Comparison of Clinical Manifestation and Laboratory Findings between H1N1 and Influenza B Infection / 소아알레르기및호흡기학회지

PURPOSE: Influenza virus is one of the most important viruses that cause the respiratory infection seasonally. In April 2009, H1N1 was detected in America and Mexico and then there was pandemic in Korea. We investigated the difference of clinical and laboratory findings between the infections of H1N1 and Influenza B. METHODS: We have retrospectively studied the patients under age of 15 years who visited Inje University Sanggye Paik Hospital from August 2009 to April 2010. Evaluation for influenza infection was performed by rapid antigen test or multiplex reverse transcriptase polymerase chain reaction. Complete blood count with differential counts, C-reactive protein and chest X-ray were checked. RESULTS: Enrolled patients were 2,226 in H1N1-infected group and 288 in influenza B-infected group. Seasonal variation was that H1N1 in autumn and winter but influenza B in spring. The male-to-female sex ratio was same as 1.23 in each group. The mean age of H1N1-infected group was higher than influenza B-infected group (P<0.001). Fever was developed similarly in both groups (P=0.114). However, cough, sputum, rhinorrhea, vomiting, diarrhea, and headache were more prevalent in influenza B infection compared to H1N1 infection (P<0.001). Pneumonia development and admission rate were higher in influenza B infection compared to H1N1 infection (P<0.001, respectively). CONCLUSION: Although H1N1 infection spread rapidly, H1N1 caused not so severe symptoms than influenza B. Because of the possibility that influenza epidemic will develop repeatedly in the future, we need to evaluate more about different characteristics depending on the virus subtype and prepare for them.

Clinical characteristics of vitamin D deficiency rickets in infants and preschool children / 소아과

PURPOSE: Vitamin D deficiency rickets is a significant public health problem that results from insufficient exposure to sunlight and inadequate vitamin D supplementation. The purpose of this study is to identify the clinical characteristics of vitamin D deficiency rickets in infants. METHODS: Data of 35 infants diagnosed as vitamin D deficiency rickets at Sanggye-Paik Hospital, Seoul, Korea, from March 2007 to May 2009 were reviewed. Children with plasma 25-hydroxyvitamin D levels <15 ng/mL and 15-30 ng/mL were considered to have vitamin D deficiency and vitamin D insufficiency, respectively. RESULTS: Thirty-five infants (22 boys, 13 girls) were diagnosed with rickets. Mean age at diagnosis was 7.4+/-7.1 months (range: 0.1-29.8 months). Eighteen infants (51%) were vitamin D deficient and seventeen infants (49%) were insufficient. Twenty-eight of all (80%) diagnosed as subclinical rickets. Twenty-nine infants (83%) were below the age of 12months. Twenty infants (57%) had breastfed and ten infants (29%) had iron deficiency anemia. Nine of breastfed infants (45%) were vitamin D deficient and ten of their mothers were vitamin D insufficient. Overall, radiographic evidence of rickets was present in 93% of the cases. Radiographic sign of rickets was evident even in vitamin D insufficient state. CONCLUSION: It is important for the clinician to screen for subclinical vitamin D deficiency rickets in inadequately supplemented infants by pairing 25-hydroxyvitamin D levels with wrist radiographs. A nationwide epidemiological study of vitamin D deficiency rickets must be conducted and evidence-based national guidelines must be defined to prevent rickets.

Study on the neurodevelopmental predictors for the results of the Bayley Scales of Infant Development II in high-risk neonates / 소아과

PURPOSE: To identify the risk factors for poor neurodevelopmental outcomes in high-risk neonates. METHODS: We studied 94 infants admitted to the neonatal intensive care unit at the Sanggye Paik Hospital between January 2002 and November 2005 and evaluated the follow-up data. The following events were considered as risk factors: < or =32 weeks of gestation, very low birth weight, Apgar scores of less than 5, neonatal resuscitation, neonatal seizure, congenital infection, and abnormalities in cranial ultrasound or magnetic resonance imaging (MRI). The infants who had any one of these risk factors were included. They were evaluated at their mean corrected age of 13.84+/-8.03 months. Mental and Psychomotor Developmental Indices (MDI, PDI) were determined by a clinical psychologist using the Bayley Scales of Infant Development II. RESULTS: The mean MDI and PDI of all the patients were 96.28+/-26.70 and 94.00+/-22.80, respectively. Abnormalities on cranial ultrasound or MRI were significant predictors of both low MDI (P<0.05) and low PDI (P<0.001). These abnormalities showed a stronger association with low PDI than with low MDI. The infants with periventricular leukomalacia had the lowest MDI and PDI (70.10+/-28.68 and 69.70+/-24.91, respectively). Apgar score at 1 minute and very low birth weight were also significant predictors for low PDI (P<0.05, P<0.05, respectively). CONCLUSION: Image findings with cranial ultrasound or MRI were the strongest predictors of neurodevelopmental outcome. Periventricular leukomalacia was the best predictive factor for mental and psychomotor development.

Study on the neurodevelopmental predictors for the results of the Bayley Scales of Infant Development II in high-risk neonates / 소아과

PURPOSE: To identify the risk factors for poor neurodevelopmental outcomes in high-risk neonates. METHODS: We studied 94 infants admitted to the neonatal intensive care unit at the Sanggye Paik Hospital between January 2002 and November 2005 and evaluated the follow-up data. The following events were considered as risk factors: < or =32 weeks of gestation, very low birth weight, Apgar scores of less than 5, neonatal resuscitation, neonatal seizure, congenital infection, and abnormalities in cranial ultrasound or magnetic resonance imaging (MRI). The infants who had any one of these risk factors were included. They were evaluated at their mean corrected age of 13.84+/-8.03 months. Mental and Psychomotor Developmental Indices (MDI, PDI) were determined by a clinical psychologist using the Bayley Scales of Infant Development II. RESULTS: The mean MDI and PDI of all the patients were 96.28+/-26.70 and 94.00+/-22.80, respectively. Abnormalities on cranial ultrasound or MRI were significant predictors of both low MDI (P<0.05) and low PDI (P<0.001). These abnormalities showed a stronger association with low PDI than with low MDI. The infants with periventricular leukomalacia had the lowest MDI and PDI (70.10+/-28.68 and 69.70+/-24.91, respectively). Apgar score at 1 minute and very low birth weight were also significant predictors for low PDI (P<0.05, P<0.05, respectively). CONCLUSION: Image findings with cranial ultrasound or MRI were the strongest predictors of neurodevelopmental outcome. Periventricular leukomalacia was the best predictive factor for mental and psychomotor development.

Questionnaire-based analysis of growth-promoting attempts among children visiting a university growth clinic / 소아과

PURPOSE: Growth-promoting attempts are widespread in Korea, but little is known about their prevalence or associated factors. This study was designed to assess the prevalence of growth-promoting attempts among children visiting a university growth clinic. METHODS: A questionnaire-based survey was carried out with 823 children (416 boys, 407 girls) who visited the growth clinic at Paik Hospital. RESULTS: The mean age of the subjects was 10.4+/-2.6 yr, and the height z-score was -1.58+/-0.91. Approximately 33.4% of the children had tried growth promotion. Among the height-gain methods, herbal medicine was the most frequently used (37.8%), followed by health-promoting supplements (37.1%), exercise or machine (3.0%), and growth hormone treatment (2.9%). The mean age at which the parents began to worry about their children's height was 7.7 yr. The mean age at which they started height-gain methods was 8.9 yr for herbal medicine, 9.1 yr for health-promoting supplements, 9.4 yr for exercise or machine, and 9.9 yr for growth hormone treatment. Motivating factors included advice from relatives or friends (36.0%), advertisements in the Internet or newspaper (28.4%), advice from pharmacist (16.8%), and advice from their medical doctor (5.5%). The degree of satisfaction from the height-gain methods was 29.1% with growth hormone treatment, 6.6% with exercise or machine, 6.4% with herbal medicine, and 2.8% with growth-promoting supplements. CONCLUSION: Approximately one third of the children reported use of growth-promoting methods, but the satisfaction rate was not high. The benefits of growth-promoting methods should be carefully weighed against their costs and side effects.

Questionnaire-based analysis of growth-promoting attempts among children visiting a university growth clinic / 소아과

PURPOSE: Growth-promoting attempts are widespread in Korea, but little is known about their prevalence or associated factors. This study was designed to assess the prevalence of growth-promoting attempts among children visiting a university growth clinic. METHODS: A questionnaire-based survey was carried out with 823 children (416 boys, 407 girls) who visited the growth clinic at Paik Hospital. RESULTS: The mean age of the subjects was 10.4+/-2.6 yr, and the height z-score was -1.58+/-0.91. Approximately 33.4% of the children had tried growth promotion. Among the height-gain methods, herbal medicine was the most frequently used (37.8%), followed by health-promoting supplements (37.1%), exercise or machine (3.0%), and growth hormone treatment (2.9%). The mean age at which the parents began to worry about their children's height was 7.7 yr. The mean age at which they started height-gain methods was 8.9 yr for herbal medicine, 9.1 yr for health-promoting supplements, 9.4 yr for exercise or machine, and 9.9 yr for growth hormone treatment. Motivating factors included advice from relatives or friends (36.0%), advertisements in the Internet or newspaper (28.4%), advice from pharmacist (16.8%), and advice from their medical doctor (5.5%). The degree of satisfaction from the height-gain methods was 29.1% with growth hormone treatment, 6.6% with exercise or machine, 6.4% with herbal medicine, and 2.8% with growth-promoting supplements. CONCLUSION: Approximately one third of the children reported use of growth-promoting methods, but the satisfaction rate was not high. The benefits of growth-promoting methods should be carefully weighed against their costs and side effects.

Preliminary analysis of metabolic syndrome components in Korean adolescents by using Korean national health and nutrition examination Survey pooling data (1998, 2001, and 2005) / 소아과

PURPOSE: This study aimed to estimate age-and gender-specific cut points for metabolic syndrome (MS) components, including body mass index (BMI), blood pressure (BP), triglycerides, high-density lipoprotein (HDL) cholesterol, and glucose. METHODS: Data from the 1998, 2001, and 2005 Korean NHANES (National Health and Nutrition Examination Survey) were analyzed (n=4164;2,139 boys and 2,025 girls, aged 10-19 years). Height, weight, waist circumference (WC), BP, triglycerides, HDL cholesterol, and fasting glucose were measured. RESULTS: BMI over 25 kg/m2 represents the 85thP (percentile) in 17-year-old boys and the 90thP in 17-year-old girls. A level of WC higher than that of the cutoff points of Asian adults was found in the 90thP of 17-year-old boys and girls. The 90thP of boys aged 15 years old and the 95thP of 13-year-old were included in the range of systolic BP over 130 mm Hg. Over the 75thP of the group showed triglycerides greater than 110 mg/dL, (criterion of MS presented by NCEP-ATP III) and the 90thP of the group showed triglycerides greater than 150 mg/dL by IDF. An HDL cholesterol level of 40 mg/dL represents the 25thP in boys and the 10thP in girls. A glucose level greater than 110 mg/dL represents the 95thP and greater than 100 mg/dL represents the 90thP. CONCLUSION: Values of the 90thP of MS components in late adolescent boys (WC, BP, and triglycerides) and girls (WC and triglycerides) were very high and in close proximity to the diagnostic criteria of adult MS.

Relationship with Eosinophil Cationic Protein (ECP)/Eosinophil-derived Neurotoxin (EDN) Levels and Growth Status among Asthmatic Children / 대한소아내분비학회지

PURPOSE: Short statue or obesity has been reported in asthmatic children, but the results are inconsistent. Recently eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN) levels has been known as important markers of airway inflammation and reflect asthma severity as well. The aim of this study is to evaluate the growth status and to analyze the possible relation with serum EDN and ECP levels. METHODS: A total of 90 children (57 boys and 33 girls, 4 to 16 years old) who had been admitted for bronchial asthma were included. To standardize the data for age and sex, standard deviation scores (SDS) were calculated for height and weight. Values less than -2 SDS below the mean were considered to be extremely low, -1 SDS to 1 SDS as normal, values higher than 2 SDS considered very high. Serum EDN and ECP levels were measured. RESULTS: The mean height SDS was 0.33+/-0.85 and weight SDS was 0.23+/-1.20. The prevalence of short stature was 2.2%, normal stature 75.5%, and tall stature 22.2%. The prevalence of underweight was 7.8%, normal weight 71.1%, and overweight 21.1%. Height SDS was negatively correlated with serum ECP (r=-0.27, P=0.01) and EDN (r=-0.27, P=0.009) and weight SDS was negatively correlated with serum ECP (r=-0.20, P=0.05). Height SDS were significantly lower in high ECP and EDN groups compared to normal ECP and EDN groups (P<0.01 and P<0.009, respectively). Weight SDS was lower in high ECP group compared to normal ECP group (P<0.05). CONCLUSION: Growth (height and weight) was inversely correlated with serum EDN and ECP levels. These results suggest that high ECP and EDN levels might be related with growth retardation of asthmatic children.

A Case of Klippel-Feil Syndrome with Recurrent Hypoglycemia / 대한소아내분비학회지

Klippel-Feil syndrome is characterized by congenital fusion of cervical vertebra which shows classic triad of short neck, low posterior hairline and limited range of motion of the neck. We report a case of Klippel-Feil syndrome not only associated with renal hypoplasia and sensorineural hearing defect but also with repetitive severe hypoglycemia with lactic acidosis.

Desmoplastic Cerebral Astrocytoma of Infancy

Desmoplastic cerebral astrocytoma of infancy is a massive cystic tumor, typically occurring in the cerebral hemisphere and a rare intracranial tumor that arises in subjects usually below the age of 18 months and shows a favorable prognosis. A 5.5-month-old boy was presented with a rapidly increasing head circumference and lethargy. A computerized tomography scan revealed a large, multicystic, partially enhancing right parieto-occipital mass with hydrocephalus. This patient was treated with a surgery and a firm plaque-like tumor along withmulticystic component was gross totally removed. The tumor mass was firmly attached to the dura and extended in fingerlike projections onto the cortical surface. The infant underwent no further therapy and has developed normally during 6 months after surgery. Desmoplastic cerebral astrocytoma of infancy is a rare intracranial tumor but recognition of this tumor should be appreciated because, despite its massive size and rapidly growing characterstics, this tumor often has a relatively benign clinical course.