Successful Treatment of Severe Hemolytic Disease of the Newborn Caused by Anti-Jk b / 임상소아혈액종양

Hemolytic disease of the newborn (HDN) is a condition in which maternal antibodies cross the placenta and cause hemolytic reactions. Anti-RhD was the most common cause, but with the introduction of immunoglobulin, the frequency has decreased sig nificantly, making hemolytic disease caused by other minor blood g roups more important. Kidd antigen is also known to cause hemolytic transfusion reactions. Only 13 cases have been reported so far, because Kidd antig en dose not usually cause HDN. Most cases have a good outcome, and only two fatal cases have been reported.A four-day-old male patient was hospitalized for jaundice, and hemolysis was confirmed by blood test. The mother’s blood was Jkb antibody positive. The patient did not improve with phototherapy, so an exchange transfusion was performed. Additional hemolysis occurred, so we undertook transfusion of red blood cells, resulting in cessation of hemolysis. We report HDN caused by Jkb antibody that responded to exchange blood transfusion.

Successful Treatment of Severe Hemolytic Disease of the Newborn Caused by Anti-Jk b / 임상소아혈액종양

Hemolytic disease of the newborn (HDN) is a condition in which maternal antibodies cross the placenta and cause hemolytic reactions. Anti-RhD was the most common cause, but with the introduction of immunoglobulin, the frequency has decreased sig nificantly, making hemolytic disease caused by other minor blood g roups more important. Kidd antigen is also known to cause hemolytic transfusion reactions. Only 13 cases have been reported so far, because Kidd antig en dose not usually cause HDN. Most cases have a good outcome, and only two fatal cases have been reported.A four-day-old male patient was hospitalized for jaundice, and hemolysis was confirmed by blood test. The mother’s blood was Jkb antibody positive. The patient did not improve with phototherapy, so an exchange transfusion was performed. Additional hemolysis occurred, so we undertook transfusion of red blood cells, resulting in cessation of hemolysis. We report HDN caused by Jkb antibody that responded to exchange blood transfusion.

Clinical or Radiological Findings Suggestive of Spontaneous Intestinal Perforation in Extremely Low Birth Weight Infants with Gasless Abdomen

PURPOSE: This study aimed to evaluate the clinical and radiologic findings suggestive of spontaneous intestinal perforation (SIP) in extremely-low-birth-weight infants (ELBWIs) with persistent gasless abdomen, and to investigate the usefulness of abdominal ultrasonography for the diagnosis of SIP. METHODS: In total, 22 infants with birth weights less than 1,000 g who showed persistent gasless abdomen on simple abdominal radiography were included. Perinatal, neonatal, and perioperative clinical findings were retrospectively reviewed, and the risk factors for intestinal perforation were evaluated. Abdominal sonographic findings suggestive of intestinal perforation were also identified, and postoperative short-term outcomes were evaluated. RESULTS: In total, eight of the 22 infants (36.4%) with gasless abdomen had SIP. The number of infants with patent ductus arteriosus who were treated with intravenous ibuprofen or indomethacin was significantly higher in the SIP group than in the non-SIP group (P<0.05). Greenish or red gastric residue, abdominal distension, or decreased bowel sound were more frequent in infants with SIP (P<0.05), in addition to gray or bluish discoloration of abdomen, suggestive of meconium peritonitis (P<0.05). Pneumoperitoneum on simple abdominal radiography was found in only one of the eight infants (12.5%) with SIP. Intramural echogenicity and echogenic extramural material on abdominal ultrasonography were exclusively observed in infants with SIP. Four infants (50%) with SIP died after surgical intervention. CONCLUSION: Intestinal perforation may occur in ELBWIs with gasless abdomen. As intramural echogenicity and extraluminal echogenic materials on abdominal ultrasonography are indicative of SIP, this technique could be useful for diagnosing SIP.

Transient intubation for surfactant administration in the treatment of respiratory distress syndrome in extremely premature infants / 소아과

PURPOSE: To investigate the effectiveness of transient intubation for surfactant administration and extubated to nasal continuous positive pressure (INSURE) for treatment of respiratory distress syndrome (RDS) and to identify the factors associated with INSURE failure in extremely premature infants. METHODS: Eighty-four infants with gestational age less than 28 weeks treated with surfactant administration for RDS for 8 years were included. Perinatal and neonatal characteristics were retrospectively reviewed, and major pulmonary outcomes such as duration of mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) plus death at 36-week postmenstrual age (PMA) were compared between INSURE (n=48) and prolonged MV groups (n=36). The factors associated with INSURE failure were determined. RESULTS: Duration of MV and the occurrence of BPD at 36-week PMA were significantly lower in INSURE group than in prolonged MV group (P < 0.05), but BPD plus death at 36-week PMA was not significantly different between the 2 groups. In a multivariate analysis, a reduced duration of MV was only significantly associated with INSURE (P=0.001). During the study period, duration of MV significantly decreased over time with an increasing rate of INSURE application (P < 0.05), and BPD plus death at 36-week PMA also tended to decrease over time. A low arterial-alveolar oxygen tension ratio (a/APO2 ratio) was a significant predictor for INSURE failure (P=0.001). CONCLUSION: INSURE was the noninvasive ventilation strategy in the treatment of RDS to reduce MV duration in extremely premature infants with gestational age less than 28 weeks.

Patterns of ischemic injury on brain images in neonatal group B Streptococcal meningitis / 소아과

PURPOSE: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. METHODS: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. RESULTS: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. CONCLUSION: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy

PURPOSE: To investigate the relationship between brain injury patterns on magnetic resonance imaging (MRI) and neurodevelopmental outcomes in neonates with postasphyxial hypoxic ischemic encephalopathy (HIE). METHODS: Clinical characteristics and brain MRI findings of 49 term neonates with postasphyxial HIE were retrospectively reviewed. Brain injury patterns in MRI were classified into five categories, along with evaluation of the posterior limb of internal capsule (PLIC). Neurodevelopmental outcomes were assessed by neurological examination combined with the Bayley Scales of Infant Development II between 1 and 2 years of age. RESULTS: Twenty-three neonates (46.9%) showed abnormal brain MRI finding associated with poor neurodevelopmental outcomes (odds ratio 9.7, 95% confidence interval 1.4, 67.4, P=0.022). The following injury patterns were seen in MRI: abnormality in the basal ganglia-thalamus (BGT) in 4 neonates (17.4%), watershed predominant (WP) pattern in 5 (21.7%), extensive global injury (EGI) in 3 (13.0%), lesions restricted to periventricular white matter (LPWM) in 4 (17.4%), and perinatal arterial ischemic stroke (PAIS) in 2 (8.7%). Additionally, 6 neonate (26.1%) showed lesion in the PLIC. Neonate with BGT and EGI injury patterns showed worse neurodevelopmental outcomes than those with WP and LPWM patterns (P<0.05). Neonate with PLIC lesion also showed poor outcomes (100%). CONCLUSION: Abnormal brain MRI findings in neonates with postasphyxial HIE were associated with the poor neurodevelopmental outcomes. BGT, EGI and PLIC patterns of injury are expected to have worse outcomes than white matter predominant injury patterns such as those in the WP and LPWM.

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain / 소아과

The use of glucocorticoids (GCs) in the perinatal period is suspected of being associated with adverse effects on long-term neurodevelopmental outcomes for preterm infants. Repeated administration of antenatal GCs to mothers at risk of preterm birth may adversely affect fetal growth and head circumference. Fetal exposure to excess GCs during critical periods of brain development may profoundly modify the limbic system (primarily the hippocampus), resulting in long-term effects on cognition, behavior, memory, co-ordination of the autonomic nervous system, and regulation of the endocrine system later in adult life. Postnatal GC treatment for chronic lung disease in premature infants, particularly involving the use of dexamethasone, has been shown to induce neurodevelopmental impairment and increases the risk of cerebral palsy. In contrast to studies involving postnatal dexamethasone, long-term follow-up studies for hydrocortisone therapy have not revealed adverse effects on neurodevelopmental outcomes. In experimental studies on animals, GCs has been shown to impair neurogenesis, and induce neuronal apoptosis in the immature brains of newborn animals. A recent study has demonstrated that dexamethasone-induced hypomyelination may result from the apoptotic degeneration of oligodendrocyte progenitors in the immature brain. Thus, based on clinical and experimental studies, there is enough evidence to advice caution regarding the use of GCs in the perinatal period; and moreover, the potential long-term effects of GCs on brain development need to be determined.

Clinical Characteristics and Outcomes of Neonatal Seizures

PURPOSE: Neonatal seizures are one of the most common neurologic manifestations in neonates and could be the important clinical sign of underlying brain disorders. The aim of this study is to review the clinical characteristics and to find the prognostic factors related to the outcomes of neonatal seizures. METHODS: We reviewed medical records retrospectively in 23 patients with neonatal seizures who admitted to Dankook University Hospital from July 2007 to June 2009. RESULTS: During the study period, neonatal seizures were diagnosed in 23/1,474 (1.56%) neonates. Nineteen of them (82.6%) were term and 4 were preterm. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (n=8, 35%). Other various causes included metabolic disorders (n=4, 17%, carnitine palmitoyl transferase 1 deficiency, severe hypernatremic dehydration, prolonged severe hypoglycemia, and pyridoxine dependent seizure), intracranial hemorrhages (n=2, 9%), congenital brain anomaly (callosal dysgenesis, hemimegalencephaly) (n=2, 9%), and infection (congenital syphilis, early neonatal sepsis, n=2, 9%). Among nineteen neonates (82.6%) who were treated with anticonvulsants, we could not stop the anticonvulsants in six of them (32%). They had severe HIE, prolonged severe hypoglycemia with residual encephalomalatic changes, sinovenous thrombotic hemorrhages due to antithrombin III deficiency, congenital brain anomaly, and septic shock, respectively. CONCLUSION: Approximately one third of neonatal seizures were caused by HIE, and moderate to severe HIE had more serious outcomes. Neonatal seizure could be a significant clinical sign indicating specific underlying etiologies such as stroke, metabolic disturbances or congenital brain anomalies. Therefore, intensive workup and prompt management for neonatal seizures should be considered for better outcomes.

Prophylactic Administration of Surfactant with Nasal Continuous Positive Airway Pressure in Preterm Infants with Gestational Age Less than 30 Weeks

PURPOSE: This study was performed to investigate the effectiveness and safety of the prophylactic administration method of surfactant, followed by rapid extubation to nasal CPAP (nCPAP) in very preterm infants. METHODS: Thirty-three preterm infants with 24-29 weeks gestational age (GA) were treated with the method of prophylactic administration of surfactant by a brief intubation within 15 minutes after birth and rapid extubation to nCPAP for the treatment of respiratory distress. The variables and complications related to oxygen therapy and mechanical ventilation (MV) were compared with those of 24 historical control infants with comparable GA, treated with the rescue surfactant administration with prolonged MV for the respiratory distress syndrome (RDS). RESULTS: Prophylactic surfactant with nCPAP did not reduce the total durations of oxygen therapy and MV, compared with the rescue surfactant with MV (P=0.622 P=122, respectively). The incidence of death and BPD at 36 weeks postmenstrual age (PMA) and other complications related to oxygen therapy and MV were not increased in the infants treated with prophylactic surfactant with nCPAP despite the lower GA and birth weight. In the subgroup analysis for infants with 27-29 weeks of GA, the total duration of MV tended to decrease in infants treated with prophylactic surfactant with nCPAP (Odd ratio, 0.93, 95% Confidence interval, 0.87, 1.00, P=0.051). CONCLUSION: Prophylactic surfactant administration followed by rapid extubation to nCPAP tended to reduce the duration of MV in infants with GA of 27-29 weeks, compared with the rescue surfactant administration with prolonged MV for RDS.

How to Do in Persistent Diarrhea of Children?: Concepts and Treatments of Chronic Diarrhea / 대한소아소화기영양학회지

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child's age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the vicious cycle of chronic diarrhea and is one of the main one thing among treatments. We should know the exact concept of chronic diarrhea and provide appropriate treatments according to etiologies of chronic diarrhea.

Neurodevelopmental Outcomes of VLBW Infants with Diffuse Excessive High Signal Intensity (DEHSI) in the White Matter of the Brain MR Imaging around a Near Term-equivalent Age

PURPOSE: The aim of this study was to investigate the relationship between diffuse excessive high signal intensity (DEHSI) in the white matter of the brain MRI and neurodevelopmental abnormalities in VLBW infants. METHODS: The T1- and T2-weighted MR images of the brain around a near term-equivalent age in 167 VLBW infants were evaluated for the white matter lesions. The presence of DEHSI was determined and classified into four grades on the extent of DEHSI. The relationship between the grade of DEHSI and neurodevelopmental abnormalities was investigated in 94 infants who were assessed for neurodevelopmental outcomes by using a neurologic examination and neurodevelopmental assessment (BSID-II) at 18-24 months of corrected age. RESULTS: DEHSI was the most commonly observed white matter lesion (68.3%) in the MR imaging of the brain around a near term-equivalent age. Gestational age and birth weight tended to increase with increasing grade of DEHSI (P=0.060, P=0.001, respectively). There was no significant relationship between the grade of DEHSI and neurodevelopmental outcomes at 18??4 months of corrected age (P>0.05). Periventricular cysts and ventriculomegaly in the brain MRI were significant risk factors for neurodevelopmental abnormalities (P<0.05). CONCLUSION: DEHSI, most commonly seen in the white matter of the brain MRI around a near term-equivalent age in VLBW infants, did not seem to be related to the neurodevelopmental abnormalities at 18-24 months of corrected age.

Meconium Obstruction in Very Low Birth Weight Infants / 대한소아소화기영양학회지

PURPOSE: Mecnoium obstruction in very low birth weight infants (VLBWI), which delays enteral feeding and is one of the major causes of bowel obstruction, can be diagnosed and treated with hyperosmolar water-soluble contrast enema. The purpose of this study was to observe the clinical findings of meconium obstruction, the improvement of small bowel obstruction after contrast enema, and the complications related to the enema. METHODS: Hypersolmolar water-soluble contrast enemas were performed in 14 VLBWIs with meconium obstruction. Clinical findings, radiologic findings, feeding intolerance, effectiveness, and complications of enemas were observed. Also, clinical findings related to meconium obstruction were compared with 18 VLBWIs without meconium obstruction. RESULTS: 1) Fourteen VLBWIs with meconium obstruction had significantly lower 5 minutes Apgar scores than 18 VLBWIs without meconium obstruction (p<0.05). Moreover, the day of last meconium passing, and the day of the first trial and full enteral feeding were delayed significantly. 2) A total of 18 enemas were performed in the 14 infants. The contrast medium passed the ileocecal valve and reached the terminal ileus in 12 enemas. Of the 12 enemas, 11 were successful, but 1 infant underwent an ileotomy, even though the contrast medium reached the terminal ileum. 3) Intestinal obstruction was not relieved in three of five infants, in whom the contrast medium failed to pass the ileocecal valve. Obstruction was relieved after repeated enemas in which the contrast medium reached the terminal ileum. 4) No complications associated with water-soluble contrast enemas were observed. CONCLUSION: Hyperosmolar water-soluble contrast enema is considered to be safe and therapeutic for meconium obstruction in VLBWIs.

Anatomic Illustrations of Cranial Ultrasound Images Through the Posterior Fontanelle in Neonates: Objective Analysis of Oblique Sonographic Scans using MRI and a Reconstruction Program

PURPOSE: Neonatal cranial sonongraphy through the posterior fontanelle is more useful than through the anterior approach for the evaluation of posterior brain structures. The aims of this study were to determine the appropriate neonatal cranial sonography scan planes through the posterior fontanelle, and to objectively evaluate the anatomy of neonatal cranial sonographic images. MATERIALS AND METHODS: Neonates who underwent cranial sonography and MRI including 3D-SPGR axial scans and showed normal features on both modalities were enrolled. We reconstructed MR images corresponding to sonongraphic planes, then constructed anatomic models of the neonatal cranial sonographic images using axial MRI as the standard reference on the same screen. RESULTS: We successfully created anatomic atlas that represents 8 oblique coronal and 4 oblique sagittal scans and planes that corresponded to the neonatal cranial sonographic images through the posterior fontanelle. CONCLUSION: The objective manner of this anatomic research provided standardized sonographic scan planes and created anatomic model through the posterior fontanelle. Cranial sonographic models through the posterior fontanelle using MRI and multi-planar reconstruction program will be helpful in the evaluation of sonographic anatomy and detection of abnormalities in the basal ganglia, thalamus and posterior part of the brain.

A Case of Hypersensitivity to Mosquito Bite Associated with Epstein-Barr Viral Infection and Natural Killer Cell Lymphocytosis

Hypersensitivity to mosquito bites (HMB) is a disorder characterized by a necrotic skin reaction and generalized symptoms subsequent to mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer cell leukemia/lymphoma. We describe here a Korean child who had HMB associated with chronic EBV infection and natural killer cell lymphocytosis. A 5-yr-old boy was suffered from necrotic skin lesions on the right ear lobe. Type A EB virus was detected from hlood cells and bone marrow biospy recognized hemophagocyrosis.

Magnetic resonance imagining findings of the white matter abnormalities in the brain of very-low-birth-weight infants / 소아과

PURPOSE: To observe the abnormal white matter findings on the magnetic resonance imaging (MRI) scans of very-low-birth-weight (VLBW) infant brains at term-equivalent age and to determine the clinical risk factors for the development of periventricular leukomalacia (PVL). METHODS: In all, MRI was performed in 98 VLBW infants and the white matter abnormalities were observed. Clinical risk factors for cystic and noncystic PVL were determined. RESULTS: MRI scans of 74 infants (75.5%) showed diffuse excessive high signal intensity (DEHSI) in the periventricular white matter, 17 (17.3%) lateral ventricle dilation, 5 (5.1%) and 11 (11.2%) focal punctate lesions and cystic changes in the periventricular white matter, respectively, 9 (9.1%), germinal layer hemorrhage (GLH) or subependymal cysts 3 (3.1%) intraventricular hemorrhage (>grade 2) 2 (2.0%) posthemorrhagic hydrocephalus and 2 (2.0%) periventricular hemorrhagic infarct. Gestational age (GA), 1-minute Apgar score, Clinical Risk Index for Babies-II (CRIB-II) score, and inotrope use, and GA, CRIB-II score, postnatal steroid administration, inotrope use, and abnormal white blood cell (WBC) count at admission were related to cystic PVL and noncystic PVL development, respectively (P<0.05). However, in logistic regression analysis, CRIB-II (odds ratio, 1.63, 295% confidence interval, 1.15-2.30 P=0.006) for cystic PVL, and GA (odds ratio 0.90, 95% confidence interval, 0.82-9.99 P=0.036) for noncystic PVL were only significant independently. CONCLUSION: White matter abnormalities could be observed on MRI scans of the VLBW infant brains at term-equivalent age, and CRIB-II and GA were only independently significant for cystic and noncystic PVL development, respectively.

Clinical significance of codetection of the causative agents for acute respiratory tract infection in hospitalized children / 소아과

PURPOSE: To determine the prevalence and clinical features of codetected respiratory etiological agents for acute respiratory infection in hospitalized children. METHODS: Nasopharyngeal aspirates were obtained from hospitalized children with acute respiratory infection at Dankook University Hospital from September 2003 through June 2005. Immunofluorescent staining and culture were used for the detection of respiratory viruses (influenza virus [IFV] types A, B; parainfluenza virus [PIV] types 1, 2, 3; respiratory syncytial virus [RSV]; adenovirus [AdV]). Polymerase chain reaction (PCR) assays were used for Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT) detection, and PCR and culture were performed for enterovirus detection. Acid-fast staining and culture were performed for tuberculosis detection. The demographic and clinical characteristics were reviewed retrospectively from the patients medical records. RESULTS: Evidence of two or more microbes was found in 28 children: RSV was detected in 14, PIV 3 in 10, AdV in 10, MP in 8, PIV 2 in 8, CT in 4, and PIV 1 in 3. Codetected agents were found as follows: RSV+PIV 2, 6 patients; AdV+MP, 4 patients; AdV+PIV, 3 patients; RSV+MP, 3 patients; PIV 1+PIV 3, 3 patients. Distinct peaks of codetected agents were found in epidemics of MP and each respiratory virus. CONCLUSION: The codetected infectious agents were RSV, PIV, AdV, and MP, with distinct peaks found in epidemics of MP and each respiratory virus. Although advances in diagnostic methods have increased the prevalence of codetection, its clinical significance should be interpreted cautiously.

Thyroid dysfunction in premature infants / 소아과

PURPOSE: Thyroid hormone is essential for development of the brain in early life. Thyroid dysfunction is more common in the first 2-4 postnatal weeks of life in premature infants than in term infants. This study aimed to identify the prevalence and clinical course of thyroid dysfunction in prematurity. METHODS: Premature infants admitted to and given neonatal screenings at Dankook University Hospital between April 1999 and March 2008 were included in this study. We retrospectively reviewed medical records and categorized subjects into six groups: normal, hypothyroidism, hyperthyrotropinemia, hypothyroxinemia, delayed onset of hypothyroidism, and delayed onset of hyperthyrotropinemia. METHODS: Among 599 subjects, 136 (23%) had initially abnormal thyroid function test (TFT); transient hypothyroxinemia was the most frequent condition (118, 20%). In addition, 8 (17%) of 46 subjects with initially normal TFT levels showed delayed onset of hyperthyrotropinemia with or without low free thyroxine (fT4). Thyroxine was prescribed for 10 patients (1.7%) due to low fT4 levels but was discontinued in 9 patients during follow-up. Thyroid scan confirmed ectopic thyroid in one patient. CONCLUSION: Thyroid dysfunction was frequently seen in premature infants, but most of the conditions were transient. In addition, some infants showed delayed TSH elevation on routine follow-up. Therefore, a recheck of the thyroid function of premature infants at 3-4 weeks is recommended, even if normal thyroid function is initially seen, especially in prematurity of less than 33 weeks of gestational age or birth weight of less than 2,500 grams.

Thyroid dysfunction in premature infants / 소아과

PURPOSE: Thyroid hormone is essential for development of the brain in early life. Thyroid dysfunction is more common in the first 2-4 postnatal weeks of life in premature infants than in term infants. This study aimed to identify the prevalence and clinical course of thyroid dysfunction in prematurity. METHODS: Premature infants admitted to and given neonatal screenings at Dankook University Hospital between April 1999 and March 2008 were included in this study. We retrospectively reviewed medical records and categorized subjects into six groups: normal, hypothyroidism, hyperthyrotropinemia, hypothyroxinemia, delayed onset of hypothyroidism, and delayed onset of hyperthyrotropinemia. METHODS: Among 599 subjects, 136 (23%) had initially abnormal thyroid function test (TFT); transient hypothyroxinemia was the most frequent condition (118, 20%). In addition, 8 (17%) of 46 subjects with initially normal TFT levels showed delayed onset of hyperthyrotropinemia with or without low free thyroxine (fT4). Thyroxine was prescribed for 10 patients (1.7%) due to low fT4 levels but was discontinued in 9 patients during follow-up. Thyroid scan confirmed ectopic thyroid in one patient. CONCLUSION: Thyroid dysfunction was frequently seen in premature infants, but most of the conditions were transient. In addition, some infants showed delayed TSH elevation on routine follow-up. Therefore, a recheck of the thyroid function of premature infants at 3-4 weeks is recommended, even if normal thyroid function is initially seen, especially in prematurity of less than 33 weeks of gestational age or birth weight of less than 2,500 grams.

Molecular identification and clinical features of enteroviral infection in children of central Korea: An overview of enteroviral epidemiology between spring 2005 and autumn 2006 / 소아과

PURPOSE: Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. METHODS: From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. RESULTS: Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions: There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea.

Molecular identification and clinical features of enteroviral infection in children of central Korea: An overview of enteroviral epidemiology between spring 2005 and autumn 2006 / 소아과

PURPOSE: Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. METHODS: From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. RESULTS: Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions: There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea.