Protective Field Efficacy Study of Influenza Vaccines for Korean Children and Adolescent in 2010-2011 Season / 소아감염

PURPOSE: We conducted a prospective comparative clinical study to determine the field efficacy of the 2010-2011 influenza vaccines [Influenza virus strains; A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2), B/Brisbane/60/2008] in healthy Korean children under 18 years of age. METHODS: In this study, we enrolled subjects aged between 6 months and 18 years and divided them into 2 study groups: a group who received the influenza vaccines (407 subjects), and a control group who did not receive the influenza vaccines (230 subjects). Ours was a multicenter study that involved 7 hospitals, including the Korea Cancer Center Hospital. The study was conducted between September 2010 and February 2011. We collected nasal wash or throat swab samples from subjects who presented with acute febrile respiratory or influenza-like illnesses at the hospital. We used PCR to confirm the presence of the influenza virus in the respiratory samples and characterize the virus type. RESULTS: In this study, we collected 22 respiratory samples from the influenza-vaccinated group and found 3 cases of influenza virus infection. Similarly, we collected 21 samples from the control group and found 12 cases of influenza virus infection among 10 subjects during the study period. We determined the field efficacy of the 2010-2011 seasonal influenza vaccines to be 83.2% in healthy Korean children and adolescents. CONCLUSION: In this study, we determined the field efficacy of the 2010-2011 seasonal influenza vaccines in healthy Korean children and adolescents. We found that the field efficacy of 2010-2011 seasonal influenza vaccines was adequate.

Molecular Serotyping of Group B Streptococcus Isolated from the Pregnant Women by Polymerase Chain Reaction and Sequence Analysis / 소아감염

PURPOSE:This study was performed to investigate the serotype distribution of group B streptococcus (GBS) isolated from pregnant Korean women using molecular methods. METHODS:The study materials included 42 GBS isolates obtained from the vagina and anorectum of pregnant women in Seoul, Korea between 2005 and 2006. Four clinical isolates with known serotypes (Ia, Ib, III, and V) were used for validation of molecular serotyping. We used serotype-specific primers for identification of the serotypes (Ia, Ib, III, V, and VI). To determine the ambiguous serotypes by serotype-specific PCR, sequence analysis of the PCR amplicons which had been amplified with GBS-common primers was used. RESULTS:The serotypes determined by the molecular methods agreed with the previously known 4 serotypes (Ia, Ib, III, and V). The serotypes of all 42 isolates were successfully determined by molecular methods. The distribution of the GBS serotype was as follows in order of frequency: serotype III was found in 12 isolates (28.6%), serotype V was found in 11 isolates (26.2%), serotype Ia was found in 11 isolates (26.2%), serotype VI was found in 4 isolates (9.5%), serotype Ib was found in 2 isolates (4.8%), and serotype II was found in 2 isolates (4.8%). CONCLUSION:Serotypes III, V, and Ia were the most frequently identified serotypes in pregnant Korean women. Molecular serotyping is useful for surveillance of the serotype distribution of GBS in colonized pregnant women and GBS diseases of neonates.

Clinical analysis of febrile infants and children presenting to the pediatric emergency department / 소아과

PURPOSE: We studied clinical patterns of the febrile infants and children presenting to the Pediatric Emergency Department(ED) in the general pediatric population. METHOD: We analyzed 1,764 infants and children who had a history of measured body temperature of 38.3degrees C or higher, before or after arrival at Pediatric ED of Ilsan Paik Hospital from September 2004 to August 2005. We analyzed their clinical patterns, such as the frequency of febrile illness, age distribution, monthly distribution, diagnosis. RESULT: The frequency of the febrile illness at Pediatirc ED was 19.9 percent (1,764/8,881 cases). The percentage of admission into hospital was 26.4 percent. The most common age group presenting to Pediatric ED with febrile illness was the 12-23 months group(22.8 percent) followed by the 4-11 months group and the 2 years group. In May, the most numerous patients presented to the Pediatric ED with febrile illness. The frequency of febrile illness was significant higher in the 'Spring & Summer group' compared to the 'Autumn & Winter group'. The ratio of male to femal was 1.4:1. The most common diagnosis was acute pharyngitis(42.5 percent), followed by acute gastroenteritis (15.3 percent), pneumonia(7.0 percent). CONCLUSION: The frequency of the febrile illness at Pediatirc ED was 19.9 percent. The most numerous patients visited Pediatric ED in May. And, the most common age group was 12-23 months. The proportion of non-urgent disease, such as acute pharyngitis, acute gastroenteritis, acute nasopharyngitis and acute bronchitis, was high. There is a need to educate parents and improve the medical system in Korea.

Clinical Feature and Dietary Pattern of Infantile Constipation Under Two Years of Age / 대한소아소화기영양학회지

PURPOSE: Infantile constipation is one of the most common problems in pediatric gastrointestinal outpatient clinic. We planed to show the clinical feature of infantile constipation and explore the possible relationship between diets and symptoms of constipation. METHODS: We analyzed the medical records and telephone questionnaire about infants under 2 years of age with constipation, who visited outpatient clinic of Department of Pediatrics, Ilsan Paik Hospital during the time from March 2002 to February 2005. Data including the symptoms and signs of constipation, diet history, and past-medical history were analyzed. RESULTS: Total 96 infants, 40 male and 56 female, were enrolled in this study. The mean age was 9 months. Twenty-three infants were exclusively breast milk fed (BMF), 20 infants were cow's milk fed (CMF) and 53 infants had a history of mixed feeding with cow's milk and breast milk (MMF). Patients showed painful defecation (95.8%), abdominal distension (53.1%), palpable rectal stool (35.1%), hard stool (30.2%), blood-tinged stool (29.2%) and anal fissure (16.7%). Patients with exclusive cow milk feeding had prominent clinical features, such as anal fissure (p=0.03), hematochezia (p=0.04) and palpable rectal stool (p=0.025). Patients who had a history of larger intake of liquid food had a tendency to get anal skin tag (p<0.05). CONCLUSION: Exclusive breast milk feeding seemed important to avoid constipation with clinical significance. To educate caregivers in appropriate way of the weaning food may help the infants with constipation.

Group B Streptococcal Colonization Rate in Korean Pregnant Women / 대한산부인과학회지

OBJECTIVE: To evaluate the colonization rate of the group B streptococcus (GBS) in Korean pregnant women and their neonates, and the antimicrobial susceptibility of isolated GBS. METHODS: From March 2005 to May 2005, pregnant women who visited 3 obstetric clinics in Goyang-si and Paju-si for antenatal care after 35 weeks of gestation were enrolled. According to Centers for Disease Control and Prevention (CDC) guideline for collecting and processing clinical specimens for group B streptococcal culture, specimens were obtained from the lower third of the vagina and perianal areas, and then inoculated on Todd-Hewitt broth. The test for antimicrobial susceptibility was performed by a disc diffusion method. RESULTS: Of the 273 pregnant women, 13 (4.8%) had a positive culture from at least 1 site (vaginal culture 6, perianal culture 3, both 4). No GBS colonization was found in their neonates. The antibiotic resistance rate was 53.9% (7/13) for erythromycin and 61.5% (8/13) for clindamycin. CONCLUSION: In this study, the colonization rate of group B streptococci in Korean pregnant women was found to be lower than those reported in USA, Western Europe, and other Asian countries. The antibiotic resistance rate for erythromycin and clindamycin was higher than those reported in other countries. Further evaluation was needed to establish the screening and chemoprophylaxis guideline for Korean pregnant women.

Etiology of Community-acquired Bacteremia in Healthy Children / 소아과

PURPOSE: A full view of the spectrum of all bacterial diseases in healthy children is essential to the establishment of public health priorities. Accurate information on the relative importance of the various pathogens in terms of the age of the affected patients, the site of infection and the case fatality rate are valuable to the clinician in choosing antimicrobial treatments. METHODS: Fifty-nine episodes of bacteremia were analysed. Data were collected at Ilsan Paik Hospital from January 2000 to December 2003. Analysis of each collected episode included isolating pathogen from blood culture, diagnosis, hospital course, isolating pathogens from other tissue sites, and studying results of antimicrobial sensitivity tests. RESULTS: Fifty-nine cases of community-acquired bacteremia were reviewed. The most common pathogen was Staphylococcus aureus (11 cases, 18.6 percent), followed by Salmonella (10 cases, 16.9 percent), E. coli (7 cases, 11.9 percent), Streptococcus pneumoniae (five cases, 8.5 percent), Streptococcus viridans (5 cases 8.5 percent). The most common diagnosis was bacteremia without an indentified focus (61 percent), followed by meningitis (12 percent), bacteremia with enteritis (10.2 percent) and bacteremia with urinary tract infection (8.5 percent). Salmonella was still an important causative agent of bacteremia. The relative importance of Haemophilus influenza and Streptococcus pneumoniae was lower than in other studies. The most common organism responsible for bacteremia without an identified focus was Staphylococcus aureus The case-fatality was 3.4 percent for all cases of bacteremia. CONCLUSION: We reviewed the etiology of community-acquired bacteremia. These data may be useful in the establishment of public health priorities and serve as a reference for selection of antibiotics in the empirical therapy of suspected invasive bacterial infection.

Small Bowel-Mesentery-Small Bowel Fistula Caused by Ingested Magnets / 대한소아소화기영양학회지

Accidental foreign body ingestion is one of the general pediatric problems. If more than one magnet are ingested, they can attract each other across the intestinal wall. This kind of event may cause necrosis, perforation or fistula. Therefore, they must be retrieved by gastroduodenoscopy while they are still in the stomach. The authors have experienced an unusual small bowel complication, which was small bowel-mesentery-small bowel fistula, caused by the ingestion of magnets.

Hippocampal Neurogenesis and Its Phenotypic Differentiation after Kainic Acid-induced Seizures in Mice

BACKGROUND: Proliferation and survival of dentate granule cells are influenced by epileptic seizures. Dentate granule cells might play an important role in the pathogenesis of temporal lobe epilepsy. However, most studies have used the rat model. We investigated the neurogenesis of dentate granule cells by the kainic acid (KA)-induced seizure model in ICR mice. METHODS: Seizures were chemically induced by intraperitoneal injections of KA (30 mg/kg) and seizure behavior grades were evaluated. Bromodeoxyuridine (BrdU, 50 mg/kg) was subsequently administered once a day for 6 consecutive days, starting at 24 hours after KA or saline treatment. Mice were sacrificed 7 days after KA administration. The number of BrdU-positive cells in the hippocampus were counted in every seventh section in a series of 30 micrometer coronal sections. We examined the long-term fate of BrdU-labeled cells after KA-induced seizures by double-labeled immunofluorescence with confocal microscopy, 28 days after the last injection of BrdU. RESULTS: After KA administration, every seizure behavior was graded II or more. Quantitative analysis of BrdU labeling revealed a significantly increased proliferation rate of neural precursor cells after seizures. BrdU-positive cells were increased at least 2-fold in KA injection (83.38+/-44.33, n=5) compared to the controls (35.61+/-17.87, n=6). Most of the newborn cells migrated into the granule cell layer from the subgranular zone after KA-induced seizures (n=6, respectively). The majority of these mitotic cells (89%) were differentiated into neurons. CONCLUSIONS: Our results indicated that mitotic activity in the about hippocampus was enhanced after KA-induced seizures in ICR mice, and that the majority of all BrdU-positive cells showed the phenotypic differentiation to neuronal cells.

Prevalence of Antibodies against Adenoviruses in Korean Children and Adults / 소아과

PURPOSE: Adenoviruses(Ads) are responsible for approximately 10 percent of lower respiratory tract infections(LRTIs) in children. The purpose of this study is to evaluate the prevalence of antibodies (Abs) against common serotypes of Ads in Korean children and adults. METHODS: The sera were tested for neutralizing Abs against Ad serotypes 1 through 7 and 21 with a colorimetric microneutralization assay employing A549 cells. Sera that neutralized 100 TCID50 of specific types of Ad at 1 : 10 dilution were considered positive. RESULTS: Two hundred and thirty seven sera(155 children, 82 adults) were tested. Generally, Ab prevalences were high in infants under 6 months of age, decreased in 6-12 months of age and then increased gradually thereafter. By 4-7 years of age, more than 70 percent of children had Abs against Ad types 1-5 and more than 50 percent had Abs against type 6, and the prevalences of Abs in adults against these types were more than 70 percent. Only against types 7 and 21, Abs were found in less than one quarters of the children. Ab prevalence for Ad 7 was less than 50 percent by 35 years and then jumped to 80 percent, which presumably reflects previous outbreaks of Ad 7 more than 30 years ago. Ab prevalence against type 21 was less than 50 percent throughout adulthood. CONCLUSION: An age-specific increase in antibody prevalence was observed to the common Ads in Korea. We expect these data to be the basis to determine the ages and serotypes of future Ads vaccines by defining the prevalence of neutralizing antibodies to the common Ads.

A Clinical Study on Benign Convulsions with Mild Gastroenteritis / 소아과

PURPOSE: 'Benign convulsions with mild gastroenteritis(BCwMG)' is afebrile seizures associated with gastroenteritis without dehydration or electrolyte imbalance in young children aged almost 6 months to 3 years. Because seizures can occur repeatedly, patients can be misdiagnosed with epilepsy. Therefore, understanding the characteristics of this disease is thought to be important. This study was carried out to investigate the clinical features of the disease. METHODS: From January, 2000 to December, 2003, 17 patients with BCwMG visited the Emergency Department, Inje University Ilsan Paik Hospital. We reviewed the clinical features of seizures, age and sex distribution, laboratory findings and follow-up results. RESULTS: Out of 17 patients with BCwMG, 13 were boys and five girls. Of 17 patients, 14(82.4%) patients were between 1 and 2 years of age. Generalized seizure was observed in all 17 patients. The duration of seizure was between 10 seconds and 10 minutes. Mean seizure frequency was 1.9 times(range, 1-5 times). Two or more seizures occurred in 10 patients(58.8%). All patients had seizures after the onset of gastroenteritis. All episodes occurred within the first five days of gastroenteritis. Rotavirus antigen was positive in stools in eight out of 12 patients(66.7%). Thirteen patients displayed normal psychomotor development at the last follow-up. No patient exhibited a the recurrence of seizures, except for one patient who had a febrile convulsion. CONCLUSION: Our results exhibited that BCwMG is characterized by seizures that are mostly brief and generalized and a cluster of episodes in those aged 1 to 2 years. Seizures occurred within the first three days of gastroenteritis. The proportion of positive rotavirus antigen was more than half.

A Clinical Study on the Etiologies of Acute Seizures in Children Who Visited Emergency Department / 소아과

PURPOSE: Although it is important to know the etiologies of childhood seizures according to age, clinical studies on this topic have been few. The present study was therefore designed to investigate the causes of acute childhood seizures. We hope this study will be helpful in the diagnosis and management of children with seizures. METHODS: This study was retrospectively undertaken to evaluate the age and sex distribution, the clinical seizure types, the seizure causes, and especially the frequencies of age-related seizure causes of 922 cases under 18 years of age, who visited Emergency Departments due to seizures from December, 1999 to January, 2004. RESULTS: The male to female ratio was 1.5 : 1 and the age range was from 1 day to 16 years, 2 months. There were 683 cases(74.1%) with generalized seizures, 61(6.6%) with partial seizures, and 178(19.3%) with unknown clinical seizure types. The causes of seizures were listed as follows : febrile convulsions in 545 cases(59.1%); epilepsies in 229(24.8%); benign convulsions with mild gastroenteritis in 19(1.6%); acute central nervous system infections in 15(1.6%); and metabolic derangements in six(0.7%). Finally, the frequencies of age-related seizure causes were analyzed. Out of 751 cases between 6 months and 5 years of age, 532 cases(70.8%) were febrile convulsions, 122(16.2%) epilepsies, 19(2.5%) benign convulsions with mild gastroenteritis, and 11(1.5%) acute CNS infections. Out of 145 cases among those over 5 years of age, 104 cases(71.7%) were epilepsies, 10(6.9%) febrile convulsions, and three(2.1%) acute CNS infections. CONCLUSION: The above results reveal that the causes of acute childhood seizures in the different age groups are different, and also suggest that febrile convulsion is the most common seizure cause between 6 months and 5 years of age, and epilepsy in more than 5 years of age. We hope that further clinical and epidermiologic studies on this topic will be performed.

Treatment of Severe Small Bowel Involvement in Henoch-Schonlein Purpura: Two Cases Report / 대한소아소화기영양학회지

Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels in skin, joints, gastrointestinal (GI) tract and kidney. GI symptoms occur in up to 85% of patients and may lead to severe problems such as intussusception, obstruction, and perforation. GI symptoms may not be easily controlled, showing refractoriness to the conventional corticosteroid therapy. Although GI involvements of HSP are acute, and self-limited in most instances, they may cause fatal results in some unusual cases. In such conditions all the possible therapeutic modalities should be considered. We report two cases of severe small bowel involvement of HSP. One case presented with severe abdominal pain showing refractoriness to corticosteroid, but improved with IV immunoglobulin therapy. In the second case, HSP with transmural infarction in the small bowel could be cured with surgical intervention.

A Study on the Age-Dependent Ketosis Induced by the Ketogenic Diet / 대한간질학회지

PURPOSE: Ketogenic diet (KD) remains a therapy in search of explanation although it is an established treatment for patients with intractable epilepsy. It has been clinically proven more efficacious at younger ages, presumably because of the enhanced ability of the immature brain to extract and utilize ketone bodies. The study was designed to investigate whether ketosis induced by the KD is age-dependent. METHODS: A KD ([fat]:[protein+carbohydrate] ratio of 4.3:1) was administered to male Sprague-Dawley rats for 3 weeks, while control animals were fed a standard rodent chow. Dietary treatment was initiated at either postnatal 3 or 12 weeks. Blood beta-hydroxybutyrate (BHB) levels were assayed from blood obtained via the tail vein with the Keto-SiteTM reflectance meter and test cards on treatment day 21. RESULTS: Blood BHB levels in the KD-treated group were significantly higher than those in the control group in 3 week-old rats (4.18+/-0.62 [n=30] vs. 0.27+/-0.02 [n=30] mM, respectively; p0.05). CONCLUSIONS: The present study demonstrates that the KD induces more severe ketosis in younger rats. Age-dependent differences in the degree of ketosis induced by the KD may explain that the diet is clinically more efficacious at younger ages.

The Prevalent Rates of Abnormal Serum Aminotransferase Levels and Total Cholesterol Levels among Adolescents with Obesity

PURPOSE: The purpose of this study was to look at prevalences of abnormal serum aminotransferase levels and abnormal serum total cholesterol levels among adolescents with obesity in Seoul area. METHODS: Body mass index[BMI(kg/m2)], serum aspartate aminotransferase(AST) alanine aminotransferase(ALT), and total cholesterol levels were measured in 26,876 adolescents(male : 13,287, female : 13,589) of first grade of high school in Seoul between the ages of 15 and 16 years, enrolled in a large health examination survey by Seoul School Health Center(SSHC) in 2001. Obesity was defined as BMI more than 95th percentile for age and sex and normal weight was defined as BMI between 25th percentile and 75th percentile for age and sex. Abnormal levels of AST, ALT and total cholesterol were defined as more than 95th percentile for age and sex. RESULTS: The BMI at 95th percentile was 28.7 in males and 26.9 in females. The prevalence of abnormal AST levels was higher in obesity group than in normal weight group. In males, those were 23.7% and 3.7%, respectively(P<0.01, x2-value : 529.2). In females, those were 11.8% and 4.9 %, respectively(P<0.01, x2-value : 56.3). The prevalence of abnormal ALT levels was significantly higher in the obesity group compared with the normal weight group. In males, those were 33.9% and 1.7%, respectively(P<0.01, chi2-value : 1,693.4). In females, those were 22.3% and 3.9%, repectively(P<0.01, x2-value : 397.6). The prevalence of abnormal total cholesterol levels was higher in the obesity group than in the normal weight group. In males, those were 16.8% and 3.5%, respectively(P<0.01, x2-value : 268.3). In females, those were 9.0% and 5.4%, respectively(P<0.01, x2- value : 14.2). CONCLUSIONS: This study revealed that the prevalences of abnormal AST, ALT and total cholesterol level were higher in the obese group than in the normal weight group.

Cerebral Salt Wasting Syndrome Associated with Meningitis in a Child

Hyponatremia is commonly seen in those patients with central nervous system injury associated with infection or trauma. And decreasing intracranial pressure through restriction of maintenance fluid and salt is practiced as a routine therapeutic measure in the early stages of meningitis to prevent or ameliorate the syndrome of inappropriate secretion of antidiuretic hormone(SIADH). However, lots of patient do not show the typical symptoms of SIADH, instead they are dehydrated, have low plasma volume, increased urine sodium concentration and increased net sodium loss, which are the symptoms of cerebral salt wasting syndrome(CSW). Recent reports have prompted a reconsideration of CSW distinct from SIADH and moreover CSW has more proportion of hyponatremia associated with acute brain insult. CSW involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. While fluid restriction is the treatment of choice in SIADH, the treatment of CSW consists of vigorous sodium and volume replacement. And by correcting hyponatremic state as soon as possible, we can reduce mortality rate and improve neurologic sequelae. We report a case of CSW which was treated by replacement of vigorous sodium and volume replacement.

A Case of Chronic Pneumonitis of Infancy in Pediatric Interstitial Lung Disease

The interstitial lung diseases(ILD) comprises a large, heterogeneous group of disorders characterized by derangement of alveolar walls and alveolar capillary unit causing restrictive pulmonary dysfunction and disordered gas exchange. It is rare, especially in children, and the opinions on investigation and treatments are controversial. The classification of adult ILD is applied to that of children. But considering occurrence during the developing state of lung and immune systems, we should be more cautious because the clinical manifestations and prognosis will be different from those of adults. In 1995, Katzenstein named a unique type of ILD, chronic pneumonitis of infancy (CPI) for the first time. CPI is characterized by marked alveolar septal thickening, striking type II pneumocyte hyperplasia, and eosinophilic alveolar exudate containing numerous macrophages. We report a 14 month-old girl, who had continuing respiratory difficulty and cyanosis after upper respiratory infection, could not sustain oxygen saturation and was finally diagnosed as CPI by histologic examination.