Neonatal and Maternal Clinical Characteristics of Late Preterm Births: Single Center Data

PURPOSE: Recently, the number of late preterm infants are increasing, and they are prone to have many clinical problems. The purpose of this study is to emphasize the importance of perinatal care for the late preterm infants and their mothers. METHODS: Total admitted numbers of late preterm infants were 547 (from 464 mothers) and of term infants were 1,514 (from 1,470 mothers) in NICU, at Chonnam National University Hospital January 2014~December 2015. Maternal and neonatal mortality rate were calculated in the total admitted numbers. Exclusion criteria were death or transfer during admission, congenital anomaly, and etc. The enrolled numbers of late preterm infants were 493 (from 418 mothers) and of term infants were 1,167 (from 1,123 mothers). Retrospective chart review was conducted. In mothers, demographics, underlying illness, and obstetric complication, and in newborns, demographics, hospital days and morbidity were compared between late preterm group and term group. RESULTS: Maternal mortality rate was not different. However, neonatal mortality rate was higher in late preterm infants. In mothers of late preterm group, there was no difference in demographic characteristics, but the rates of autoimmune disease and obstetric complication were higher. In infants of late preterm group, body size was smaller, artificial conception and C-section rate were higher, and one and five-minute Apgar scores were lower, and hospital duration was longer. And the incidence of respiratory distress, transient tachypena of newborn, intraventricular hemorrhage and metabolic abnormalities were higher, but the incidence of meconium aspiration syndrome was lower compare to the term infant group. CONCLUSIONS: Maternal mortality was not different. However, neonatal mortality was higher in late preterm infants. In late preterm group, the mothers had higher rate of autoimmune disease and obstetric complication, and the infants had higher morbidity compare to the term group. When the obstetrician decides on delivery time in high risk pregnancy, maternal medical condition and neonatal outcome should be considered.

Comparison of Survival by Risk-stratified Therapy in Children and Adolescents with Acute Lymphoblastic Leukemia in a Single Institute / 임상소아혈액종양

BACKGROUND: Impressive improvement of survival rate has been achieved in childhood acute lymphoblastic leukemia (ALL). In an effort to balance the risks and benefits of therapy, risk-stratified therapy has been adopted. The aim of this study was to evaluate treatment outcome of childhood ALL by risk stratification.METHODS: From 184 patients (age, <18 years) with ALL newly diagnosed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital between 2000 and 2010, we retrospectively analyzed 157 patients. Patients with infant ALL, L3, Down syndrome, and those transferred to another hospital were excluded. Three risk groups were defined as standard risk (SR, n=88), high risk (HR, n=52) and very high risk (VHR, n=17).RESULTS: The 7-year overall survival and event-free survival (EFS) rates were 85.2+/-2.9% and 80.2+/-3.3%, respectively. The 7-year EFS rates were 86.5+/-3.9% for SR, 78.8+/-5.7% for HR and 52.9+/-12.1% for VHR (P<0.001). Relapse occurred in 17 patients, and the cumulative incidence of relapse at 7 years was not different according to risk groups (SR vs. HR vs. VHR=8.9% vs. 17.3% vs. 5.9%, P=0.171). Among relapsed patients, 11 underwent hematopoietic stem cell transplantation of whom 5 survive event-free with a median follow-up of 5.2 years. The cumulative incidence of non-relapse mortality was highest in VHR (SR vs. HR vs. VHR=4.6% vs. 3.8% vs. 47.2%, P<0.001).CONCLUSION: Although, the number of patients included in this study is relatively small, the survival rates of childhood ALL with current strategies are encouraging. Also, efforts should be focused to further improve survival in the VHR, especially to reduce non-relapse mortality.

A Case of Nasal Type Extranodal NK/T Cell Lymphoma Incidentally Detected in a Child / 임상소아혈액종양

A nasal type extranodal NK/T-cell lymphoma (ENKL) is very rare in children. A pediatric nasal type ENKL is generally localized and is likely to have sensitivity to radiotherapy. The most common site is the upper airway tract, such as nasal region, Waldeyer's ring, paranasal sinuses and palates. It usually presents with nasal symptoms, such as obstruction or epistaxis. We describe our experience of concurrent chemoradiotherapy in a 13-year old boy having incidentally detected nasal type ENKL on laryngoscopic examination who did not have nasal symptoms. He received three cycles of dexamethasone (40 mg/day for 3 days), ifosfamide (1,000 mg/m2/day for 3 days), VP-16 (67 mg/m2/day for 3 days) and carboplatin (200 mg/m2 for 1 day) at 3-week intervals and 45 Gy intensity-modulated radiation therapy. He has been disease-free for 18 months after cessation of therapy.

Comparison of Survival by Risk-stratified Therapy in Children and Adolescents with Acute Lymphoblastic Leukemia in a Single Institute / 임상소아혈액종양

BACKGROUND: Impressive improvement of survival rate has been achieved in childhood acute lymphoblastic leukemia (ALL). In an effort to balance the risks and benefits of therapy, risk-stratified therapy has been adopted. The aim of this study was to evaluate treatment outcome of childhood ALL by risk stratification. METHODS: From 184 patients (age, <18 years) with ALL newly diagnosed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital between 2000 and 2010, we retrospectively analyzed 157 patients. Patients with infant ALL, L3, Down syndrome, and those transferred to another hospital were excluded. Three risk groups were defined as standard risk (SR, n=88), high risk (HR, n=52) and very high risk (VHR, n=17). RESULTS: The 7-year overall survival and event-free survival (EFS) rates were 85.2+/-2.9% and 80.2+/-3.3%, respectively. The 7-year EFS rates were 86.5+/-3.9% for SR, 78.8+/-5.7% for HR and 52.9+/-12.1% for VHR (P<0.001). Relapse occurred in 17 patients, and the cumulative incidence of relapse at 7 years was not different according to risk groups (SR vs. HR vs. VHR=8.9% vs. 17.3% vs. 5.9%, P=0.171). Among relapsed patients, 11 underwent hematopoietic stem cell transplantation of whom 5 survive event-free with a median follow-up of 5.2 years. The cumulative incidence of non-relapse mortality was highest in VHR (SR vs. HR vs. VHR=4.6% vs. 3.8% vs. 47.2%, P<0.001). CONCLUSION: Although, the number of patients included in this study is relatively small, the survival rates of childhood ALL with current strategies are encouraging. Also, efforts should be focused to further improve survival in the VHR, especially to reduce non-relapse mortality.

A Case of Nasal Type Extranodal NK/T Cell Lymphoma Incidentally Detected in a Child / 임상소아혈액종양

A nasal type extranodal NK/T-cell lymphoma (ENKL) is very rare in children. A pediatric nasal type ENKL is generally localized and is likely to have sensitivity to radiotherapy. The most common site is the upper airway tract, such as nasal region, Waldeyer's ring, paranasal sinuses and palates. It usually presents with nasal symptoms, such as obstruction or epistaxis. We describe our experience of concurrent chemoradiotherapy in a 13-year old boy having incidentally detected nasal type ENKL on laryngoscopic examination who did not have nasal symptoms. He received three cycles of dexamethasone (40 mg/day for 3 days), ifosfamide (1,000 mg/m2/day for 3 days), VP-16 (67 mg/m2/day for 3 days) and carboplatin (200 mg/m2 for 1 day) at 3-week intervals and 45 Gy intensity-modulated radiation therapy. He has been disease-free for 18 months after cessation of therapy.