Association between the Human Surfactant Protein-A(SP-A) Gene Locus and Respiratory Distress Syndrome in Korean Neonates / 소아과

PURPOSE: Respiratory distress syndrome(RDS) is caused by a deficiency of pulmonary surfactant, which is a lipoprotein complex. Both low levels of surfactant protein A(SP-A) and SP-A alleles have been associated with RDS. However, the genes underlying susceptibility to RDS are insufficiently known. The candidate-gene approach was used to study the association between the SP-A gene locus and RDS in the genetically homogeneous Korean population. METHODS: A PCR-cRFLP-based methodology was used to detect SP-A genotype. Twenty four neonates with RDS were matched pairwise to those without RDS. RESULTS: The frequencies of specific genotypes such as 6A(2), 1A(0) were increased, but the frequency of specific 1A(2) genotype was increased in control group. 6A(2)/1A(0) were also increased in the RDS group. Infants who did not have RDS develop, despite prematurity and lack of steroid therapy, had a higher frequency of the 1A(2) allele than infants who had received steroid therapy and had RDS develop. However, infants who had received steroid therapy and had RDS develop had a higher frequency of the 1A(0) allele than infants who did not have RDS develop, despite prematurity and lack of steroid therapy. CONCLUSION: SP-A alleles/haplotypes are susceptible(6A(2), 1A(0), 6A(2)/1A(0)) or protective(1A(2)) factors for RDS. We conclude that the SP-A gene locus is an important determinant for predisposition to RDS in neonates

Assessment of Cardiac Function in Neonates by Using Tissue Doppler Imaging / 소아과

PURPOSE: Tissue Doppler imaging(TDI) is recently being used for assessement of regional ventricular function in adults. However, data in neonates have not been established yet. The aim of this study is to establish reference values of TDI velocities and to investigate the effect of other factors on TDI velocites in the neonatal population. METHODS: Forty eight healthy neonates with anatomically normal hearts from July 2003 to August 2003 were enrolled. Blood was collected after 12 hours of birth and Troponin T(TnT) was measured. TDI of mitral and tricuspid annulus was obtained from apical four chamber views within three days. TDI measurements included peak early diastolic annular velocity, peak diastolic annular velocity with atrial contraction, peak systolic annular velocity and duration of systole. RESULTS: In neonates, peak systolic velocity and peak diastolic velocity were lower than those of children and adults. The ratio of peak early diastolic velocity to peak diastolic velocity with atrial contraction(e'/a') was lower compared with known data in children and adults. With faster heart rates, peak early diastolic velocity and peak systolic velocity of mitral septal annulus and peak early diastolic velocity of tricuspid lateral annulus were significantly increased. PFO, PDA and TR did not affect TDI parameters. CONCLUSION: Annular TDI parameters of neonates were different from those of children and adults. TDI is a simple, rapid tool for assessing global ventricular function and the data of this study can be used as reference values for ventricular dysfunction in the neonatal period.

A Case of Multiple Septic Arthritis by Streptococcus pneumoniae in Kawasaki Disease / 소아과

In Kawasaki disease, arthritis may occur, generally affecting the hands, knees, ankles, or hips. Operations have not usually been needed. We report a case of Kawasaki Disease with multiple septic arthritis which was caused by S. pneumoniae and which needed athrotomy with drainage for both hips, both knees, and both ankle joints. A two year, ten-month-old girl was admitted to our pediatric department. She had a high fever for four days, erythema of the oral and pharyngeal mucosa with a "strawberry" tongue and dry, cracked lips and scarlatiniform rash around the neck and in the groin area, perianal desquamation and a nonsuppurative left cervical lymphadenopathy. At first, we diagnosed her condition as typical Kawasaki disease, and treated her with intravenous immunoglobulin(IVIG) and aspirin. On the sixth admission day, arthralgia developed in both hip joints. She refused to bear weight on the both lower limbs and resisted all passive motion of the hip. An ultrasonogram of the both hip joints revealed an effusion, and four milliliters of grossly purulent material was aspirated from them. Gram staining of this material showed many leukocytes and Gram-positive diplococci. The finding was consistent with septic arthritis. An open arthrotomy of the hip was done and antibiotics prescribed. On the 7th admission day, the findings of multiple athritis were found including ultrasonogram, in both hips, both knees, both ankles, both shoulders, and both elbow joints as well as both wrist joints. The purulent material culture from the left hip and right knee joints' fluid revealed S. pneumoniae. On the 9th and 11th admission day, arthrostomy was performed on the both hips, both knees, and both ankle joints.