Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts / 대한소아소화기영양학회지

Usefulness of the procalcitonin test in young febrile infants between 1 and 3 months of age / 소아과

PURPOSE: To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. METHODS: We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. RESULTS: Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. CONCLUSION: Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.

Early Infliximab Yields Superior Long-Term Effects on Linear Growth in Pediatric Crohn's Disease Patients

BACKGROUND/AIMS: Information regarding the efficacy of early infliximab treatment in pediatric patients with Crohn's disease (CD) is limited. We aimed to evaluate the impact of early combined immunosuppression on linear growth in pediatric patients with CD by performing step-up comparisons. METHODS: This retrospective study included pediatric patients with moderate-to-severe CD, who received a combination therapy with infliximab and azathioprine for at least 3 years and sustained corticosteroid-free remission without loss of response. The z-scores of the growth indicators obtained at the time of diagnosis and annually for 3 years thereafter were compared between the two groups. RESULTS: The early combined immunosuppression group displayed significantly increased linear growth 3 years after diagnosis (p=0.026). A significant difference was also observed in the linear growth 3 years after diagnosis between subgroups of Tanner stages 1–2 (p=0.016). CONCLUSIONS: The early introduction of biologics should be considered to improve linear growth in pediatric patients with CD.

The Association between Socioeconomic Status and Obesity in Korean Children: An Analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012) / 대한소아소화기영양학회지

PURPOSE: Obesity is one of the most common health problems among children and its prevalence has increased in recent decades. Socioeconomic status (SES) is a well-known risk factor for childhood obesity although the associations were different across countries. Previous studies in other countries have reported a positive association between childhood obesity and SES in developing countries, and inverse correlation has been reported in developed countries. For this reason, we wanted to investigate the relationship between SES and obesity in Korean children. METHODS: Data were acquired 3,095 boys and girls who participated in the fifth Korea National Health and Nutrition Examination Survey, which was conducted from 2010 to 2012. Body mass index was calculated from measured anthropometric data using the 2007 Korean National Growth Charts. RESULTS: Upon univariate analysis, we did not find any statistically significant differences in the parental employment status, monthly family income between children with and without obesity. Multiple logistic regression analysis showed childhood obesity was positively associated with maternal overweight (OR, 1.889; 95% CI, 1.079-3.309), maternal obesity (OR, 3.409; 95% CI, 2.228-5.215) and paternal obesity (OR, 2.135; 95% CI, 1.257-3.627). CONCLUSION: The present study showed that socioeconomic status might not an important risk factor for obesity in Korean children. These results warrant further studies to clarify the association between SES and obesity in Korean children.

Clinical Manifestation and PRRT2 Analysis of Korean Patients with Paroxysmal Kinesigenic Dyskinesia / 대한소아신경학회지

PURPOSE: Paroxysmal kinesigenic dyskinesia (PKD) is a rare paroxysmal movement disorder characterized by recurrent and brief dyskinesia attacks triggered by sudden voluntary movement. The diagnosis of PKD is based on clinical findings, and mutations in the proline-rich transmembrane protein 2 (PRRT2) gene have been identified as the cause of PKD. Two Korean cohorts have been reported on PRRT2 mutation analysis in PKD patients. The purpose of this study was to determine the mutation spectrum of the PRRT2 gene and to examine the clinical characteristics associated with PRRT2 mutations. METHODS: We studied 23 members of four families with familial PKD and two families with sporadic PKD which included 9 patients and 2 patients, respectively. Mutation analysis of the PRRT2 gene was performed using Sanger sequencing. Clinical features of PKD were compared between patients with a PRRT2 mutation and those with no detectable PRRT2 mutation. RESULTS: PRRT2 mutations were detected in three of four PKD families (75%), and in none of the two sporadic cases (0%). All detected PRRT2 mutations were c.649dupC (p.Arg217Profs*8). Subjects with detected PRRT2 mutations had earlier age at onset and longer duration of attacks. CONCLUSION: As previously reported in Korean PKD patients, our results confirmed that PRRT2 is a major causative gene for familial PKD, and the c.649dupC is the most frequent mutation. PRRT2 mutation analysis is required for the molecular diagnosis of familial PKD and for evaluating the clinical manifestations of PKD.

Pediatric Mycoplasma pneumoniae Infection Presenting with Acute Cholestatic Hepatitis and Other Extrapulmonary Manifestations in the Absence of Pneumonia / 대한소아소화기영양학회지

Mycoplasma pneumoniae infections mainly involve respiratory tract; however, also can manifestate other symptoms by site involved. Extrapulmonary manifestations of M. pneumoniae infection are rarely known to occur without pneumonia. Herein we report a case of a 9-year-old boy who presented with acute cholestatic hepatitis in the absence of pneumonia. Rhabdomyolysis, skin rash, and initial laboratory results suspicious of disseminated intravascular coagulopathy were also observed in this patient. M. pneumoniae infection was identified by a 4-fold increase in immunoglobulin G antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. This is the first pediatric case in Korea of M. pneumoniae infection presenting with acute cholestatic hepatitis in the absence of pneumonia.

Propofol versus Midazolam for Sedation during Esophagogastroduodenoscopy in Children

BACKGROUND/AIMS: To evaluate the efficacy and safety of propofol and midazolam for sedation during esophagogastroduodenoscopy (EGD) in children. METHODS: We retrospectively reviewed the hospital records of 62 children who underwent ambulatory diagnostic EGD during 1-year period. Data were collected from 34 consecutive patients receiving propofol alone. Twenty-eight consecutive patients who received sedation with midazolam served as a comparison group. Outcome variables were length of procedure, time to recovery and need for additional supportive measures. RESULTS: There were no statistically significant differences between the two groups in age, weight, sex, and the length of endoscopic procedure. The recovery time from sedation was markedly shorter in propofol group (30+/-16.41 minutes) compared with midazolam group (58.89+/-17.32 minutes; p<0.0001). During and after the procedure the mean heart rate was increased in midazolam group (133.04+/-19.92 and 97.82+/-16.7) compared with propofol group (110.26+/-20.14 and 83.26+/-12.33; p<0.0001). There was no localized pain during sedative administration in midazolam group, though six patients had localized pain during administration of propofol (p<0.028). There was no serious major complication associated with any of the 62 procedures. CONCLUSIONS: Intravenous administered propofol provides faster recovery time and similarly safe sedation compared with midazolam in pediatric patients undergoing upper gastrointestinal endoscopy.

Delayed Response of Amylin Levels after an Oral Glucose Challenge in Children with Prader-Willi Syndrome

PURPOSE: Amylin secretion is increased parallel to insulin in obese subjects. Despite their marked obesity, a state of relative hypoinsulinemia occurs in children with Prader-Willi syndrome (PWS). Based on the hypothesis that amylin levels may be relatively low in PWS children, contributing to their excessive appetite, we studied amylin levels after oral glucose loading in children with PWS and overweight controls. MATERIALS AND METHODS: Plasma levels of amylin, glucagon, insulin, and glucose were measured at 0, 30, 60, 90, and 120 min after a glucose challenge in children with PWS (n = 18) and overweight controls (n = 25); the relationships among the variables were investigated in these two groups. RESULTS: Amylin levels were significantly correlated with insulin during fasting and during the oral glucose tolerance test in both groups. Amylin levels between 0 and 60 min after glucose loading were statistically different between the two groups. They were lower in children with PWS than in the controls between 0 and 30 min after glucose loading. CONCLUSION: The relatively low levels of amylin, compared to those in overweight controls, during the early phase of glucose loading in patients with PWS, may contribute, in part, to the excessive appetite of PWS patients as compared to the overweight controls.

A Single Center Experience of Self-Bougienage on Stricture Recurrence after Surgery for Corrosive Esophageal Strictures in Children

PURPOSE: This study was undertaken to evaluate the long-term treatment of esophageal strictures in children with corrosive esophagitis and to determine the effect of self-bougienage on recurrent strictures. MATERIALS AND METHODS: We reviewed the medical records of nine children that were treated for corrosive esophageal strictures from May 2000 to May 2008. Six males and three females were included and their average age was 30 months. Six patients had ingested acids, two patents had ingested alkali, and one ingested an unknown agent. RESULTS: The interval between caustic ingestion and esophageal stricture ranged from one to eight weeks. The average length of the esophageal strictures was 3.8 cm (range, 1 to 9.2 cm). Four patients had a long segment stricture (longer than 5 cm) and one patient had multiple strictures. The most common site of involvement was the upper third followed by the mid third of the esophagus. Eight patients received repeated dilatation using a balloon catheter or bougie dilator. Among the eight patients, two patients had complete resolution of symptoms and six patients required surgery. Among five patients that developed restenosis of the esophageal anastomosis site, three patients had improved symptoms after self-bougienage and two patients had improved symptoms with repeated balloon dilatation or endoscopic bougienage. There were no complications in these patients. CONCLUSION: Although a small number of patients were studied, self-bougienage was safe, less invasive, and effective for the management of esophageal restenosis in patients who required frequent dilation after surgery.

Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients in Korea

PURPOSE: We identified pediatric liver transplant recipients with successful withdrawal of immunosuppression who developed tolerance in Korea. MATERIALS AND METHODS: Among 105 pediatric patients who received liver transplantation and were treated with tacrolimus-based immunosuppressive regimens, we selected five (4.8%) patients who had very low tacrolimus trough levels. Four of them were noncompliant with their medication and one was weaned off of immunosuppression due to life threatening posttransplant lymphoproliferative disorder. We reviewed the medical records with regard to the relationship of the donor-recipients, patient characteristics and prognosis, including liver histology, and compared our data with previous reports. RESULTS: Four patients received the liver transplantation from a parent donor and one patient from a cadaver donor. A trial of withdrawal of the immunosuppressant was started a median of 45 months after transplantation (range, 14 months to 60 months), and the period of follow up after weaning from the immunosuppressant was a median of 32 months (range, 14 months to 82 months). None of the five patients had rejection episodes after withdrawal of the immunosuppression; they maintained normal graft function for longer than 3 years (median, 38 months; range, 4 to 53 months). The histological findings of two grafts 64 and 32 months after weaning-off of the medication showed no evidence of chronic rejection. CONCLUSION: The favorable markers for successful withdrawal of immunosuppression were 1) long-term (> 3 years) stable graft function, 2) no rejection for longer than 1 year after withdrawal of immunosuppression, 3) non-immune mediated liver diseases, and 4) pediatric patients.

Killian-Jamieson Diverticula Mimicking a Right Thyroid Nodule on Ultrasonography: A Case Report

A Killian-Jamieson diverticulum is a type of pharyngoesophageal diverticuli and can be visualized on thyroid ultrasonography (US). Although most of the lesions are located in the deep layer of the left thyroid lobe, we encountered a case of a right-sided Killian-Jamieson diverticulum in a 64-year-old man that was mistaken for a thyroid nodule on US. We describe the US, computed tomographic, and esophagraphic findings of this case. In addition, we describe the US findings of a left Killian-Jamieson diverticulum in a 55-year-old woman that was seen as a hyperechoic mass in the thyroid on US.. The shape and echogenecity of the diverticulum changed with swallowing as depicted on real-time US and the need for a needle aspiration biopsy was avoided.

Infliximab: The Benefit for Refractory Crohn Disease andTop-down Induction Therapy in Severe Crohn Disease / 대한소아소화기영양학회지

PURPOSE: The aim of this study is to report the efficacy of infliximab, a monoclonal antibody directed against tumor necrosis factor alpha which is used for both treatment of refractory pediatric Crohn disease (CD) and induction of remission. METHODS: Among pediatric patients who were diagnosed with CD at Samsung Medical Center between March 2001 and August 2007, a total of 16 patients were given infliximab to treat conventional therapy- resistant refractory CD and severe active CD for induction of remission. Patients needing maintenance therapy were treated with an infliximab infusion every 8 weeks, and fistulizing CD patients occasionally received the infusion upon the condition that a fistula developed. The efficacy of treatment was assessed by comparing the Pediatric Crohn Disease Activity Index (PCDAI), Hct, ESR, CRP, and serum albumin levels using paired t-test. RESULTS: The male/female ratio was 13:3, and the median age was 13 years (range, 21 months~15 years). The patients included 7 cases of therapy-resistant refractory CD, 7 cases of severe active CD, and 2 cases of fistulizing CD. Mean PCDAI before infliximab therapy was 34.19+/-14.96, and mean follow-up PCDAI within 2 to 4 weeks after the last infusion was significantly lower, at 6.88+/-10.31 (p= 0.000). Hematological markers such as ESR (p=0.000), serum albumin (p=0.016), and CRP (p=0.009) also improved significantly after infusion. Remission was achieved in 2 of 4 patients refractory to conventional therapy. Among 3 steroid-dependent patients, 2 were able to discontinue steroid therapy, and dose reduction was possible in 1 patient. Remission after top-down therapy without prior use of other immunomodulators was achieved in 6 weeks in all 7 of the patients who had severe CD. Nine of ten refractory fistulizing CD patients also showed improvement after infliximab therapy. CONCLUSION: Infliximab was effective in pediatric refractory CD for induction of remission and maintenance therapy, as well as in severe CD for top-down induction therapy. Furthermore, infliximab has contributed to steroid cessation and dose reduction. Long-term follow-up evaluation is needed to determine safety and efficacy of infliximab in the future.

A Case of Congenital Extra Hepatic Portocaval Shunt(Abernethy Malformation Type 2) with a very LargeLiver Mass and an Atrial Septal Defect / 대한소아소화기영양학회지

Extrahepatic portosystemic shunts, known as Abernethy malformations, were first reported by John Abernethy in 1793. They are classified into two types: Type I refers to a congenital absence of the portal vein and Type II refers to a shunt involving a side-to-side anastomosis with reduced portal blood flow into the liver parenchyma. This malformation is so rare that less than 100 cases have been reported in the medical literature. We report the case of a 13-month-old boy who had a congenital extrahepatic portocaval shunt with a hypoplastic portal vein. This case was complicated with an atrial septal defect and a large hyperplastic nodule in the liver. The patient was diagnosed with a Type II Abernethy malformation. We planned on surgical occlusion of the extrahepatic portocaval shunt. However, six months later, the patient had a sudden onset of a fever of unknown origin and developed hepatic encephalopathy. Although he underwent a liver transplantation, he died of acute hepatic failure.

Spontaneous Passage of Gastrointestinal Foreign Bodies in Children / 대한소아소화기영양학회지

PURPOSE: Ingested foreign bodies are removed by endoscopy, surgery or spontaneous passage, however, the decision of therapeutic modality chosen depends on the type, size, shape and location of the ingested foreign bodies. Therefore, this study was conducted to investigate the rate and characteristics of foreign bodies that were passed spontaneously out of the intestine. METHODS: One hundred and sixty patients who visited Samsung Medical Center for treatment of gastrointestinal foreign bodies between January 2001 to July 2007 were enrolled in this study. Related data was colleted by reviewing the medical records of patients with proven foreign bodies retrospectively, as well as by conducting phone interviews with the parents of the patients. All cases were classified based on the nature and location of the ingested foreign body, as well as whether it was treated by spontaneous passage. RESULTS: Of the 160 cases involving the passage of foreign bodies in children were included in this study (95 boys and 65 girls), endoscopic removals, operative removals or spontaneous passages were conducted in 80, 3 and 77 patients, respectively. The spontaneous passage rates for each type of object were as follows; coins (36.5%), bead and baduk stones (83.3%), long and sharp materials (52.6%), magnets (69.2%) and disc batteries (50.0%). In cases involving round-shaped foreign bodies, such as coins, the diverse spontaneous passage rates were more diverse. When foreign bodies were stuck below esophagus, similar sized coins and baduk stones had spontaneous passage rates greater than 80% regardless of age. CONCLUSION: It is better for clinicians to wait for spontaneous passage to occur in cases involving coins or round-shaped foreign bodies that are located at or below the stomach.

Spontaneous Passage of Gastrointestinal Foreign Bodies in Children / 대한소아소화기영양학회지

PURPOSE: Ingested foreign bodies are removed by endoscopy, surgery or spontaneous passage, however, the decision of therapeutic modality chosen depends on the type, size, shape and location of the ingested foreign bodies. Therefore, this study was conducted to investigate the rate and characteristics of foreign bodies that were passed spontaneously out of the intestine. METHODS: One hundred and sixty patients who visited Samsung Medical Center for treatment of gastrointestinal foreign bodies between January 2001 to July 2007 were enrolled in this study. Related data was colleted by reviewing the medical records of patients with proven foreign bodies retrospectively, as well as by conducting phone interviews with the parents of the patients. All cases were classified based on the nature and location of the ingested foreign body, as well as whether it was treated by spontaneous passage. RESULTS: Of the 160 cases involving the passage of foreign bodies in children were included in this study (95 boys and 65 girls), endoscopic removals, operative removals or spontaneous passages were conducted in 80, 3 and 77 patients, respectively. The spontaneous passage rates for each type of object were as follows; coins (36.5%), bead and baduk stones (83.3%), long and sharp materials (52.6%), magnets (69.2%) and disc batteries (50.0%). In cases involving round-shaped foreign bodies, such as coins, the diverse spontaneous passage rates were more diverse. When foreign bodies were stuck below esophagus, similar sized coins and baduk stones had spontaneous passage rates greater than 80% regardless of age. CONCLUSION: It is better for clinicians to wait for spontaneous passage to occur in cases involving coins or round-shaped foreign bodies that are located at or below the stomach.

Ghrelin Levels in Gastric Mucosa before and after Eradication of Helicobacter pylori

BACKGROUND/AIMS: The relationship between Helicobacter pylori infection and ghrelin is controversial. We compared ghrelin levels in gastric mucosa and plasma between H. pylori-positive and -negative subjects, and between before and after H. pylori eradication. METHODS: We compared the ghrelin levels in the antrum, body, and fundus between H. pylori-positive and -negative subjects; in stomach tissues between before and after H. pylori eradication; and in plasma and tissue in 10-person cohorts between before and after H. pylori eradication therapy. Body mass index, age, and sex were controlled for when comparing ghrelin levels. RESULTS: Stomach ghrelin levels (in the antrum, body, and fundus) did not differ significantly between H. pylori-positive and -negative samples (p=0.095, 0.316, and 0.897, respectively), or between before and after H. pylori eradication (p=0.19, 0.178, and 0.513, respectively). In the ten-person cohort study, plasma ghrelin levels in the eight H. pylori-positive subjects were 2,260 pg/mL (range, 1,280-3,770 pg/mL) and 1,900 pg/mL (range, 1,350-5,200 pg/mL) before and after eradication therapy (p=0.871). Stomach ghrelin levels did not differ significantly in the eight H. pylori-positive subjects between before and after H. pylori eradication (p=0.732, 0.618, and 0.435 in the antrum, body, and fundus, respectively), or between six eradicated and two noneradicated subjects (p=0.071, 0.857, 0.429, and 0.857 in the antrum, body, fundus, and plasma, respectively). CONCLUSIONS: These results show that H. pylori infection has no effect on stomach ghrelin levels and that eradication therapy does not influence plasma or tissue ghrelin levels.

The Spectrum of Various Intracranial Manifestations in Leukemic Patients: A Pictorial Review

The recent therapeutic advances for treating hematologic neoplasm have improved patients' survival, but these treatments have increased the frequency of neurologic complications and toxic effects. Most of the neurological features of leukemia are divided into three main categories: the primary effects of the disease, the treatment-related side effects and the infectious complications. The purpose of this pictorial assay is to document the radiologic abnormalities seen in the intracranial structures during and after the treatment of leukemia, and to aid in the clinical management of patients.

Voiding cystourethrography in children with an initial episode of febrile urinary tract infection / 소아과

PURPOSE: Because voiding cystourethrography(VCUG) is an invasive method, we studied whether VCUG could be postponed through evaluation of alternative non-invasive tests including renal ultrasonography and (99m)Tc-DMSA renal scan. METHODS: We reviewed the medical records of 175 patients initially diagnosed with febrile urinary tract infection during the one year period of 1999, and compared 3-tests:renal ultrasongraphy, (99m)Tc-DMSA renal scan, and VCUG. RESULTS: Renal ultrasonography didn't contribute to the prognostication of pyelonephritis(photopenic areas) or vesicoureteral reflux(VUR). Presentation of photopenic areas in (99m)Tc-DMSA renal scan was related to VUR. If both findings of renal ultrasonography and (99m)Tc-DMSA renal scans were normal, this condition was closely related to normal results in VCUG. And if both examinations were abnormal, the condition was closely related to VUR. But this state could not always guarantee the normal result from VCUG because of low sensitivity in finding VUR. CONCLUSION: In cases in which acute phyelonephritis is demonstrated by (99m)Tc-DMSA renal scan, VCUG is required. In addition to this, if the conditions of hydronephrosis, vesicoureteral dilatation, increases of renal volume, and changes of echogenesity are shown by renal ultrasonography, VCUG should be performed. If a patient has difficulty undergoing VCUG, temporary postponement of VCUG can be taken into consideration, but only in cases where both examinations of renal ultrasonography and (99m)Tc-DMSA renal scan are normal. Nevertheless, close observation is be advised even in this case.