Development of a Nutrition Questionnaire and Guidelines for the Korea National Health Screening Program for Infants and Children / 대한소아소화기영양학회지

PURPOSE: A new health policy, referred to as the National Health Screening Program for Infants and Children, was launched in November 2007 by the Ministry of Health and Welfare and National Health Insurance Corporation in Korea. We have developed a nutrition-counseling program that was incorporated into this project. METHODS: We reviewed the nutritional guidelines published by The Korean Pediatric Society and internationally well-known screening programs such as Bright Future in the United States. We also reviewed the recent Korean national surveys on nutritional issues, including the Korea National Health and Nutrition Examination Survey (KNHANES) and the 2005 National Survey of Physical Body and Blood Pressure in Children and Adolescents. The development of questions, pamphlets, computer programs, and manuals for doctors was carried out after several meetings of researchers and governmental officers. RESULTS: We summarized the key nutritional issues according to age, including breastfeeding in infants, healthier complementary feeding, and prevention of iron deficiency anemia, establishment of healthier diets, as well as dietary prevention of overweight children with an emphasis on physical exercise. We have constructed a new Korean nutrition questionnaire and an anticipatory guidance program based on the primary care schedule of visits at 4, 9, 18, 30, and 60 months of age. Five to eight questions were asked at each visit and age-matched pamphlets for parents and guidelines for doctors were provided. CONCLUSION: We developed a nutrition-counseling program based on recent scientific evidence for Korean infants and children. Further research on this national program for screening the nutritional problems in detail and setting the therapeutic approaches may help identify areas of success as well as those that need further attention.

A Case of Autoimmune Chronic Pancreatitis in a Child / 대한소아소화기영양학회지

We present a case of autoimmune chronic pancreatitis in a previously healthy child without any history of autoimmune disease. A 12-year-old boy was admitted to the hospital with abdominal pain. The serum amylase, lipase, and IgG levels were elevated and autoantibodies (antinuclear antibody, antineutrophil antibody) were detected. An abdominal CT (computed tomographic) scan revealed diffuse enlargement of the pancreas. ERCP (endoscopic retrograde cholangiopancreaticography) demonstrated an irregular stricture of the main pancreatic duct in the pancreas tail. After two years of oral steroid and immunosuppressive drug therapy, the clinical, laboratory and radiological findings were improved. The patient has been symptom-free for 18 months after the discontinuation of medication.

A study on cow's milk and nursing method in relation to iron deficiency / 소아과

PURPOSE: This study investigated the breast-feeding period, the milk bottle-using period, the age of cow's milk, introduced and the amount of cow's milk consumed in relation to anemia. METHODS: Over the course of three years, 930 children(12 months to 36 months) who went to the Presbyterian Medical Center, Chonju, Korea were tested for anemia and their parents were surveyed for a history of their children's milk consumption. RESULTS: Anemia appeared more likely between 30 months and 36 months, however, iron-deficiency anemia appeared more likely between 18 months and 23 months. Anemia, low serum ferritin levels and iron-deficiency anemia appeared more likely in children breast fed less than 6 months and greater than 12 months. Although there were survey reports of side effects with cow's milk, including constipation, diarrhea and skin rash, the milk bottle-using period, age of cow's milk introduced and amount of cow's milk consumed had no connection with anemia, serum ferritin levels and iron-deficiency anemia. CONCLUSION: The data showed no correlation between the cow's milk, milk bottle-using period and iron deficiency. But the data revealed that iron deficiency anemia is more likely in children who are breast fed for less than 6 months and over 12 months, so we suggest careful attention during this period to prevent iron deficiency anemia.

Risk Factors of Nosocomial Rotavirus Infections in Children / 소아과

PURPOSE: Rotavirus is one of the most important causes of nosocomial infections among children. The aim of this study is to determine the risk of nosocomial rotavirus infections and to evaluate the effectiveness of breast-feeding and probiotics in the prevention of nosocomial rotavirus infections. METHODS: This study was carried out on admitted children without diarrhea between March 1, 2003 and February 29, 2004. Three hundred ninety patients aged 4 days to 13 years during this study were available. We examined the feces of all children for rotavirus by latex agglutination on admission, during hospital, and after discharge, to see whether they developed diarrhea or not. RESULTS: Nosocomial rotavirus infections was significantly increased with children under 12 months of age(P=0.008). The monthly attack rate was great between December and March(P=0.046). Prolonged hospital stay was associated with an increased attack rate of nosocomial rotavirus infections (P=0.003). The risk of nosocomial rotavirus infections was not associated with the number of roommates and whether or not they were breast-fed or fed on probiotics. CONCLUSION: Nosocomial rotavirus infections are significantly more likely to occur in children under 12 months of age, admitted between December and March, and with prolonged hospital stays. Prompt identification and isolation of children with nosocomial rotavirus infections, even without diarrhea, may decrease rates of nosocomial rotavirus infections.

A Case of Esophageal Candidiasis in a Healthy Child / 대한소아소화기영양학회지

Esophageal candidiasis is an opportunistic infection, often reported in patients who have acquired immune deficiency syndrome (AIDS), a neoplastic disease, or undergoing protracted antibiotic therapy. Impaired cell mediated immunity was often considered as the major predisposing factor in patients of esophageal mucosal colonization of Candida spp. However, it is increasingly reported that the occurrence of esophageal candidiasis with no underlying disease or immune suppression. We have experienced a case of esophageal candidiasis in a 15-year-old girl who was immunologically normal and have no underlying disease and whose main symptoms were epigastric and retrosternal pain with dysphagia. This case suggests the possibilities of candidal infections in children without predisposing factors such as immune compromised conditions, so it will be needed to differentiate the esophageal candidiasis among healthy children with symptoms of odynophagia and dysphagia.

A Case of Colitis Cystica Profunda Mixed with Juvenile Retention Polyp in a 7-month-old Infant / 대한소아소화기영양학회지

Colitis cystica profunda is a rare benign condition characterized by the presence of mucus-filled cysts in the submucosa of the colon and the rectum. Although it may diffusely involve the entire colon, this disease primarily affects the pelvic colon and rectum. It has rarely been described in the pediatric literature. The surgical treatment has been widely advocated. We report a 7-month-old case, successfully treated by colonoscopic polypectomy without complication. Histologically, components of juvenile retention polyp were mixed with colitis cytsica profunda.

A Case of Solid and Papillary Epithelial Neoplasm of Pancreas in a Young Adolescent / 대한소아소화기영양학회지

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor and is found predominantly in young females. The most common clinical presentation is an abdominal mass. The tumor has a low grade malignant potential and complete removal is the treatment of choice. We report a case of SPEN in a 13-year-old girl who presented with abdominal pain and increasing size of an abdominal mass after abdominal trauma. CT and sonographic findings showed a well-demarcated mass in the pancreas tail with solid and cystic portion. She got a distal pancreatectomy and pathologic finding was SPEN of pancreas.

A Case of Herpes Simplex Virus Esophagitis in a Renal Transplant Child / 대한소화기내시경학회지

Herpes simplex esophagitis can occur in those with normal immune function, but is more often seen in those who are immunocompromised. In one series, 5 percent of post-kidney transplant recipients had herpes esophagitis. We experienced a case of herpes simplex esophagitis, following renal transplantation in a 9 year old male. He complained of epigastric pain, nausea and blood-tinged vomiting. Endoscopic examination showed volcano ulcer, mucosal friability and multiple confluent ulcers covered by whitish exudates on elevated margin in the middle and lower esophagus. Microscopic findings revealed multinucleated giant cells, margination of chromatin, intense nonspecific inflammation and strong positive for herpes simplex virus immunohistochemical staining. Esophageal lesions and symptoms improved after acyclovir therapy.

A Case of Mesenchymal Hamartoma Associated with Biliary Atresia / 대한소아소화기영양학회지

Mesenchymal hamartoma is an uncommon benign tumor usually found in childhood, especially during the first two years of life. The tumor consists of a solid component and multiple cyst. Without treatment, these lesions can grow to an enormous size. We experienced a case of mesenchymal hamartoma which was found incidentally, in a 8 month old girl who had ascending cholangitis after Kasai operation due to biliary atresia. On abdominal ultrasonography and CT, there was a well-defined homogeneous small echogenic mass in the right lobe of the liver with cirrhosis. Five months later, she underwent liver transplantation. Gross picture of the resected liver showed a dark greenish pigmented solid mass in the right lobe of the cirrhotic liver. Microscopic findings showed reactive mesenchyma and epithelial overgrowth.

Rehospitalization of Low-birth-weight Infants Who Were Discharged from NICU

PURPOSE: We tried to compare normal term infants with low-birth-weight infants discharged from NICU by evaluating morbidity. So we studied rates of rehospitalization, reasons for rehospitalization and neonatal risk factors that affect rehospitalization of normal term infants and low-birth-weight infants discharged from NICU. METHODS: This study was performed on 217 low-birth-weight infants discharged from NICU and 126 normal term infants born in Presbyterian Medical Center from January 1992 to December 1994. RESULTS: Low-birth-weight infants discharged from NICU had higher rates of rehospitalization than normal term infants. Twenty-nine percent of low-birth-weight infants discharged from NICU were rehospitalized, compared with 12.7% of normal term infants(P<0.001). Rates of rehospitalization by birth weight was 45.5% in infants of 1500g or less and 31.2% in infants of 1500-1999g of birth weight. The rates of rehospitalization increased as birth weight decreased (P<0.001), but there was no significant difference between 16.4% in infants of 2000-2500g of birth weight and 12.7% of normal term infants(P=0.442). Reasons for rehospitalization of low bith weight infants were respiratory problem(63.1%), congenital/developmental problem(10.8%), surgical problem(9.2%), G-I problem(7.7%), ophthalmic problem(3.1%), and cardiac problem(1.5%). Neonatal risk factors related to rehospitalization of low birth weight infants were mechanical ventilation, duration of mechanical ventilation, bronchopulmonary dysplasia and duration of hospitalization(P<0.01). CONCLUSION: Rates of rehospitalization increased accordingly to decreasing birth weight. The most common cause of rehospitalization was respirartory problem. Neonatal risk factors related to rehospitalization were mechanical ventilation, bronchopulmonary dysplasia and duration of hospitalization. The data suggest that high risk infants of rehospitalization require close follow up.