Epidemiology of Respiratory Syncytial Virus Lower Respiratory Tract Infection and Analysis of Risk Factors in Severe Infections from 1995 to 2004 / 소아알레르기및호흡기학회지

PURPOSE: Respiratory syncytial virus (RSV) infection is the one of the leading causes of hospitalization of infants in the worldwide. In particular, children younger than 6 weeks of age prematurity, bronchopulmonary dysplasia, congenital heart disease, neuromuscular disease, or immunosuppressive states are likely to have severe RSV infection. This study aims to review the epidemiologic characteristics of RSV infection and to examine the relationship of risk factors for severe disease courses and length of hospital stay. METHODS: A total of 294 patients with acute lower respiratory tract infections by RSV who were hospitalized in Samsung Medical Center from December 1995 to June 2004 were enrolled in this study. The medical records were retrospectively reviewed. RSV was detected with rapid RSV antigen test or viral culture of nasopharyngeal aspirates. RESULTS: The male to female ratio was 1.7: 1. Children under 2 years old made up 86 percent; bronchiolitis and pneumonia patients made up 90 percent. Outbreaks of RSV occurred in September through February. One or more risk factor for severe RSV infection were present in 40 percent. The group with risk factors had longer length of hospital stay (P< 0.05), were more likely to be admitted to the pediatric intensive care unit (PICU) and required oxygen therapy and mechanical ventilation (P< 0.05) compared to the groups without risk factors. CONCLUSION: Infants and children with high risk factors are likely to develop severe RSV infection. Early detection and proper management is necessary in Korea, especially in fall and winter.

Factors Affecting the Response to Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn Infants

Persistent pulmonary hypertension of the newborn infant (PPHN), is a clinical syndrome characterized by elevated pulmonary vascular resistance, resulting from reactive vasoconstriction or structural remodeling of the pulmonary vasculature. Although inhaled nitric oxide (iNO) has emerged as a novel selective treatment of PPHN, responses to iNO are variable according to the etiologies or the clinical situation. A retrospective chart review of 51 newborn infants with PPHN and treated with iNO, was undertaken to evaluate the factors affecting response to iNO. Response to iNO was defined as a reduction in the oxygenation index (OI) of more than 20%, or disappearance of the difference in oxygen saturation between preductal and postductal circulation after iNO therapy. The patients were divided into two groups; the responder group and the non- responder group. Respiratory distress syndrome (RDS) was more commonly associated with PPHN in the responder group than in the non-responder group (p < 0.05), while there were many more patients with congenital diaphragmatic hernia (CDH) in the non-responder group than in the responder group (p < 0.05). Infants with meconium aspiration syndrome (MAS) were similar in both of the two groups. Initial OI, initial mean airway pressure (MAP), and initial and peak NO concentration were significantly lower in the responder group compared to the non-responder group (p < 0.05). Rapid response (response to iNO within the first hour) was shown in 74% of the responder group and 33% of the nonresponder group (p < 0.05). There was no significant differences in the initial chest radiographic findings, such as normal, focal or bilateral diffuse infiltration, with the exception of CDH, between each group. Lower initial OI, lower initial MAP and significant response within the first hour were shown to be favourable factors in response to iNO therapy. Patients with RDS associated with PPHN responded much better to iNO than those with other diseases.

Comparison of Mortality and Morbidity in Multiple versus Singleton Very Low Birth Weight Infants in A Neonatal Intensive Care Unit

Multiple births in Korea have been increased recently as a consequence of increased infertility due to advancing maternal age at first birth, and increased use of assisted reproductive technology. Multiples suffer higher mortality and morbidity than singletons. However, it is not clear whether preterm multiple very low birth weight infants (VLBWI) suffer higher mortality and morbidity than comparable singletons. We evaluated 266 singleton and 113 multiple VLBWI to determine whether mortality and morbidity in multiple VLBWI were higher than those in comparable singletons. The rate of in vitro ertilization and cesarean section were significantly higher in multiples than singletons. The total and the adjusted mortality with gestational age and birth weight were not significantly different between the two groups. Maternal age and the incidence of respiratory distress syndrome, patent ductus arteriosus, bronchopulmonary dysplasia, intracranial hemorrhage (grade> or=3), cystic periventricular leukomalacia, and retinopathy of prematurity (stage> or=3) were not significantly different between the two groups, and the incidence of abnormal brainstem auditory evoked potential was higher among the singletons. These results suggest that multiple VLBWI do not suffer higher mortality or morbidity than comparable singletons.

Efficacy of Hepatitis B Immune Globulin for Prevention of De Novo Hepatitis B in Living-related Liver Transplantation / 대한소아소화기영양학회지

PURPOSE: Hepatic allografts from donors with hepatitis B core antibody have been demonstrated to transmit hepatitis B virus (HBV) infection to recipients after liver transplantation (LT). The efficacy of hepatitis B immune globulin (HBIg) to prevent de novo hepatitis B was investigated by comparing active immunization in the early phase to HBIg monotherapy in the late phase of pediatric liver transplants at Samsung Medical Center. METHODS: Among pediatric liver transplants, from May, 1996 to June, 2002, 15 recipients who were hepatitis B surface antigen (HBsAg) (-) received an allograft from a donor with hepatitis B core antibody (HBcAb) (+). Except two who died from unrelated causes, eleven of 13 recipients were HBsAb (+), and 2 were naive (HBsAb(-), HBcAb(-)). All patients were vaccinated for HBV before LT. In the early phase (January, 1997~November, 1997, 3 patients), HBsAb (+) recipients received booster vaccination after LT. In the late phase (December, 1997~, 10 patients), all recipients were given booster vaccination and received HBIg therapy in order to maintain HBsAb titer greater than 200 IU/L. Lamivudine was given in one case because of severe side effect of HBIg. We retrospectively analyzed the effect of the preventive therapy for de novo hepatitis B through medical records. RESULTS: De novo hepatitis B developed in three of 13 recipients (23.1%). All of 3 patients who received active immunization in the early phase became HBsAg (+) at 7~19 months after transplantation. One of them was naive before LT and the other two were HBsAb (+). All of 10 recipients who were given HBIg in the late phase remained HBsAg (-) at 7~55 months' follow-up. CONCLUSION: Passive immunization with HBIg was effective for prevention of de novo hepatitis B in HBsAg (-) recipients of hepatic allografts from HBcAb (+) donors.

Clinical Characteristics and Treatment Outcome of Pediatric Patients with Burkitt Lymphoma / 대한소아혈액종양학회지

PURPOSE: Burkitt lymphoma (BL) occurs mainly in pediatric populations. Data on the clinical characteristics and treatment results are scarce in Korea. We report our single center experience on BL in children to improve the treatment efficacy while minimizing treatment-related toxicities. METHODS: We undertook a retrospective analysis of 15 patients diagnosed as BL or Burkitt leukemia-lymphoma (BLL) between Aug., 1995 and Feb., 2002. Several induction chemotherapy regimens were used including CCG 106B (prednisolone, cyclophosphamide, daunorubicin, vincristine, L-asparaginase; N=10). Post-induction regimens consisted of CCG 106B (N=12), high dose chemotherapy and autologous stem cell transplantation (N=1), and others (N= 2). RESULTS: The incidence of BL and BLL was 27.2% of Non-Hodgkin's lymphoma diagnosed at our institution. Abdominal mass was the most common presentation (80%) and many patients had advanced stage diseases. Six patients suffered from tumor lysis syndrome, all of whom eventually improved. None died from infection or bleeding. All patients are alive disease-free for median 20 months (range 2~26 months) of follow-up duration except for one who is alive with a residual liver mass. CONCLUSION: Though recent therapeutic trials of repeated intensified chemotherapy including high dose cytarabine and methotrexate led to improvement of survival in patients with BL, many patients suffers from therapy-related toxicities. We successfully treated pediatric BL patients with tolerable toxicities using CCG 106B regimen which is known to be highly effective in high-risk acute lymphoblastic leukemia. More experiences are needed to establish the optimal duration of therapy.