Late Detection of Thyroid Dysfunction in NICU Patients / 대한주산의학회잡지

OBJECTIVE: To evaluate the incidence, the time of detection, classification, and risk factors of thyroid dysfunction in very low birth weight (VLBW) and sick infants in order to help with the diagnosis and treatment of thyroid dysfunction in the neonatal intensive care unit (NICU). METHODS: We reviewed the medical records of 78 infants, who were admitted for more than 1 month in the NICU at Chungbuk National University Hospital from July 2004 through June 2006. In these infants, at least to 2 thyroid function tests were performed, a initial screening whthin 2 weeks of age and a repeated thyroid function test after 2 weeks of age. RESULTS: 1) The study infants were divided into 2 groups, VLBW (birth weight or =1,500 g). 2) In the VLBW groups (n=48), 24 infants (50%) showed thyroid dysfunction. Six infants (12.5%) were detected at initial screening test and all had transient hypothyroxinemia. The remaining 18 infants (37.5%) were detected at repeated tests, most commonly detected at 4~8 weeks of age (n=8). Their types of thyroid dysfunction were primary hypothyroidism (PH) with a delayed marked TSH rise (n=3), PH with a delayed mild TSH rise (n= 7), euthyroid sick syndrome (ESS, n=8), and central hypopituitary hypothyroidism (HH, n=1). 3) In the NVLBW groups (n=30), 11 infants (36.7%) showed thyroid dysfunction. Three infants (10%) were detected at initial screening test, while 8 (26.7%) were detected at repeated tests. Their types of thyroid dysfunction were PH (n=5), ESS (n=3), transient hyperthyrotropinemia (n=2), and HH (n=1). 4) Among 35 infants with thyroid dysfunction, 20 infants (57.1%) were treated with thyroxine. CONCLUSION: Thyroid dysfunction was very common in sick infants in the neonatal intensive care unit, especially in the very low birth weight infants. Often, they were not detected at the initial screening test, but detected at later repeated tests. The repeated thyroid function test need to be performed in infants at risk for late detection of thyroid dysfunction after 2~4 weeks of age.

Predictive Clinical Factors for the Treatment Response and Relapse Rate in Childhood Idiopathic Nephrotic Syndrome

PURPOSE: This study was aimed to determine the predictive risk factors for the treatment response and relapse rate in children diagnosed with idiopathic nephrotic syndrome. METHODS: We analyzed the medical records of children who were diagnosed and treated for childhood idiopathic nephrotic syndrome from November 1991 to May 2005. Variables selected in this study were age at onset, sex, laboratory data, concomitant bacterial infections, days to remission, and interval to first relapse. RESULTS: There were 46 males and 11 females, giving a male:female ratio of 4.2:1. The age(mean+/-SD) of patients was 5.8+/-4.1 years old. Of all patients who were initially given corticosteroids, complete remission(CR) was observed in 54(94.7%). Of the 54 patients who showed CR with initial treatment, 40(70.2%) showed CR within 2 weeks and 14(24.6%) showed CR after 2 weeks. The levels of serum IgG were lower in the latter group who showed CR after 2 weeks(P=0.036). Of the 54 patients who showed CR with initial treatment, 47(82.5%) relapsed. Of these patients, 35.1% were frequent relapsers and 43.9% were infrequent relapsers. There was no significant correlation between the frequency of relapse and the following variables:sex, days to remission, and laboratory data. However, age at onset and interval to first relapse had a negative correlation with the frequency of relapse (Pearson's coefficient=-0.337, -0.433, P<0.012, P<0.01). CONCLUSION: The age at onset and the interval to first relapse were found to be predictive clinical parameters for the relapse rate, while the levels of serum IgG at initial presentation were a predictive laboratory factor for treatment response in childhood idiopathic nephrotic syndrome.

A Case of Acetaminophen-induced Acute Interstitial Nephritis Presenting with Acute Renal Failure

Acute interstital nephritis can occur by acetaminophen, but it is rarely presented as acute renal failure with azotemia. We report a case of acute interstitial nephritis induced by acetaminophen in a 14-year-old girl who developed non-oliguric acute renal failure. She has taken acetaminophen to control the persistent throat pain for the last two months. Renal biopsy revealed diffuse infiltration of mononuclear inflammatory cells admixed with eosinophils in the edematous interstitia. After the discontinuation of acetaminophen and the administration of corticosteroid, the serum creatinine level returned to normal.

A Case of Acute Renal Failure due to Rhabdomyolysis Induced by Convulsion

Rhabdomyolysis is a syndrome resulting from skeletal muscle injury with release of muscle cell contents into the plasma. It has been reported as a cause of acute renal failure(ARF), and often associated with alcohol abuse, muscle compression, infections, and generalized seizure. Rhabdomyolysis-induced ARF is rare in children. We experienced a case of rhabdomyolysis-induced ARF in a 12-year-old boy who presented with azotemia and oliguria secondary to convulsion. After the control of convulsion by antiepileptic drugs, the daily urine output gradually increased and systemic features recovered with appropriate hydration and alkalinization.