Sedative Effect of Chlorpheniramine in Children Failed to sedate with Chloral hydrate and Midazolam

PURPOSE: To evaluate the sedative effect of add-on chlorpheniramine in children with neurologic diseases failed to sedate with chloral hydrate and midazolam. METHODS: Thirty three patients who had not been successfully sedated with oral chloral hydrate and intravenous midazolam for diagnostic examinations were attempted for sedation with intravenous chlorpheniramine at Chonnam National University Hospital from September 2007 to September 2012. The sedative effects were compared on the aspects of age, sex, body weight, dosage of drug and underlying neurologic conditions with the retrospective review of medical records. RESULTS: Among 33 patients, 26(78.7%) were successfully sedated and 7(24.2%) failed to sedate. The success rates were different by age and were decreased with age: 100%(0-4y), 84.6%(5-9y), 50%(10-14y). The effectiveness of chlorpheniramine was not significantly different in terms of ages, sex, body weight, dosage of drug and the underlying neurologic conditions-developmental delay, seizures or organic brain lesions. Children with ADHD(attention-deficit hyperactivity disorder), however, showed a significantly lower success rate than the non-ADHD patient group (28.5%, P=0.002). No serious side effects were reported except for one case with transient perioral cyanosis. CONCLUSION: Chlorpheniramine appeared highly effective in children with neurologic diseases who had not been sedated with chloral hydrate and midazolam. The efficacy seemed to be higher in the younger age groups and lower in children with ADHD.

Low-dose, Once-a-day Treatment of Topiramate in Benign Childhood Epilepsy with Centrotemporal Spikes

PURPOSE: Benign childhood epilepsy with centrotemporal spikes (BECTS) is known to have a good prognosis, and is easily controlled with antiepileptic drugs. In this study, we evaluate the efficacy of low-dose topiramate (TPM), once at night time in children with BECTS, and compare with that of oxcarbazepine (OXC). METHODS: OXC was used as a first drug in 58 patients with BECTS at the department of pediatrics, Chonnam National University hospital from Jan. 2003 to Nov. 2010. Their medical records were reviewed, focusing on the onset age of seizure, the dosage of drugs, response to treatment and other clinical features. Since Aug. 2008 through Apr. 2011, some newly diagnosed patients with BECTS were given a low-dose (25mg) of TPM, once at nighttime. The efficacy was reviewed in 14 children, who had been followed up in the outpatient clinic for longer than twelve months. RESULTS: Forty five out of 58 (77.6%) patients were well controlled with OXC. Thirteen out of 58 (22.4%), seizures recurred, on whom TPM (n=9) or lamotrigine (n=4) was added. Nine (64.3%) of the 14 patients who were started with low dose TPM became seizure-free for at least 12 months. However, Two out of 14, the dose of TPM had to be increased up to 100 mg/day and 75 mg/day, respectively. In three, seizure was controlled with OXC. CONCLUSION: A single low-dose TPM would be as effective as the conventional OXC without any adverse effects in children with BECTS.

The Poor Seizure Outcome of Acute Febrile Encephalopathy in Children

PURPOSE: The aim of this study was to describe the clinical course and outcome of the patient with epilepsy after acute febrile encephalopathy. METHODS: Medical records of the twenty patients with acute febrile encephalopathy from Mar. 2003 to Dec. 2011, were reviewed. The outcome of epilepsy over 12 months after discharge from encephalopathy was investigated and compared with non-epilepsy group on several clinical and laboratory aspects. RESULTS: All revealed negative on viral study. Eight of 20 patients evolved to epilepsy eventually and 3 out of them had a status epilepticus as initial manifestation. Five of them remained medically intractable. Two showed ongoing violent behavior during follow-up period and 1 had motor weakness of lower limbs for a year. All had non-specific brain MRI findings, except the one who showed suspected cerebritis of right basal ganglia on follow-up study. Five of 8 epilepsy patients showed epileptic discharges on the first electroencephalogram. Two of them showed sustained frontal spikes and one who had abnormal brain MRI findings showed left temporal spike on follow-up EEG. Longer period of altered mentality and more frequent epileptiform discharges on initial EEG appeared to be related with progression to epilepsy during follow-up period. CONCLUSION: Acute febrile encephalopathy in children may be related to poor seizure outcome and resultant psychomotor problems. Further studies including laboratory exams to define its pathophysiology would be needed.

Congenital hernia of the lung through the azygoesophageal recess / 소아과

A lung hernia, defined as the protrusion of pulmonary tissue and pleural membranes through a defect in the thoracic wall, is a rare event. It can be congenital or acquired, and cervical, thoracic, or diaphragmatic in location. We report the rare occurrence of a congenital atraumatic lung herniation through the azygoesophageal recess. An 8 -month-old male infant, who was born at 3 5 weeks gestation, had a chronic cough. Chest radiography showed haziness at the right lower lobe of the lung (RLL). Chest computed tomography (CT) revealed herniation of the RLL through the azygoesophageal recess. If persistent unilateral haziness is observed on chest radiography, the possibility of lung herniation should be considered.

A case of subcutaneous paragonimiasis presented with pleural effusion / 소아과

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae from crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection, but several ectopic paragonimiasis cases have also been reported. Among them, cases of subcutaneous paragonimiasis are rare, especially in children. We report a case of subcutaneous paragonimiasis of the right abdominal wall with pleural effusion with hepatic involvement and without abnormal pulmonary infiltration in a boy aged 2 years and 5 months. He had eaten soybean sauce-soaked freshwater crabs (kejang) 6 months prior to complaining of right abdominal wall distension. On evaluation, right pleural effusion without abnormal pulmonary infiltration was detected, as well as blood eosinophilia, an elevated serum IgE level, pleural fluid eosinophilia and a positive enzyme-linked immunosorbent assay that detected P. westermani antibody in the serum. Thoracentesis, praziquantel administration, and excision of subcutaneous lesions were performed. After treatment, the eosinophil count and serum IgE level were decreased, and the subcutaneous lesions did not recur. The frequency of paragonimiasis has decreased recently, but it is still prevalent in Korea. Paragonimiasis should be suspected if pleural fluid eosinophilia is associated with blood hypereosinophilia and a high level of serum IgE; however clinicians should obtain a thorough history of travel and food habits.

Frequency and Clinical Outcome of the Respiratory Tract Disease in Full-term Infant

PURPOSE: To investigate the frequency of underlying diseases associated with respiratory distress in full-term infants, as well as its relation to the mode of delivery and clinical outcomes. METHODS: We conducted a retrospective review of 4,264 infants who had been admitted to the neonatal intensive care unit (NICU) of Chonnam University Hospital (CUH) over 5 years from January 2000 to December 2004. Full-term infants with respiratory distress such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), congenital pneumonia, meconium aspiration syndrome (MAS) and pneumothorax were included. We analysed the incidence of underlying disease, its relation to the mode of delivery, rate of mechanical ventilator therapy, prevalence of hypoxic ischemic encephalopathy (HIE), mortality and the length of hospitalization of surviving patients. RESULTS: Of the 4,264 patients who admitted to the NICU of CUH over the last five years, preterm infants made up 2,278 (53.4%) and full-term infants made up 1,982 (46.5%). The number of full-term patients who admitted due to respiratory distress associated with respiratory system problems excluding a congenital anomaly was 246 (12.4%). The most common underlying disease was TTN (n=161, 65.4%), and the next was RDS (n=39, 15.9 %), congenital pneumonia (n=11, 4.5%), MAS (n=7.9, 8.5%), and pneumothorax (n=14, 5.7 %). RDS was more statistically common in full-term infants born by Caesarian section (P<0.05). But there was no difference according to the mode of delivery statistically in other respiratory tract diseases. The rate of mechanical ventilator therapy was significantly higher in RDS and MAS, and the prevalence of HIE was higher in MAS (P<0.05). Mortalities of RDS and MAS were 7.7% and 9.5% each. There was no significant difference in the length of hospitalization of surviving patients. CONCLUSION: TTN was the most common respiratory tract disease in the full-term infant, and RDS was more common in the infant who was born by Cesarean section. The rates of mechanical ventilator therapy and mortality were significantly higher in the infants with RDS and MAS, and HIE was exclusively manifested by infants with MAS.