Kawasaki Disease with Fever and Cervical Lymphadenopathy as the Sole Initial Presentation

BACKGROUND AND OBJECTIVES: Some patients with Kawasaki disease (KD) present with fever and cervical lymphadenopathy alone. The purpose of this study was to characterize the clinical features of these unusual KD patients and determine whether this is a severe form of KD associated with increased risks of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs). SUBJECTS AND METHODS: A total of 146 children with KD were reviewed retrospectively, and classified into two groups according to initial clinical features. Those presenting with only fever and cervical lymphadenopathy (LKD) were classified as LKD patients. Other-KD patients included all except the LKD patients. RESULTS: Among 146 KD patients, 13 (8.9%) were classified as LKD patients. The LKD patients were significantly older and admitted earlier. The duration between fever onset and KD diagnosis was significantly longer in the LKD patients (5.9 days vs. 4.9 days, p=0.023). The frequency of IVIG resistance was not different between the two groups., In the LKD patients, the incidence of CALs was significantly higher in the acute phase, and without significant difference in the convalescent phase. The percentage of neutrophils and C-reactive protein, albumin, and total bilirubin levels were significantly higher in LKD patients. CONCLUSION: Even though LKD patients were older, admitted earlier, and had higher inflammatory marker levels, they did not have a greater risk of CALs or IVIG resistance. However, echocardiography may be helpful in the acute stage if patients have only fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics.

Physical Activity Measurements with a Pedometer in the Fun and Run Health Camp for Children

BACKGROUND: Obesity in children emerged as a serious problem, and an increase in exercise and a decrease in sedentary activity are important to preventing obesity in children. This study aimed to evaluate the difference in physical activity between the overweight and control groups and whether the activity difference is related to the program provided. METHODS: This study included one-hundred fifty five children who participated in the Fun and Run Health Champ from June 2013 to October 2015. The Health Camp program consisted of lectures in the morning and exercise in the afternoon in 2013 and 2014 (program 1). The morning program in 2015 was changed to Exercise (program 2). The participants were categorized according to their BMI z-score into either the overweight (BMI z-score ≥1) group or the control group (BMI z-score <1). Physical activity was measured with a pedometer. RESULTS: The overweight group had 83 children (53.6%) and the control group had 72 (46.4%). The mean height z-score, weight z-score, and BMI z-score were higher in the overweight group than in the control group. The number of steps per hour in the exercise program (1,561) was greater than for the lecture program (456) (P<0.0001). After the change from lecture to exercise, the number of steps per hour increased significantly (P<0.0001). A greater change in physical activity according to the provided program was observed in the overweight group (overweight-1,033, control-686, P<0.007). CONCLUSION: This study suggests that a designed program considering physical activity could lead to a greater change in physical activity in overweight children. It is necessary to develop the program so that it is fun for children.

Use of Omega-3 Polyunsaturated Fatty Acids to Treat Inspissated Bile Syndrome: A Case Report / 대한소아소화기영양학회지

Inspissated bile syndrome (IBS) is a rare condition in which thick intraluminal bile, including bile plugs, sludge, or stones, blocks the extrahepatic bile ducts in an infant. A 5-week-old female infant was admitted for evaluation of jaundice and acholic stool. Diagnostic tests, including ultrasound sonography, magnetic resonance cholangiopancreatography, and a hepatobiliary scan, were not conclusive. Although the diagnosis was unclear, the clinical and laboratory findings improved gradually on administration of urodeoxycholic acid and lipid emulsion containing omega-3 polyunsaturated fatty acids (PUFAs) for 3 weeks. However, a liver biopsy was suggestive of biliary atresia. This finding forced us to perform intraoperative cholangiography, which revealed a patent common bile duct with impacted thick bile. We performed normal saline irrigation and the symptom was improved, the final diagnosis was IBS. Thus, we herein report that IBS can be treated with omega-3 PUFAs as an alternative to surgical intervention.