital-Associated Infections in Children Admitted in the Intensive Care Unit of a University Hospital / 소아감염

PURPOSE: Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. METHODS: We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. RESULTS: In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patient-days. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. CONCLUSION: ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.

Successful Opening of Ductus Arteriosus with Milrinone in a Newborn with Tetralogy of Fallot and Pulmonary Atresia

Tetralogy of Fallot (TOF) assumes its' most severe form when accompanied by pulmonary atresia (PA). Preserving the patent ductus arteriosus to maintain pulmonary blood flow is life-saving for patients with this congenital heart disease. Milrinone, a selective phosphodiesterase III inhibitor, is a potent vasodilator. Here, we report the successful use of milrinone for a newborn infant with TOF and PA for keeping the ductus arteriosus open and thereby maintaining pulmonary circulation. Milrinone is a useful drug because of its inotropic, lusitropic, and pulmonary vasodilating effects, in addition to its ability to keep the ductus arteriosus open and its relatively mild side-effects. Case series and comparative studies will be needed in the future to verify the effectiveness of this drug.

The Relationship between Endometrial Thickness and Anemia, Iron Status in Adolescent Females with Dysfunctional Uterine Bleeding / 임상소아혈액종양

BACKGROUND: We performed this study to investigate the relationship between endometrial thickness and anemia in adolescent females with dysfunctional uterine bleeding (DUB). METHODS: We investigated retrospectively the endometrial thickness and initial complete blood count (CBC) profile in 42 girls with DUB or other gynecologic problems (non-DUB). The endometrial thickness was compared between DUB group and non DUB group. The relationship between endometrial thickness and hemoglobin was elucidated in both groups. In DUB group the relationship between endometrial thickness and the state of anemia was investigated. Besides, the status of body iron was compared with the endometrial thickness. RESULTS: At diagnosing time, each mean/median age was 15.1+/-0.4/15.0 years, 15.3+/-0.5/14.5 years in DUB and non-DUB groups. The endometrial thickness of DUB group was statistically significantly thicker than that of non DUB group (p=0.013). A statistically significant correlation was observed between the increase of endometrial thickness and the decrease of hemoglobin level in all the subjects (P=0.007). However, in the comparison of the DUB group only, the relationship between the endometrial thickness and the hemoglobin, hematocrit were not statistically significant (P=0.337, 0.213). In addition, the level of iron, total iron binding capacity, and ferritin were not statistically significantly related to the endometrial thickness (P=0.604, 0.459, 0.139). CONCLUSION: The endometrium was thicker in adolescent females with DUB than those with other gynecologic problems. The anemia was proportionate to the endometrial thickness in all subjects of this study. However, in the DUB group only, the anemia and body iron status were not affected by the endometrial thickness.