Relationship Between Rotavirus P6 Infection in Korean Neonates and Histo-Blood Group Antigen: a Single-Center Study

Background@#Rotaviruses are a major cause of pediatric gastroenteritis. The rotavirus P[6] genotype is the most prevalent genotype isolated from Korean neonates but has rarely been reported in other countries. Histo-blood group antigen (HBGA) is known to play an important role in rotavirus infection. We investigated the relationship between rotavirus genotype and HBGA-Lewis blood type in Korean children and explored the reasons for the predominance of rotavirus P[6] strain in Korean neonates. @*Methods@#Blood and stool samples were collected from 16 rotavirus-infected patients. Rotavirus G (VP7) and P (VP4) genotyping was performed using reverse transcription-PCR and sequencing. Lewis antigen phenotypes (Lea /Leb ) were tested, and HBGA-Lewis genotype was determined by sequencing the secretor (FUT2) and Lewis (FUT3) genes. Deduced amino acid sequences and three-dimensional structures of the VP8* portion of the rotavirus VP4 protein were analyzed. @*Results@#All P[6] rotaviruses were isolated from neonates under one month of age, who were negative or weakly positive for the Leb antigen. However, 10 of the 11 non-P[6] rotaviruses were isolated from older children who were Leb antigen-positive. The VP8* amino acid sequences differed among P[6], P[4], and P[8] genotypes. Korean P[6] strains showed a unique VP8* sequence with amino acid substitutions, including Y169 > L169, which differed from the sequences of P[6] strains from other countries. @*Conclusions@#The predominance of the rotavirus P[6] genotype in Korean neonates may be related to the interaction between HBGA-Lewis antigen and the VP8* portion of the VP4 protein, and this information will be helpful in future neonatal vaccine development.

The Comparison of Clinical Characteristics in Three Types of Viral Acute Diarrhea in Infants and Toddlers and the Effect of Lactobacillus acidophilus on Rotaviral Diarrhea

The most common causes of acute viral diarrhea in infants and toddlers are rotavirus, astrovirus and norovirus. The purpose of this study was to evaluate epidemiological data of pathogens obtained from stool exams and compare them with the clinical course in pediatric patients with symptoms of viral acute diarrhea and to investigate the clinical efficacy of Lactobacillus acidophilus (L. acidophilus) for acute diarrhea caused by rotavirus. Clinical data for three types of viral acute diarrhea were compared with the viral detection results by enzyme-linked immunosorbent assay. Viruses were detected in 65.8% of subjects, with rotavirus being the most commonly reported in 63.3% of subjects. To examine the characteristics of each virus, a clinical epidemiological study was performed for 482 cases. Noroviral infection symptoms included vomiting and diarrhea in patients of all age groups. Dehydration in noroviral acute diarrheal patients was less common than in rotaviral acute diarrheal patients. The clinical efficacy of orally administered L. acidophilus in the treatment of acute viral diarrhea in infants and toddlers was also evaluated. L. acidophilus was a probiotic adjuvant in viral acute diarrhea in infants and toddlers.

Inflammatory Cytokines and Their Prognostic Ability in Cases of Major Burn Injury

BACKGROUND: Major burn injuries induce inflammatory responses and changes in the levels of various cytokines. This study was conducted to assess early changes in the serum levels of inflammatory cytokines after burn injury, identify cytokines associated with mortality, and characterize correlations among cytokines. METHODS: Blood samples of 67 burn patients were collected on days 1 and 3 after burn injury, and the concentrations of 27 cytokines were measured using the Bio-Plex Suspension Array System (Bio-Rad Laboratories, USA). Blood samples of 25 healthy subjects were used as controls. We analyzed statistical differences in the concentrations of each cytokine between the control and patient groups, between day 1 and day 3, and between survival and nonsurvival groups. Correlations among 27 cytokines were analyzed. RESULTS: Median concentrations of granulocyte colony-stimulating factor (G-CSF), granulocyte macrophage colony-stimulating factor (GM-CSF), interleukin 1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), interleukin 15 (IL-15), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein 1beta (MIP-1beta), and vascular endothelial growth factor (VEGF) were significantly higher in burn patients than in controls. IL-1RA, IL-6, and MCP-1 levels were significantly higher in the nonsurvival group than in the survival group on day 1 after burn injury. Correlation analysis of 27 cytokines showed different relationships with one another. Stronger correlations among interferon gamma (IFN-gamma), IL-2, IL-4, IL-7, IL-12p70, and IL-17 were found. CONCLUSIONS: IL-1RA, IL-6, and MCP-1 may be used as prognostic indicators of mortality in burn patients and the increase in cytokine concentrations is induced by interactions within a complex network of cytokine-related pathways.

Immunogenicity and safety of a tetravalent measles-mumps-rubella-varicella vaccine: an open-labeled, randomized trial in healthy Korean children

PURPOSE: This study (NCT00751348) evaluated the immunogenicity and safety of a combined measles-mumps-rubella-varicella (MMRV) vaccine compared to co-administration of measles-mumps-rubella and varicella (MMR+V) vaccines in Korean children during their second year of life. MATERIALS AND METHODS: Healthy children aged 11-24 months received one dose of MMRV or MMR+V. Antibody titers against measles, mumps and rubella were measured using enzyme-linked immunosorbent assay and against varicella using an immunofluorescence assay. Parents/guardians recorded adverse events in diary cards for up to 43 days post-vaccination. The primary objective was to demonstrate non-inferiority of MMRV to MMR+V for all antigens in terms of seroconversion rates (SCRs), defined as a group difference with a lower limit of the 95% confidence interval (CI)>-10%. RESULTS: Of 474 subjects enrolled, 458 (MMRV, 301; MMR+V, 157) were included in the according-to-protocol cohort. For measles (98.0% vs. 99.4%), rubella (99.7% vs. 100%) and varicella (98.9% vs. 100%) SCRs, the lower limits of the 95% CIs for group differences were greater than -10%; however, for mumps SCRs (88.8% vs. 94.2%), it was -10.40%. The primary objective of non-inferiority in mumps SCRs was therefore not met, although the observed group difference in a post-hoc analysis of anti-mumps antibodies using a plaque reduction neutralization assay was 0.39% with a 95% CI lower limit of -4.03%. Adverse events occurred at comparable frequencies for both groups, except for more frequent fever in MMRV recipients. CONCLUSION: Based on the pre-specified non-inferiority criterion, SCRs of the MMRV vaccine were non-inferior to that elicited by MMR+V vaccines for all antigens except mumps.

A Case of Hereditary Spherocytosis with Hemolytic Anemia due to Mycoplasma pneumonia / 소아감염

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, with a peak incidence at 5-14 years. Extrapulmonary manifestations occur in 20-25% of patients with M. pneumoniae infection. Most auto-antibodies that cause immune hemolytic anemia in humans are cold agglutinins. The formation of cold agglutinins is frequently observed during M. pneumoniae infections, and cold agglutinin disease usually occurs during M. pneumoniae infections. Nevertheless, severe hemolysis is exceptional. If a patient has any underlying disease related to hemolysis, it is possible to accelerate hemolysis. Hereditary spherocytosis is a common cause of hereditary hemolytic anemia resulting from red blood cell membrane defects. Hemolysis of red cells may result from corpuscular abnormalities or extracorpuscular abnormalities, such as immune or non-immune mechanisms. We report a case of hereditary spherocytosis associated with severe hemolytic anemia due to Mycoplasma pneumonia.

Changes in the outcomes of neonatal intensive care unit at a single center over 12 years / 소아과

PURPOSE: The survival rate of very low birth weight infant (VLBWI) had increased as a result of advances in neonatal intensive care. We evaluated the changes in outcomes of VLBWI who admitted to the neonatal care unit of Hallym University Kangnam Sacred Heart Hospital. METHODS: Retrospective review of 339 VLBWI who were born from 1st January 1997 to 31th December 2008 were performed. Outcomes including survival rate, birth weight (BW), gestational age (GA), morbidities, and mortality between period I (1997- 2003) and period II (2004-2008) were compared. RESULTS: Overall incidence of VLBWI was 2.3% and it was significantly higher in period II(3.3%). Mean BW and GA were significantly decreased in period II (P<0.001, P=0.01). The survival rate increased from period I (59.1%) to period II (74.2%). BW-specific survival rate increased in 1,000-1,249 gm and GA-specific survival rate significantly increased in 27-28 weeks and 29-30 weeks. The incidences of respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), sepsis, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, periventricular leukomalacia, and necorotizing enterocolitis were same except patent ductus arteriosus. CONCLUSION: The survival rate of VLBWI was increased in period II, especially in less than 1,000 gm and below 27 weeks. This may be due to recent dramatic improvement of neonatal care. But more efforts are needed to improve outcome during initial phase and to reduce long term complication such as BPD and ROP.

Once daily dosing of aminoglycoside in children / 소아과

Aminoglycosides are frequently used antibiotics in children. The multiple daily dosing (MDD) in infants and children is twice or three times daily depending on age. Recent studies in adults have shown that once daily dosing (ODD) maximizes the bactericidal activity and might minimize the toxicity of antibiotics. So, I reviewed many studies about efficacy, toxicity and cost effectiveness of ODD of aminoglycosides in children. Most studies suggest that ODD compared with MDD of aminoglycosides is theoretically more efficacious and has no higher toxicity in infants and children. But, the total number of patients included in the studies is not large. Multi-center, controlled prospective studies are required in larger numbers of infants and children to determine the efficacy and safety of the ODD regimen in children before ODD of aminoglycosides can be recommended for routine use.

Provisional update on varicella vaccination in Korea, 2008 / 소아과

No abstract available.

A Case of Chronic Daily Headache Attributed to Hashimoto's Thyroiditis

We present a case of Hashimoto's thyroiditis accompanied by chronic daily headache which was relieved by levothyroxine therapy. A 12-year-old girl was referred to our hospital complaining of continuous, bilateral, and non-pulsatile headache which had begun 9 months before. After 2 weeks of appropriate levothyroxine therapy, headache markedly improved. After 4 months of follow-up, she had no new episode of headache.

Intrauterine Femur Fracture in Premature Neonate-A Case Report / 대한주산의학회잡지

Intrauterine fracture in a neonate is rare but can occur without trauma to the mother and can be caused by genetic factor or external pressure, or skeletal disorder. Authors experienced a case of intrauterine femur fracture in a female premature patient which was discovered at birth. The patient was born at 28+3 weeks by a cesarean section. Her birth weight was 900 g. Amniotic fluid was clear and there was no amniotic membrane adhesion. The mother was 31 years old and had preeclampsia but had no other previous medical history. She had no experience of trauma in daily activities and abnormal findings during antenatal care. On x-ray finding taken after birth, there was callus formation at the epiphysis of the right distal femur. We found no shortening of the limbs during physical examination of the neonate but there were edematous change at the distal portion of the right thigh. She had no neurologic abnormality. We report a case of intrauterine femur fracture with no special history in the mother.

Intrauterine Femur Fracture in Premature Neonate-A Case Report / 대한주산의학회잡지

Intrauterine fracture in a neonate is rare but can occur without trauma to the mother and can be caused by genetic factor or external pressure, or skeletal disorder. Authors experienced a case of intrauterine femur fracture in a female premature patient which was discovered at birth. The patient was born at 28+3 weeks by a cesarean section. Her birth weight was 900 g. Amniotic fluid was clear and there was no amniotic membrane adhesion. The mother was 31 years old and had preeclampsia but had no other previous medical history. She had no experience of trauma in daily activities and abnormal findings during antenatal care. On x-ray finding taken after birth, there was callus formation at the epiphysis of the right distal femur. We found no shortening of the limbs during physical examination of the neonate but there were edematous change at the distal portion of the right thigh. She had no neurologic abnormality. We report a case of intrauterine femur fracture with no special history in the mother.

Comparison of neonatal outcomes between the spontaneous and in vitro fertilization twin pregnancies / 소아과

PURPOSE: There is a dominant opinion that in vitro fertilization (IVF) leads to an increased incidence of twins, low birth weight (LBW) infants, prematurity and mortality. On the other hand, technical development of IVF and improvement of neonatal intensive care have increased the survival rate of neonates. The purpose of this study was to verify the tendency by comparing the clinical aspects of IVF and spontaneously conceived twins, and to establish methods to increase the survival rate of neonates after IVF. METHODS: Retrospective reviews were performed on all twin infants who were admitted to the nursery and NICU at Kangnam Sacred Heart Hospital, Hallym University from January 1, 2000 to December 31, 2006. Medical records of IVF twins (study group, n=92) and spontaneously conceived twins (control group, n=265) were analyzed and compared. Neonatal outcomes and complications, as well as obstetric outcomes, were analyzed and compared. RESULTS: Mean gestational age and birth weight of the study group (34.6+/-3.5 weeks, 2,203.9+/-617.2 g) were considerably lower than those of the control group (36.3+/-2.4 weeks, 2,367.0+/-517.9 g). The frequency of prematurity less than 37 weeks (68.5% vs 51.3%) and extremely LBW (15.2% vs 6.4%) were also significantly higher in the study group. Other neonatal outcomes were all insignificant. The obstetric characteristics, maternal age (32.6+/-3.3 years vs 30.3+/-3.9 years) and the frequency of cesarean delivery(95.7% vs 79.9%) were significantly higher in the study group. Other obstetric outcomes were insignificant except for the frequency of incompetent internal os of cervix (36.2% vs 3.6%) and cerclage operation (38.3% vs 4.3%). CONCLUSION: Based on the above results, clinical outcomes of twin infants will be further improved by careful attention and thorough antenatal care of the IVF twins.

The Effects of Family History on the Diagnosis of Childhood Migraine

PURPOSE: Headache is a common problem in children and adolescents, and they experience severe pain and disabilities from headache. But there had not been an appropriate system for the diagnosis and the classification for headache in children and adolescents before the international classification of headache disorders(ICHD-II) was developed. But family history was not included in this classification's criteria. So we evaluated the effects of family history on the diagnosis of children with recurrent headaches. METHODS: 217 patients with recurrent headaches younger than fifteen years old were selected. To diagnose the patients' headache, we utilized headache questionnaires, headache diaries, and studied the family history of headache on the patients' maternal and paternal lines. Final diagnosis was based on the ICHD-II. RESULTS: In the migrainous patients, 78.1% had positive family history of headache on the maternal lines, and 16.2% on the paternal lines. In the patients with tension-type headache, 56.8% had positive family history of headache on the maternal lines. When the mother of a patient suffered from recurrent headaches, migraine occurred 2.94 times as frequently as tension-type headache(Mantel-Haenszel odds ratio, 2.94; P<0.01; 95% confidence interval, 1.36-6.38). And if a patient had parents with recurrent headaches, migraine occurred 3.22 times as frequently as tension-type headache(odds ratio, 3.22; P<0.005; 95% confidence interval, 1.48-7.02). CONCLUSION: We can consider migraine rather than tension-type headache when a patient has family history of recurrent headaches. In our study, we were able to validate that positive family history of headache was important in diagnosing the headache of children.

A Role of Sepsis in Bronchopulmonary Dysplasia of Premature Infants

PURPOSE:The aim of this study was to determine whether postnatal sepsis is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature infants. METHODS:Premature infants of less than 32 weeks of gestation or birth weight under 1,500 g who admitted at Kangnam Sacred Heart Hospital of Hallym University during 1997-2005 were investigated. Among them, infants born at other hospitals or died within 4 weeks of life and infants who got sepsis after neonatal period were all excluded. Total 268 cases were included in this study. They were divided into those with respiratory distress syndrome (RDS) (n=77) and without RDS (n=191) and each was subdivided into groups with sepsis and without sepsis. Based on the medical records, the incidence of BPD and its correlation with sepsis were analyzed. RESULTS:Incidence of typical BPD was 63.0% in group with sepsis and 26% in group without sepsis. In case of atypical BPD, incidence was 20.5% in group with sepsis and 1.3% in group without sepsis. When logistic regression analysis was performed for correcting the confounding factors, sepsis was found to be statistically significant for BPD de development (OR 3.159, 95% CI=1.241-8.039, P<0.05). RDS, birth weight were also independently significant. Other perinatal factors such as gestational age, 1 min & 5 min Apgar score, total duration of assisted ventilation, total duration of O2 administration, PDA, ROP, and IVH were found to be significant risk factors for developing BPD. We could not find any statistically significant maternal risk factors for BPD occurrence. CONCLUSION:For premature infants under 1,500 g of birth weight or 32 week of gestational age and less, sepsis during the first 4 weeks of age was a significant risk factor for developing both typical and atypical BPD.

Clinical Features of GEFS+ and its Neurological Outcome

PURPOSE:The aim of this study was to characterize the clinical and electroencephalographic features as well as the neurologic outcomes of GEFS+(Genenralized Epilepsy with Febrile Seizures Plus). METHODS:We evaluated 55 children with GEFS+ who admitted at the Department of Peditrics, Kangnam Sacred Heart Hospital from 1993 to 2004. We formed them into two groups by age of first febrile seizure; Group A( or = 6 years). We analyzed the clinical features, electroencephalographic findings and the neurological outcomes of the subjects. RESULTS:The mean age of the initial febrile seizures of 55 subjects was 3 years and 9 months. 41 subjects had their initial febrile seizures under 6 years of age while 14 subjects after 6 years of age. 17 subjects had family history of seizures. The mean frequency of seizure is 4.4 times and the types of convulsions were mainly generalized. Nineteen(37.3%) showed abnormal finding on EEG and twenty three(41%) were treated with antiepileptic drug(AED) for long-term prophylaxis. Never the less, there was no subject with abnormalities in the neurological outcomes. The group with the initial seizures occurred under 6 years of age had more family history of seizures, higher frequency of total seizures, febrile seizures, and was administered with AEDs longer than the other group. CONCLUSION:In our study of GEFS+, the clinical features and the results of the electroencephalograms were various. While there were cases with a need of long term administration of AEDs, few cases of neurological abnormalities or developmental delay were seen. The group of the initial febrile seizures under 6 years of age revealed more family history of seizures, higher frequency of seizures than the other group.

A Case of Pneumococcal Meningitis Associated with Posttraumatic Cerebrospinal Fluid Rhinorrhea

Bacterial meningitis after head trauma is a rare complication, but the cerebrospinal fluid(CSF) leakage after head trauma greatly increases the risk of bacterial meningitis. Most of the infections passes through the defects in the basal skull fracture, and Streptococcus pneumoniae is the most common organism. MRI, coronal thin sections of cranial CT and radioiosotope cisternography are considered to diagnose the CSF fistulae. We report a case of a 14-year-old girl with pneumococcal meningitis complicated by CSF rhinorrhea following an asymptomatic period of 3 years after head trauma. We found a bone defect of the cribrium of the skull base by means of paranasal sinus CT scanning and MRI.

A Case of progressive elevation of serum gamma-GTP level in ataxia-telangiectasia

Ataxia-telangiectasia is an autosomal recessive disorders characterized by cerebellar ataxis, oculocutaneous telangiectasia and frequent respiratory infections due to immunoincompetence. Ataxia usually appear by age of 2 years with most patients need wheelchairs for morbility by early teenage. Speech and eye movements are also affected. Other important features are immunodeficiency, a high level of serum alpha-fetoprotein concentration, growth retardation, telangiectasia and a very high risk of a lymphoid tumor. Patients also show an increased sensitivity to ionizing radiation. We report a case of a 7-year-old girl who had ataxic gate, conjunctival telangiectasia, and frequent upper respiratory infection. Her alpha-fetoprotein was elevated and the serum IgA was decreased. The brain MRI showed prominent cerebellar atrophy. From the 1 st year of life to death, the level of serum gamma- GTP became steadily elevated up to 10 times of a normal level.

The Optimal Time for Retinopathy of Prematurity (ROP) Screening and Preventable Risk Factors Related to the Progression of Threshold ROP

PURPOSE: The aim of this study was to evaluate the optimal time for ROP screening and to find any preventive risk factors related to the progression to threshold ROP. METHODS: A retrospective analysis of ROP-diagnosed inborn neonates with gestational age of less than 32 weeks and birth weight of less than 1, 500 g who were admitted to Kangnam Sacred Heart Hospital from January 1997 to December 2003 were done. ROP infants were classified into two groups: PreT-ROP (prethreshold ROP, n=28) and T-ROP (threshold ROP, n=23). First ophthalmic examination time, time of onset ROP, time of threshold disease requiring cryotherapy or laser therapy, and risk factors were compared between two groups. RESULTS: Among all 220 infants, 51 (23.2%) patients were found to have ROP and 23 progressed to threshold ROP (10.5%). First ophthalmic examination time was significantly earlier in T-ROP for chronologic age. T-ROP was diagnosed at even 32+3 gestational weeks. Factors contributed to progression of ROP were gestational age, birth weight, Apgar score at 1 minute, duration of hospitalization, duration of TPN, duration of ventilator and oxygen supply, and number of transfusion. With logistic regression analysis, only birth weight (OR=1.001, 95% CI=1.001-1.016), duration of ventilation supply (OR=0.697, 95% CI=0.501-0.973), number of transfusions after the diagnosis of ROP (OR= 0.090, 95% CI=0.014-0.678) were relate to progression of ROP. CONCLUSION: For premature infants under 1, 500 g or 32 weeks and below should receive first ophthalmologic examination at least before 33 postconceptional age. The progression to threshold ROP after the diagnosis of ROP could be prevented by minimizing the duration of ventilator apply and number of transfusion after diagnosis of ROP.

A Case of Tyrosinemia Type 1 with Cytomegalovirus Infection / 소아과

Tyrosinemia type 1 is an autosomal recessive inborn error of tyrosine metabolism that caused a mutation in the gene coding for the enzyme fumarylacetoacetate hydrolase(FAH). As a result, maleylacetoacetate(MAA) and fumarylacetoacetate(FAA) are formed. The accumulated FAA is converted into succinylacetone(SA) and succinylacetoacetate(SAA) which are excreted in urine. The first report with typical clinical and biochemical findings was presented by Sakai in 1957. Clinically, the disorder is characterized by progressive liver damage with liver failure, a high risk of hepatocellular carcinoma and renal tubular dysfunction hypophosphataemic rickets. Some patients have porphyria-like episodes. Liver transplantation has been the ultimate treatment of tyrosinemia. However pharmacological therapy with 2-(2-nitro-4-trifluoromethylbenzoyl) -1,3-cyclohexanedione(NTBC) has offered a new therapeutic option in addition to dietary restriction of tyrosine and phenylalanine. We experienced a case of tyrosinemia type 1 with cytomegalovirus infection in a 4-month-old male who improved by dietary restriction of tyrosine and phenylalanine.

A Case of Rhizomelic Chondrodysplasia Punctata Occurring in Siblings / 소아과

Chondrodysplasia punctata is a group of heterogeneous bone dysplasia characterized by punctate calcifications of the cartilage, frequently associated with a shortening of the limbs, cataracts, icthyosis and alopecia, alterations of the nervous system, and mental and growth deficiencies. Our case presented findings of the rhizomelic chodrodysplasia punctata : a characteristic face, a sucking difficulty and a short neck. Skeletal radiographies showed punctate calcification and stippling on femurs, lumbar vertebral bodies and vertebral coronal cleft. According to his family history, his brother, who had the same characteristic face and punctate calcification at the neonatal period, died at the age of six months due to respiratory failure. The rhizomelic form of chondrodysplasia puntata is rare, the prognosis is bad and death usually occurs within the first year of age. We report a case of rhizomelic chondrodysplasia punctata occurring in siblings diagnosed by clinical and radiological criteria.