Early stress hyperglycemia as independent predictor of increased mortality in preterm infants / 소아과

Purpose: Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods: In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results: There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion: Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.

The relationship between leptin adiponectin ratio and insulin resistance in healthy children / 소아과

PURPOSE: Leptin and adiponectin are two representative adipocytokines. Leptin increases, but adiponectin decreases, with obesity and insulin resistance. We aimed to study the relationship between the leptin/adiponectin ratio and insulin resistance in healthy children. METHODS: Seventy-seven healthy children (36 boys and 41 girls) were enrolled in this study. Anthropometric measurements were performed, and the percentage of weight for height (%WFH) was calculated in each subject. Fasting plasma levels of glucose, insulin, leptin, adiponectin, testosterone, estradiol, and sex-hormone binding globulin (SHBG) were measured. The free androgen index (FAI) was used as a representative of testosterone bioactivity. The homeostasis model assessment was used to estimate the degree of insulin resistance (HOMA-IR). RESULTS: In the boys, HOMA-IR was significantly correlated with age, pubertal stage, free androgen index (FAI), leptin, and the leptin/adiponectin ratio. HOMA-IR was also significantly related to age, percentage of weight for height (%WFH), pubertal stage, estradiol, leptin, and the leptin/adiponectin ratio in girls. The leptin/adiponectin ratio was independently related to HOMA-IR after adjusting for age, %WFH, and FAI in the boys (P<0.05). The leptin/adiponectin ratio was not independently related to HOMA-IR after adjusting for age, %WFH, and estradiol in girls. CONCLUSION: In non-obese healthy children, the leptin/adiponectin ratio was significantly correlated with insulin resistance. The leptin/adiponectin ratio was independently related to insulin resistance even after adjusting for age, degree of obesity, and androgen levels in healthy boys.

A case of Spontaneous Transsphenoidal Encephalocele with Recurrent Bacterial Meningitis

Encephaloceles are congenital defects in the skull through which menings and brain tissues herniated. Basal encephaloceles are found in 1 in 40,000 live births. Transsphenoidal basal encephaloceles are very rare, accounting for only 5% of all basal encephaloceles. Currently, most encephaloceles are diagnosed antenatally and present at birth. Postnatally, infants may present with CSF rhinorrhea, recurrent meningitis, headache, hypothalamic- pituitary dysfunction. Some, particularly trasnssphenoidal encephaloceles are often clinically occult and diagnosis of the disease may be postponed up to adulthood. Surgical indications and approaches for transsphenoidal encephaloceles have been remained controversial. We report a case of CSF rhinorrhea and recurrent meningitis caused by transsphenoidal encephalocele.

Successful Treatment of Aortic Thrombosis after Umbilical Catheterization with Low-Molecular-Weight Heparin

Aortic thrombosis is one of the common complications caused by umblical cord catheterization. There are three treatment options for aortic thrombosis:anticoagulation, thrombolysis, surgery. Low-molecular-weight heparin has several advantages over unfractionized heparin in the treatment of thrombosis. However, there is limited experience on using low-molecular-weight heparin in children, especially in the newborns. We experienced a case of aortic thrombosis caused by umbilical cord catheterization, which was successfully treated with low-molecular-weight heparin.

A Case of Goldenhar's Syndrome with Vesicoureteral Reflux / 대한주산의학회잡지

Goldenhar's syndrome is a kind of congenital anomaly with epibulbar dermoid, preauricular skin tag, blind-ended fistula and vertebral anomaly. The primary cause is unknown but thought to be a structural developmental abnormalities of the 1st, and 2nd branchial arch. In this syndrome, we can observe characteristic anomalies of the face, ear, vertebrae, heart, and the nervous system. Treatment is surgical correction, removal of epibulbar dermoid, prevention of hearing loss through early hearing test. The consultations of ophthalmologist, otorhinolaryngologist, orthopedist and dentist are necessary for this syndrome. We report a case of Goldenhar's syndrome with hemifacial hypoplasia, preauricular skin tags, blind-ended fistulas, hemivertebrae and vesicoureteral reflux.

A Case of Goldenhar's Syndrome with Vesicoureteral Reflux / 대한주산의학회잡지

Goldenhar's syndrome is a kind of congenital anomaly with epibulbar dermoid, preauricular skin tag, blind-ended fistula and vertebral anomaly. The primary cause is unknown but thought to be a structural developmental abnormalities of the 1st, and 2nd branchial arch. In this syndrome, we can observe characteristic anomalies of the face, ear, vertebrae, heart, and the nervous system. Treatment is surgical correction, removal of epibulbar dermoid, prevention of hearing loss through early hearing test. The consultations of ophthalmologist, otorhinolaryngologist, orthopedist and dentist are necessary for this syndrome. We report a case of Goldenhar's syndrome with hemifacial hypoplasia, preauricular skin tags, blind-ended fistulas, hemivertebrae and vesicoureteral reflux.