Predisposing factors to nipple confusion / 소아과

PURPOSE: The purpose of this study is to investigate the predisposing factors for nipple confusion by using questionnaires. METHODS: From October, 2005 to October, 2006, we performed a survey on guardians of neonates who had been admitted to the nursery at Dongguk University Medical Center and were discharged 10 to 14 days before the survey. We reviewed their medical records retrospectively. The neonates were categorized into two groups; nipple-unconfused group and nipple- confused group. RESULTS: There were 71 neonates in the nipple-unconfused group and 29 neonates in the nipple-confused group. In the nipple-confused group, 12 neonates (41.4%) had nipple-suckling experience before admission, whereas in the nipple-unconfused group, 54 neonates (76.1%) had nipple-suckling experience before admission; showing a difference that was statistically significant (P=0.001). Regarding to breast-feeding experience before admission, 11 neonates (37.9%) had experience in the nipple-confused group, whereas 49 neonates (69.0%) had in the nipple-unconfused group. This also showed a statistically significant difference (P=0.004). However, the relationship between the duration of breast-feeding prior to hospitalization was not different (P=0.151). CONCLUSION: In this study, we believe that the suckling experience and the breast-feeding of neonates before admission may be factors affecting the development of nipple confusion. This study particularly revealed that neonates who had only nipple suckling experience, regardless of breast-feeding, had less nipple confusion. Thus, allowing neonates enough time to make an attempt at nipple suckling may be helpful to prevent nipple confusion.

Survey on the Awareness of Guardians of Young Infants on the Weaning of Food in Pohang and Gyeongju Area / 대한소아소화기영양학회지

PURPOSE: This study was carried out to investigate the awareness of the weaning of food using questionnaires, and the relationship with the weight gain in young infants. METHODS: From September 2005 to December 2005, we performed a survey on 141 guardians of young infants aged from 6 to 18 months, who visited the pediatric out-patient department at Dongguk University Medical Center. We calculated the total score for each responder from ten questions on the weaning of food and assessed the body weight percentile of each of the young infants. RESULTS: The most commonly reported information source for weaning food was 'the friends around' by 62 respondents (44.0%); 54 (38.3%) responded that the definition of weaning food was the preparatory step before starting a solid diet. Most used a spoon (90.8%) to feed when weaning food with a thin gruel of rice (78.7%). The time for weaning of food was before breast or infant formula feeding (55.3%). Addition of cow's milk was around 12 months (77.3%). The mean score was 6.21; however this did not show a statistically significant correlation with weight gain in young infants. CONCLUSION: The overall awareness of weaning of food has improved; however, information from doctors has decreased. Although the relationship between the awareness of weaning of food and the growth of young infants was not statistically significant, further studies on weaning of food, with larger and controlled sample sizes may provide important information.

Hydroxyurea Therapy in Hemoglobin Madrid Patients / 대한혈액학회지

Unstable hemoglobins (Hb) are variants of adult Hb that tend to precipitate and form insoluble inclusions (Heinz bodies) within red blood cells (RBC) and RBC precursors. More than 100 structurally different unstable Hb variants showing broad spectrum of manifestations from asymptomatic to severe hemolytic anemia and dyserythropoiesis have been discovered. Hydroxyurea is a potent ribonucleotide reductase inhibitor and have been proposed as a new therapy for beta chain hemoglobinopathies through activation of gamma chain synthesis. We treated two patients (A : son, B : father) with highly unstable Hb diagnosed as Hb Madrid [Beta 115(G17)Ala->Pro] by direct DNA sequencing and restriction enzyme analysis. Our patients received hydroxyurea in dosages varying from 0.75g to 1.3g daily for 89 weeks. We could not show the clinical and hematological improvements after hydroxyurea therapy in thses patients. Optimization of dosage and long term side effects of hydroxyurea should be studied further.

Two Cases of Gitelman's Syndrome Diagnosed by Renal Clearance Study

Gitelman's syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria that has recently been reported to be linked to thiazide-sensitive Na-Cl cotransporter gene mutation. In this study, we performed renal clearance studies to differentiate Gitelman's from Bartter's syndrome and to confirm the diagnosis in two patients clinically diagnosed with Gitelman's syndrome. Each patient was hydrated by 20 mL/kg body weight of oral water within 30 minutes, which was followed by intravenous half saline. When urinary flow reached 10 mL/min, samples of urine and serum were obtained to calculate the osmolar clearance, free water clearance, chloride clearance, and distal fractional chloride reabsorption. Subsequently, furosemide or hydrochlorothiazide was administered. Samples were collected and the same parameters were calculated. In our patients, chloride clearance was increased more than 10 times after furosemide administration(2.1:25.7 and 2.2:27.4 mL/min/100 mL GFR), but not increased after hydrochlorothiazide treatment(2.1:1.6 and 2.2:2.6 mL/min/100 mL GFR). And the distal fractional chloride reabsorption was significantly decreased by furosemide injection (73%:15% and 75%:4.6%), whereas hydrochlorothiazide had no effect on it(73%:63% and 75%:78%). These findings indicate that our patients have a defect in thiazide-sensitive Na-Cl cotransporter in the distal tubule, which is compatible with the pathophysiology of Gitelman's syndrome.

Expression of Multidrug Resistance (MDR1) and Multidrug Resistance Associated Protein (MRP) Genes in Pediatric Malignant Solid Tumors / 대한소아혈액종양학회지

PURPOSE: Multidrug resistance (MDR) is one of the main obstacles in the successful anticancer chemotherapy. Classic MDR phenotype is characterized by overexpression of membrane bound permeability-glycoprotein (Pgp) drug-efflux pump, encoded by MDR1 gene. The non-Pgp MDR phenotype is caused by overexpression of multidrug resistance associated protein (MRP), another membrane transport protein, encoded by MRP gene. We examined the mRNA expression of MDR1 and MRP genes in various types of pediatric malignant solid tumors at diagnosis. METHODS: Five fresh frozen tissue and 15 primarily cultured cell samples from 20 children diagnosed as malignant solid tumors (8 neuroblastomas, 5 medulloblastomas, 3 Burkitt lymphomas, 2 Wilms tumors, 1 each of rhabdomyosarcoma and rhabdoid tumor) were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Among 20 pediatric solid tumors, MDR1 mRNA expression was observed in 14 cases (70%), and MRP mRNA expression was observed in 15 cases (75%). The co-expression of MDR1 and MRP was recognized in 12 (60%) of 20 cases. Event (death or relapse) occurred in 7 cases during observation period of median 9 months after diagnosis, and 6 of these 7 cases (86%) showed the co-expression of MDR1 and MRP. CONCLUSION: These data suggest that MRP, like MDR1, may have an important negative impact on the outcome of chemotherapy in pediatric malignant solid tumors, and it is possible that these two genes may collaborate in causing the appearance of MDR under certain circumstances.