Study on the Effects of the Family Support in the Very Low Birth Weight Infants Follow-Up: Focus on Dodam Dodam Bring-Up Center / 대한주산의학회잡지

PURPOSE: After discharge from the hospital, very low birth weight infants require care consultation, information, and interaction and so forth, due to sequelae, different growth and developmental pattern; which increase the burdens and the worries of patients in nurturing them. With the counseling of experts in the related fields, the authors and the Food for the Hungry have run a department of childcare for a year, emphasizing on more family support than extreme early detection of disabilities. This study reports on relieving child care anxiety, promoting growth and development, educating parents on home treatment of sequelae, finding and coping with minor disabilities. METHODS: The subjects were chosen among infants under 1,500 g of birth weight and younger than a corrected age of 6 months. Meetings were held once in a month for a year. Infant care support classes were taught by experts in their fields including a music therapist (with play program), neonatologist, a children's nurse, a child-care director, a clinical psychologist, a rehabilitation therapist, a social worker and, a nutritionist. Within the self-dependent groups, the families were able to share their concerns and experiences on child-caring. Second home visits were carried out to monitor home oxygen therapy, tube feeding, cerebral palsy signs, and to find neglect or abuse in suspected cases. RESULTS: Fifty-one infants participated; the average weight was 1,060 g, the average gestational age was 27 weeks and 2 days. Eighteen were boys and 23 girls. The average age of the mothers was 33.4, and there were 26 appropriate for gestational age, 8 small for gestational age, and, 5 large for gestational age. Twenty three were first-born, 13 were second-born, 1 was third-born, and twins were 4 pairs. Home visits were done in 33 families, and secondary visits were done in 6 families. The depression score of mothers in the attendant group decreased from 10.47+/-5.18 to 8.18+/-5.87 (P=0.080). CONCLUSION: The depression score of mothers in the attendant group decreased after infant care support classes.

A case of pyogenic liver abscess in a 10-year-old girl / 소아과

Pyogenic liver abscesses are rare in children. In pediatric patients, altered host defences seem to play an important role. However, pyogenic liver abscess also occurs in healthy children. We experienced a case of pyogenic liver abscess in a healthy immunocompetent 10-year-old-girl. The patient presented two distinct abscesses: one subphrenic and the other intrahepatic. The intrahepatic abscess resolved with percutaneous drainage and 3 weeks of parenteral antibiotic therapy but the subphrenic abscess which could not be drained needed prolonged parenteral antibiotic therapy in addition to oral antibiotic therapy. We performed follow-up serial CT scan of the abscess cavity to decide on the duration of antibiotic therapy. Here we present this case with a brief review of the literature.

The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection / 소아과

PURPOSE: To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI). METHODS: From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results. RESULTS: VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (> or =36 hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. CONCLUSION: Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

Disorder of Sex Development with 5alpha-reductase Deficiency in Identical Twins / 대한소아내분비학회지

Children with abnormal sex development may present with ambiguous genitalia in the newborn period or lacking of secondary sexual characteristics in puberty. Clinicians should make a prompt and accurate diagnosis and counsel parents on therapeutic options to minimize or avoid medical and psychological complications. 5alpha-reductase deficiency is a rare autosomal recessive disorder of sex development caused by a mutation of the 5alpha-reductase type 2 gene. As a result, there is an abnormality in conversion of testosterone (T) to dihydrotestosterone (DHT) and children with 5alpha-reductase deficiency are born with ambiguous genitalia. Here, we report identical twins who presented with ambiguous genitalia with a 46,XY karyotype and were diagnosed as 5alpha-reductase deficiency.

A Case of Peters' Anomaly / 대한주산의학회잡지

Peters' anomaly is a rare form of anterior segment dysgenesis in which abnormal cleavage of the anterior chamber occurs. It is defined as a congenital central corneal opacity with corresponding defects in the posterior corneal stroma, Descemet's membrane, and endothelium. Peters' anomaly may be associated with other ocular or systemic abnormalities like microphthalmos, colobomata, retinal and optic nerve dysplasia, developmental delay, central nervous system defects, craniofacial abnormalities, seizure disorders, genitourinary malformations, and cardiopulmonary defects. Peters' anomaly may also have an inherited pattern, mostly autosomal recessive and dominant inheritance. Mutations involve the PAX6 gene, RIEG1 gene, and other genes. Management of infants with congenital corneal opacity is quite difficult, but penetrating keratoplasty is known as the effective treatment for visual outcome if it is performed within the first 3 months of life. We recently experienced a case of Peters' anomaly in association with atrial septal defect & chromosomal abnormality, therefore herein present it with a brief review of relevant literature.

A Case of Peters' Anomaly / 대한주산의학회잡지

Peters' anomaly is a rare form of anterior segment dysgenesis in which abnormal cleavage of the anterior chamber occurs. It is defined as a congenital central corneal opacity with corresponding defects in the posterior corneal stroma, Descemet's membrane, and endothelium. Peters' anomaly may be associated with other ocular or systemic abnormalities like microphthalmos, colobomata, retinal and optic nerve dysplasia, developmental delay, central nervous system defects, craniofacial abnormalities, seizure disorders, genitourinary malformations, and cardiopulmonary defects. Peters' anomaly may also have an inherited pattern, mostly autosomal recessive and dominant inheritance. Mutations involve the PAX6 gene, RIEG1 gene, and other genes. Management of infants with congenital corneal opacity is quite difficult, but penetrating keratoplasty is known as the effective treatment for visual outcome if it is performed within the first 3 months of life. We recently experienced a case of Peters' anomaly in association with atrial septal defect & chromosomal abnormality, therefore herein present it with a brief review of relevant literature.