Prophylactic Treatment of Anemia of Prematurity with Recombinant Human Erythropoietin and High Doses of Iron

PURPOSE: We conducted randomized study to determine whether high doses (6mg/kg/ day) of iron would exert a more supplemental effect than low doses (3mg/kg/day), and which regimen of recombinant human erythropoietin (rHuEPO) and iron would be more beneficial in the prophylactic treatment of anemia of prematurity. METHODS: We randomly assigned 38 sick premature infants who were more likely than symptom-free premature infants requiring erythrocyte transfusions for infants with anemia of prematurity to receive rHuEPO, 100unit/kg, tiw, subcutaneously, plus iron, 3mg/kg/day, po, daily from the second day of life (group 1), 100unit/kg and 6mg/kg/ day (group 2), 200unit/kg and 3mg/kg/day (group 3), and 200unit/kg and 6mg/kg/day (group 4), respectively. RESULTS: There were no significant differences of hemoglobin levels and iron balances during treatment among all 4 groups. The rates of increase in reticulocyte counts were greater in group 4 and group 2 compared with group 3 and group 1, respectively, though these rates were statistically not significant. The blood volume differences (volume of phlebotomies-volume of transfusions) during treatment were higher in group 4 compared with group 1 (p<0.05). CONCLUSIONS: High doses of iron may be more effective in rapidly increasing reticulocyte counts, and 200unit/kg, tiw of rHuEPO plus 6mg/kg/day of iron is more beneficial in reducing the need for blood transfusions than any other regimen. Therefore the prophylactic treatment of anemia of prematurity and acute blood loss from frequent blood sampling in risky premature infants with rHuEPO, 200unit/kg, tiw, subcutaneously, plus iron 6mg/kg/day, po, daily from the second day of life is effective in reducing the number of blood transfusions. Additional controlled trials utilizing high doses of iron with rHuEPO and larger numbers of patients are justified.

A Case Report of Autoimmune Hepatitis Associated with Choledochal Cyst and Pancreatitis

Autoimmune hepatitis in children is a rare and severe inflammatory disease of unknown etiology, and progress to cirrohosis and liver failure, generally is responsive to immunosuppressive therapy. It is more prevalent in women than men, and characterized by the presence of circulating autoantibodies, a high serum globulin. Extrahepatic manifestations such as thyroiditis, ulcerative colitis, glomerulonephritis and autoimmune hemolytic anemia, are associated. We report, to our knowledge, the first case of autoimmune hepatitis in conjunction with choledochal cyst and pancreatitis in 11-year-old female patient. At the time of diagnosis, she suffered from acute upper abdominal pain, jaundice, and pallor. Laboratory findings showed Cooms positive hemolytic anemia, hypergammaglobulinemia, hyperbilirubinemia, and high serum transaminases. Antinuclear antibody was of homogeneous type. In liver biopsy, cellular infiltrates largely lymphocytes were noted. Treatment with corticosteroids induced clinical, biochemical remission, but subsequent withdrawal leaded to relapse. Incidentally choledochal cyst were found and then acute pancreatitis developed. After management for acute pancreatitis, surgical resection of cyst with hepatojejunostomy was performed.

A Study on Blood Lead Levels in Pediatric Inpatients

Lead is one of the most widespread environmental toxins and its poisoning in children was considered a rarity, usually resulting from unique circumstances such as inappropriate use of leadbased body cosmetics or direct administration of lead-containing folk medicines. The increasing concern about children with lower levels of lead exposure has developed, but there are no data regarding the mean blood lead levels and the incidence of symptomatic or asymptomatic lead poisoning in Korean children. We analyzed the zinc protoporphyrine (ZPP) values and blood lead concentrations in 163 pediatric inpatients for a prospective study of lead exposure. The blood lead concentrations in all 163 children were 15~54 g/dl, of whom 111 children (68.1%) were 25~54 g/dl which needs decision to chelate based on the EDTA provocation test. Among 111 children whose blood lead concentrations are 25~54 g/dl, 59 children(53.2%) were between 7 months and 3 years of age, which revealed no significant higher incidence of lead exposure than any other age group. The ZPP values in 126 children (77.3%) were above 35 g/dl. The mean blood lead concentration and ZPP values are 27.8 g/dl and 48.8 g/dl, respectively. We conclude that there are many asymptomatic children with increased absorption of lead in the urban area of Korea, and we need further studies regarding lead poisoning. It is important that there must be a national counterplan and that pediatricians continue to pay attention to lead posioning in children.

A clinical study of neonatal sepsis

The 35 newborns with neonatal sepsis admitted to the Neonatal Intensive Care unit of Dong-A University Hospital during 2 years and 6 months from April 1990 to October 1992, and were reviewed on the bases of incidence, clinical manifestations, underlying conditions, etiologic organisms, results or antibiotics sensitivity test and mortality rates. The results were summarized as follows; 1) The incidence of neonatal sepsis was 1.2% and male predominated. Sepsis was more prevalent in premature babies (7.5%) than in full term babies (0.8%). 2) Neonatal sepsis occured more frequently in low birth weight infant below 2500 g(6.3%) than in normal birth weight infant. 3) Underlying conditions associated with neonatal sepsis were as follows; pneumonia (25.7%), HMD (17.1%), urinary tract infection (11.4%), DIC (8.6%). 4) Common clinical manifestations observed in neonatal sepsis were jaundice (45.7%), poor feeding (22.9%), abdominal distension (20.0%), lethargy, convulsion, apnea and diarrhea in order. 5) Blood culture report revealed that gram negative organisms (57.1%) were more frequently associated with neonatal sepsis than gram positive organisms (37.1%). Klebsiella pneumoniae was the most common microorganisms in neonatal sepsis. 6) Vancomycin (100%), cephalothin (84.6%) and chloramphenicol (84.6%) were the sensitive drug to gram positive organisms. Gram negative organisms were sensitive to amikacin (100%), and cephalothin (95%). 7) Overall mortality rate was 17.1% in all patients with neonatal sepsis, 7.7% in gram positive sepsis and 25% in gram negative sepsis. We conclude that the etiologic organisms of neonatal sepsis have been altered, and have to choose appropriate antibiotics which particularly sensitive to these gram negative organisms such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and also have to specify antibiotics according to the predominant organisms of the each institute.