Relationship between cord blood level of IL-12 in preterm newborns and development of wheezing / 소아과

PURPOSE: Abnormal activation patterns of Th1/Th2-cells have been suggested to increase the prevalence of allergic diseases. Prevention is regarded as an important corner stone in the management of allergic diseases. In this study, we have investigated the relationship between cord blood levels of IL-4, IL-10, and IL-12 in preterm newborns and the development of allergic respiratory diseases in infancy METHODS: Forty-six preterm newborns born at the Ewha Womans University Mokdong Hospital between January 2003 and July 2005, were enrolled for this study, and consent was obtained to test their cord blood samples. Clinical history was obtained from the hospital records. Cord blood was obtained at birth and kept frozen until it was tested. The levels of IL-4, IL-10, and IL-12 were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: All infants were followed-up for a median of 16.0 months+/-13.2 d (range, 12.0 to 36.0 months). Eighteen infants who developed wheezing showed lower cord blood levels of IL-12 (366.60+/-140.40 vs 435.09+/-91.20 pg/mL, P=0.009). Cord blood levels of IL-4 and IL-10 showed no significant difference between the two groups. Four newborns who later developed asthma, and infants with asthma showed lower IL-12 level in the cord blood than other groups. CONCLUSION: Lower concentration of cord blood levels of IL-12 in newborns who later developed wheezing and asthma suggested that they had abnormal activation patterns of Th1/Th2-cells at the time of birth, and cord blood IL-12 level can be used as a predictor of allergic respiratory diseases.

Clinical Usefulness of Esophagopraphy in Term Infant with Oxygen Desaturation during and after Feeding

PURPOSE:Transient desaturation in fullterms related to feeding may be ignored. But those who are presenting significant cyanosis during feeding without any underlying disease, esophagogastric or laryngopharyngeal reflux must be regarded. The goal of this study was to investigate the incidence of reflux diseases in those newborns using esophagography. METHODS:157 newborn infants showing cyanosis during feeding were collected among 705 neonates born after 37 weeks of festation from July 2003 to June 2005. Excluding infants with other underlying diseases, 40 newborns were studied for reflux diseases by esophagography. RESULTS:117 (74.5%) infants had underlying diseases among 157 presenting cyanosis. The other 40 (25.5%) cases had decrease in oxygen saturation during and after feeding, which were spontaneously restored after ceasation of feeding. The mean gestational age and weight of the 40 newborns (composed of 21 boys and 19 girls) were 38.9+/-1.42 wks and 3.3+/-0.59 kg. Imaging study was done at 9.5th day of life in average. The level of desaturation was 79.4+/-9.1%. From 31 (77.5%) patient who showed reflux in esophagograhy, 21 patients had laryngopharyngeal reflux, 16 cases showed major degree GERD, 8 of which had GERD minor degree. Omeprazole was prescribed to the patients with major degree of GERD and the others were educated only (feeding position & feeding skills) which lead to improvement of symptom. CONCLUSION:We concluded that the esophagography is a valuable tool in evaluation of full tern infants with desaturation during feeding.

Infliximab treatment for a patient with refractory Kawasaki disease / 소아과

Intravenous immunoglobulin (IVIG) infusion is an effective therapy for acute Kawasaki disease (KD). Nonetheless, approximately 10 percent to 20 percent of patients have persistent or recrudescent fever despite IVIG treatment, leading to a higher risk for coronary artery aneurysms (CAA). This unresponsiveness may pose a challenge to the clinicians. Tumor necrosis factor-alpha levels are elevated in the acute phase of the disease, especially in patients who develop CAA. We report a 10-month-old male with KD who failed to respond to multiple doses of IVIG and methylprednisolone and who then was treated with infliximab (5 mg/kg single dose). After infliximab treatment, he became afebrile with normalization of inflammatory markers and no further progression of CAA.