Current Status of the Delivery Rate within the Jurisdiction of Local Government in Korea

Purpose@#This study aimed to analyze the rate of delivery within the jurisdiction of local governments in Korea. @*Methods@#Information regarding the population, number of women of childbearing age, and number of births was extracted from the Korean Statistics Information Service, National Health Insurance Service, and health map of the National Medical Center. We defined the rate of delivery within the jurisdiction of the local government as the ratio of the number of deliveries delivered by maternity facilities in the region to the total number of deliveries of pregnant women living in the region. @*Results@#The average nationwide delivery rate in the jurisdiction of local governments was 48.0%. The Si area was the highest at 54.9%, and the Gun area was the lowest at 22.1%. Compared to 2014, the national average delivery rate in the jurisdiction decreased by 4.3%; however, the gun area increased by 4.9%. The geographic maternity service area was 122 in 2014; however, this number decreased to 104 in 2020. @*Conclusion@#The national average rate of delivery in the jurisdiction of local governments was 48.0%, and the rate decreased between 2014 and 2020.

Experience of Milrinone Treatment for Persistent Pulmonary Hypertension of the Newborn

PURPOSE:Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN. METHODS:Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI. RESULTS:Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage. CONCLUSION:Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.

Urinary Transforming Growth Factor-beta-inducible Gene-h3 in Patients with Glomerular Diseases / 대한신장학회잡지

BACKGOUND: Transforming growth factor-beta (TGF-alpha) has been implicated in the pathogenesis of a number of kidney diseases. However, TGF-alpha is secreted in a latent form requiring extracellular modification to become biologically active. Recently, the activity of TGF-alpha has been assessed by the measurement betaig-h3, a novel TGF-alpha induced gene product. Thus we evaluated the pattern of urinary betaig-h3 expression in various glomerular diseases. METHODS: 64 patients with biopsy-proven primary glomerulonephritis (FSGS 6, HSPN 16, IgAN 20, MPGN I 7, and MesPGN 15), 10 patients with nephrotic syndrome and 12 healthy controls were enrolled in the study. A total 86 subjects (51 males, 59.3% and 35 females, 40.7%, mean age 13.9+/-4.28 years) constituted study population. First morning urine were collected and betaig-h3 in the urine was determined by indirect competitive ELISA (Regen Biotech Inc, Seoul, Korea). RESULTS: betaig-h3 excretion was significantly higher in the urine from patients with HSPN (27.5+/-6.46, p=0.002), with IgAN (40.83+/-12.27, p=0.026), with MPGN I (21.64+/-7.29, p=0.042), MesPGN (26.42+/-6.68, p=0.007). In patients with FSGS (21.65+/-17.12) and minimal change nephrotic syndrome (6.26+/-2.18), mean urinary betaig-h3 excretion was not significant higher than that in control group (3.56+/-0.78). CONCLUSION: Urinary betaig-h3 excretion was high in proliferative renal diseases. However, betaig-h3 excretion was not high in non-proliferative renal diseases.

Current Management of Acute Bronchiolitis in Incheon / 소아알레르기및호흡기학회지

PURPOSE: Although acute bronchiolitis is the most common lower respiratory tract infection in the first year of life, the use of pharmaceutical agents has been debated. The purpose of this study was to examine the current management practice of acute bronchiolitis by pediatricians in Incheon and to compare this with management internationally. METHODS: We sent postal questionnaires to all pediatricians in Incheon to assess their current practice for treating acute bronchiolitis. We analyzed the frequency of bronchodilators, steroids, xanthines use. These results were compared with international management. RESULTS: Of a total 131 questionnaires, 80(61 percent) were returned. Ninety percent of pediatricians used bronchodilator inhalation, either routinely(41 percent) or occasionally(43 percent). Steroid were used by 93 percent of the respondents, always(23 percent) or sometimes (65 percent). Pediatricians in Incheon tended to use pharmaceutical agents more frequently than Australian pediatricians who have consensus guidelines for the management of acute bronchiolitis, and as frequently as Swiss pediatricians who do not. CONCLUSION: Pharmaceutical agents are frequently used in the management of acute bronchiolitis by pediatricians in Incheon. Better therapeutic approaches are needed for bronchiolitis care.

Positive Ratio of Routine EEG in Clinically Diagnosed Child Epilepsy / 대한간질학회지

PURPOSE: Positive ratio of routine EEG in adult epilepsy was widely known, but small number was reported in child epilepsy. Thus, we studied the difference of positive ratios between ages. METHODS: We reviewed the clinical records of 756 patients, who visited the pediatric neurology clinic with more than 2 afebrile seizures except neonatal seizures, from March 1997 to December 2004. Excluded were children with previous history of antiepileptic medication or failure of EEG. Clinical aspects and EEG findings of left 609 patients were evaluated retrospectively. RESULTS: Median age of EEG examination was 7.0 years (range, 3 months to 19.8 years) and male was 339. Number of child under 2 years was 112, 2-4 was 96, 5-9 was 233, 10-14 was 160 and over 15 was 8. All 279 positive past history was known in 222 persons, 98 of them had previous febrile seizures, 37 had CP or MR, 11 had neonatal seizures, 11 had birth asphyxia, 28 was prematurity. Waking EEG was checked in 398, sleep EEG in 547. Abnormal findings were found in 443 (72.7%). Definite epileptiform discharges were found in 388 patients (63.7%), suspicious spike discharges in 37 (6.2%). Patients under 2 years had 50.0% positive ratio of epileptiform discharges, 2-4 had 62.5%, 5-9 had 85.8%, 10-14 had 66.3% and over 15 had 37.5%. CONCLUSIONS: High positive ratio of routine EEG was found in child epilepsy, thus routine EEG seems to be very useful for the first diagnostic examination in child epilepsy.

Hepatitis Complicated with Mycoplasma pneumoniae Infection in Children / 소아과

PURPOSE: Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has been reported rarely in Korea. METHODS: A clinical study was performed on 556 patients of M. pneumoniae pneumonia diagnosed serologically at Gil hospital from January 2001 to December 2004. We reviewed 65 cases among these patients, who had elevated level of serum AST and ALT greater than 50 IU/L respectively without evidence of hepatitis A, B, C, Cytomegalovirus and Ebstein-Barr virus infections. RESULTS: Hepatitis occurred in 11.7% of Mycoplasma pneumoniae pneumonia, especially in fall and winter times. Male to female ratio was 1.2: 1 and the mean age was 4 years and 3 months. Besides hepatitis, cough (95.4%), sputum (52.3%) and dyspnea (12.3%) were common as pulmonary manifestations. And among gastrointestinal manifestations, nausea/vomiting (26.2%) was the most common symptom, followed by poor oral intake (12.3%), diarrhea (12.3%) and abdominal pain (6.2%). In addition to hepatomegaly (4.6%) and splenomegaly (4.6%), coarse breathing sound was the most common physical manifestation, followed by rale (63.1%), pharyngeal injection (26.2%), and rash (10.8%). Anemia was noted in 20.0%, neutrophilia in 10.8%, eosinphilia in 38.5% and thrombocytosis in 6.2%, respectively. Mean level of ESR and CRP was 32.02 mm/hr and 6.69 mg/dL, respectively. Mean level of AST and ALT was 293.80 IU/L and 181.48 IU/L, respectively. Hyperbilirubinemia was noted in 7.7% and hypoalbuminemia was noted in 58.5%. Lobar or lobular pneumonia (78.5%) was the most common finding in chest X-ray and left lower lobe (39.2%) was most commonly affected. Pleural effusion was noted in 26.2%. Mean duration of hospitalization was 9.91 days. Serum AST/ALT level was normalized within 9.94 days and pulmonary consolidation resolved within 14.29 days. CONCLUSION: The prognosis of M. pneumoniae hepatitis is good. However, liver function should be considerately checked in M. pneumoniae infection because its incidence is not so low.

The Effect of Post-natal Weight Changes on the Development of Bronchopulmonary Dysplasia in Infants with Respiratory Distress Syndrome / 소아과

PURPOSE: The subjects were compared and measured for differences in the aspects of weight changes between the groups that developed bronchopulmonary dysplasia(BPD) after treatment and those that did not, to analyze the relations between the patterns of early weight change after birth and the development of BPD. METHODS: Retrospective analysis of medical records were performed for birth weight and a corresponding pattern of weight change after birth and a case history of 70 respiratory distress syndrome (RDS) patients born at Kyunghee Medical Center from September 1999 to December 2002. Patients who developed BPD after being treated for RDS were classified as group A and the rest as group B. Each respective group was subdivided into subgroups of birth weight greater and lesser than 1,500 grams. RESULTS: BPD was observed in 12(17.1%) patients. The duration of initial weight loss and the time to restitution of birth weight were meaningfully longer in group A, and the ratio of initial weight loss to birth weight was significantly greater in group A. On the other hand, when the above comparisons were executed in each group subdivided by birth weight above and below 1500 grams, no significant variables were generated. CONCLUSION: The postulated points to the duration of initial weight loss and time to restitution of birth weight being significantly longer in groups with BPD. It was also confirmed that this group had a greater ratio of initial weight loss(%) to birth weight were confirmed.

A Prospective Study on Duodenitis, Duodenal Ulcer, and Gastric Metaplasia in Children Infected by Helicobacter pylori / 대한소아소화기영양학회지

PURPOSE: Helicobacter pylori (H. pylori) infection has been known to be vital in the pathogenesis of duodenal ulcer disease in children as well as in adults. But the relationship between H. pylori infection and the histopathologic findings of the duodenum has not been explained obviously in children yet. So the aim of this study is to determine whether duodenitis and/or gastric metaplasia in the duodenum increases the risk of duodenal ulcer disease in children infected by H. pylori. METHODS: From October 2001 to April 2004 gastric and duodenal biopsies were performed in 177 children who visited Department of Pediatrics, Gil Hospital, Gachon Medical School. Biopsy sections were stained with hematoxylin and eosin and also with Giemsa for identification of H. pylori. The grades of duodenitis and gastric metaplasia were classified from 0 to 3 and from 0 to 4, respectively. RESULTS: The incidence of H. pylori infection was 54% in total patients. Amongst 163 children with duodenitis there was a lack of correlation between H. pylori infection and the grade of duodenitis. Amongst 11 patients with duodenal ucler, only 4 children were infected by H. pylori. And amongst 5 patients with gastric metaplasia, H. pylori and duodenal ulcer were detected in 2 and 3 children, respectively. The occurrence of duodenal ulcer and gastric metaplasia were increased significantly in proportion to the grade of duodenitis (p<0.0001 and p=0.0365, respectively). CONCLUSION: As opposed to the results of previously reported articles, there were lacks of correlation between H. pylori infection and duodenitis, duodenal ulcer, and gastric metaplasia. So further study hould be done to clarify the effect of H. pylori on the duodenal histopathology in children infected by H. pylori.

Three Cases of Hemolytic Diseases of Newborns due to Anti - E Antibody / 대한주산의학회잡지

No abstract available.

Clinical Review of the Development Epilepsy in Patients with Febrile Seizure

PURPOSE: Febrile seizure is a common neurological disorder in children and it has been reported that it may progress to epilepsy in a few cases. We have set forth to carry out a prospective study of patients who developed epilepsy after febrile seizures to determine their clinical characteristics. METHODS: The subjects of this research were 104 patients who met WHO's definition of epilepsy after at least 6 months had passed since their first seizure of the 612 patients admitted to the pediatrics department of Kyung-hee Medical Center during 5 years from January of 1993 to January of 1998 for their first febrile seizure. Epilepsy was categorized as epileptic seizure according to ILAE(1981). RESULTS: 1) The incidence of epilepsy was highest in children from 3 years to 5 years. 2) Of 104 children who developed epilepsy, 60 children were males and 44 were females. 3) Of children who eventually developed epilepsy, 37% of them had the family history of seizure. 4) Of 612 cases of first attack febile seizure, generalized tonic-clonic type was the most frequent type and at the time of diagnosis of epilepsy, generalized tonic-clonic type was also the most frequent type. 5) The abnormal EEG findings are found in 95% of children who developed epilepsy. CONCLUSIONS: We observed the clinical characteristics of patients who developed epilepsy after febrile seizures, but we feel that continuous research is necessary in establishing a correlation between the two disorders.