A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain / 대한소아소화기영양학회지

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.

A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain / 대한소아소화기영양학회지

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.

Autoimmune Hemolytic Anemia after Intravenous Immunoglobulin Therapy in a Child with Kawasaki Disease / 임상소아혈액종양

Kawasaki disease (KD) can cause acquired heart disease and systemic vasculitis in children. It is treated with intravenous immunoglobulin (IVIG). A significant complication is development of coronary artery lesions such as dilatations or aneurysms. However, uncommon complications can occur, like autoimmune hemolytic anemia when IVIG is used. We present a case of autoimmune hemolytic anemia associated with KD. Dilatation of right coronary artery was found at echocardiography and he was treated twice with IVIG (2 g/kg) with interval of 48 hours. Laboratory finding showed hemoglobin 7.1 g/dL, hematocrit 20.8%, corrected reticulocyte 5.86%, total bilirubin 0.29 mg/dL, lactate dehydrogenase 425 IU/L, and haptoglobin 5 mg/dL. Normocytic, normochromic anemia with anisopoikilocytosis was found on peripheral blood smear, and direct antiglobulin test was positive. The patient was started on oral prednisolone for 3 weeks, with which all symptoms resolved. We report this rare case, prompting consideration of IVIG associated complications when treating KD.

Autoimmune Hemolytic Anemia after Intravenous Immunoglobulin Therapy in a Child with Kawasaki Disease / 임상소아혈액종양

Kawasaki disease (KD) can cause acquired heart disease and systemic vasculitis in children. It is treated with intravenous immunoglobulin (IVIG). A significant complication is development of coronary artery lesions such as dilatations or aneurysms. However, uncommon complications can occur, like autoimmune hemolytic anemia when IVIG is used. We present a case of autoimmune hemolytic anemia associated with KD. Dilatation of right coronary artery was found at echocardiography and he was treated twice with IVIG (2 g/kg) with interval of 48 hours. Laboratory finding showed hemoglobin 7.1 g/dL, hematocrit 20.8%, corrected reticulocyte 5.86%, total bilirubin 0.29 mg/dL, lactate dehydrogenase 425 IU/L, and haptoglobin 5 mg/dL. Normocytic, normochromic anemia with anisopoikilocytosis was found on peripheral blood smear, and direct antiglobulin test was positive. The patient was started on oral prednisolone for 3 weeks, with which all symptoms resolved. We report this rare case, prompting consideration of IVIG associated complications when treating KD.

Relation Between Absoute Nucelated Red Blood Cell Count at Birth and Retinopathy of Prematurity

PURPOSE: The aim of this study is to prove the association between potential fetal hypoxia and retinopathy of prematurity (ROP) development and absolute nucleated red blood cell (aNRBC) is used to evaluate it in premature infants without any hypoxic or ischemic history. METHODS: Medical records of 43 premature infants with ROP who were admitted to the neonatal intensive care unit at Wonkwang University Hospital from January 2004 to December 2014 were analyzed retrospectively. We excluded 15 infants who had a confounding medical condition that could have increased the aNRBC count. Finally, 28 premature infants affected by ROP were enrolled and compared with 28 pair-matched controls. The aNRBC counts at birth in these infants were compared. Statistical analysis was performed with a paired t-test for continuous data, and a Fisher's exact test for categorical data. P24 hours), prenatal betamethasone, surfactant or respiratory distress syndrome between the ROP and the control infants. In addition, neither group differed in major morbidities such as patent ductus arteriosus, periventricular leukomalacia, intraventricular hemorrhage (> or =Grade 2), or bronchopulmonary dysplasia. Regardless of the severity of ROP, the aNRBC counts at birth in premature infants with ROP were not higher than in the control infants. CONCLUSION: The aNRBC counts at birth may not be related directly to the development of ROP.

Clinical Consideration of Surveillance Cultures for Out-born Neonates Transferred to Neonatal Intensive Care Unit / 대한주산의학회잡지

PURPOSE: To identify trends in bacterial organisms and antimicrobial susceptibilities for transmission by outborn neonates, it is important to perform surveillance cultures. The aim of this study was to investigate major organisms and any other clinical factors through surveillance cultures of out-born neonates who transferred to neonatal intensive care units (NICU). METHODS: This study is a retrospective collected data among 189 out-born neonates admitted to NICU from Mar. 2012, to Feb. 2014. Surveillance cultures were obtained routinely from both nasal and axillary region and inoculated CHROM agar(TM) MRSA immediately. Bacterial culture identification and antibiotic susceptibility were carried out using Vitek II ID-GPI card. RESULTS: The most prevalent organisms isolated from the nasal surveillance cultures were methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative Staphylococcus (CoNS) (each 17 cases vs. 11 cases); both vancomycin and rifampin were susceptible. Only 1 case of S. epidermidis has same result in blood and surveillance culture. Demographic, clinical and healthcare related parameters according to surveillance culture results were compared, but no obvious association was apparent on above parameters. Nevertheless, positive surveillance culture group showed lower birth weight and longer duration until transferred to NICU. CONCLUSION: In our surveillance culture study showed that MRSA and CoNS were the most common organisms in out-born neonates; both were penicillin- and oxacillin-resistant on antibiotic susceptibility testing. Although there is no statistical meaning, positive surveillance culture group showed relatively lower birth weight and longer duration from birth to NICU arrival. These findings were contributed to obtain a reliable policy of the transmission in NICU.

Serum procalcitonin as a diagnostic marker of neonatal sepsis / 소아과

PURPOSE: We evaluated serum procalcitonin (PCT) as a diagnostic marker of neonatal sepsis, and compared PCT levels with C-reactive protein (CRP) levels. METHODS: We retrospectively reviewed the medical records of 269 neonates with a suspected infection, admitted to Wonkwang University School of Medicine & Hospital between January 2011 and December 2012, for whom PCT and CRP values had been obtained. Neonates were categorized into 4 groups according to infection severity. CRP and PCT values were analyzed and compared, and their effectiveness as diagnostic markers was determined by using receiver operating characteristic (ROC) curve analysis. We also calculated the sensitivity, specificity, and positive, and negative predictive values. RESULTS: The mean PCT and CRP concentrations were respectively 56.27+/-81.89 and 71.14+/-37.17 mg/L in the "confirmed sepsis" group; 15.64+/-32.64 and 39.23+/-41.41 mg/L in the "suspected sepsis" group; 9.49+/-4.30 and 0.97+/-1.16 mg/L in the "mild infection" group; and 0.21+/-0.12 and 0.72+/-0.7 mg/L in the control group. High concentrations indicated greater severity of infection (P<0.001). Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels. In the ROC analysis, the area under the curve was 0.951 for CRP and 0.803 for PCT. The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively). CONCLUSION: PCT is a highly effective early diagnostic marker of neonatal infection. However, it may not be as reliable as CRP.

Evaluating Neonatal Morbidity According to Maternal HbA1c in Infants of Diabetic Mother

PURPOSE: Blood glucose control in diabetic mothers during pregnancy is very important because it can affect fetal and neonatal outcomes. We therefore investigated the clinical outcomes of infants of diabetic mothers in relation to the maternal HbA1c level. METHODS: The subjects were diabetic mothers and their newborns who were admitted in Wonkwang University Hospital from July 2007 to June 2012. We retrospectively reviewed the medical records of 73 neonates, out of the 128 born to diabetic mothers and investigated neonatal and maternal characteristics based on the differences in maternal HbA1c levels. 55 neonates was excluded because maternal HbA1c was not measured. RESULTS: The mean time for testing the maternal HbA1c was 30+/-5.0 weeks, and the mean level was 6.7+/-1.4%. The mean birth weight in neonates was 3,094+/-831.6 g and was higher in the group with > or =7% HbA1c than in the group with or =7% HbA1c than in those with or =7% HbA1c than those with or =4,000g), there were no differences in birth weights between both groups. CONCLUSION: If the maternal HbA1c level during pregnancy is above 7% with glucose control failure, infants born to diabetic mothers are susceptible to hypoglycemia, large baby syndrome and CHD.

Fulminant Clinical Course on Listeria Sepsis in Preterm and Late Preterm Neonates / 대한주산의학회잡지

Listeria monocytogenes is a facultative anaerobic, gram-positive bacillus. Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. This bacterium is an important cause of severe infection in neonates and pregnant women. Pregnant women are at high risk for listeriosis, but symptoms are non-specific and diagnosis is difficult. Neonatal Listeriosis is generally a severe and fatal disease. There are two forms of the disease in the neonate, early- and late-onset, suggesting different modes of transmission. Generally, early detection and empirical treatment of listeriosis help to improve survival and prognosis. We explained two cases of L. monocytogenes sepsis with culture-proven in preterm and late preterm newborns from asymptomatic mothers. These neonates had fulminant clinical course even if standard antibiotics treatments were administrated.

Obstetric and Neonatal Outcomes of Teenage Pregnancies

PURPOSE: The number of teenage pregnancy is increasing on these days due to changes in sexual awareness, precocious puberty, lack of proper sex education and abortion restrictions. We evaluated the clinical features including the rate and perinatal complications of mother and neonates caused by teenage births. METHODS: Subjects were mothers whose ages were below 19 at time of admission in Wonkwang University Hospital from January 2000 to July 2011. We reviewed the medical records of teenage mothers and her neonates retrospectively, and investigated the differences between above and below the age of 16. RESULTS: The number of neonates of teenaged mothers was 73, which is 10.4 per 1,000 births and it showed an upward trend during the late decade of 2,000's. 14 (19.2%) of the mothers were multiparous, and 69 (94.5%) unmarried, 25 (34.2%) no prenatal examinations, 11 (15.1%) an abortion history, 47 (64.4%) middle or high school students, and 25 (34.2%) a single parent. Among the maternal complications, premature birth was the most prevalent with 34 cases (46.6%), followed by 11 (4.1%) of premature rupture of membrane. The most common neonatal complication was prematurity in 37 cases (50.7%), followed by 30 (41.1%) low birth weight, 19 (26%) ICU admission. There were no significant differences between above and below the age of 16 in neonatal and obstetrical complications. CONCLUSION: The number of teenage pregnancy is increasing recently, and they had a high prevalence rate of prematurity, low birth weight and respiratory distress syndrome. And, the grouping by age of above and below 16 was no affect the prognosis.

A Case of Hemolytic Disease of Newborn due to Anti-JKa / 대한주산의학회잡지

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.

A Case of Hemolytic Disease of Newborn due to Anti-JKa / 대한주산의학회잡지

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.

A Case of Acute Myopericarditis Associated With Mycoplasma Pneumoniae Infection in a Child

Mycoplasma pneumoniae (M. pneumoniae) primarily causes respiratory tract infections in persons aged 5-20 years. Tracheobronchitis and bronchopneumonia are the most commonly recognized clinical symptoms associated with M. pneumoniae infection. Complications of this infection are unusual; in particular, cardiac involvement is very rare and is generally accompanied by pneumonia. Nonrespiratory illness can therefore involve direct invasion by M. pneumoniae or autoimmune mechanisms, as suggested by the frequency of cross reaction between human antigens and M. pneumoniae. Herein, we report a case of severe acute myopericarditis with pneumonia caused by M. pneumoniae in a healthy young child who presented with fever, lethargy, oliguria and dyspnea. She survived with aggressive therapy including clarithromycin, intravenous immunoglobulin, inotropics, and diuretics. The patient was discharged on the 19th day after admission and followed up 1 month thereafter at the outpatient clinic without sequelae.

Hypernatremia and Intraventricular Hemorrhage in Very Low Birth Weight Infants (<1,250 g)

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.

A Case of Supernumerary Derivative (22) Syndrome Resulting from a Paternal Balanced Translocation

Supernumerary derivative (22) syndrome is a rare genomic syndrome. It is characterized by severe mental retardation, microcephaly, failure to thrive, preauricular tag or sinus, ear abnormalities, cleft and/or high-arched palate, micrognathia, kidney abnormalities, congenital heart defects, and genital abnormalities in males. In 99% of the cases, one of the parents is a balanced carrier of a translocation between chromosome 11 and chromosome 22. To date, there have been about 100 case reports of supernumerary derivative (22) syndrome. In most of the cases, supernumerary derivative (22) syndrome was the result of 3:1 meiotic segregation in the maternal 11;22 translocation carrier. We now report a case of 47,XX, + der(22)t(11;22)(q23;q11.2) resulting from 3:1 meiotic segregation of the paternal translocation carrier.

A case of severe transient hyperammonemia in a newborn / 소아과

Transient hyperammonemia in a newborn is an overwhelming disease manifested by hyperammonemic coma. The majority of affected newborns are premature and have mild respiratory syndrome. The diagnosis may be difficult to determine. This metabolic disorder is primarily characterized by severe hyperammonemia in the postnatal period, coma, absence of abnormal organic aciduria and normal activity of the enzymes of the urea cycle. Hyperammonemic coma may develop within 2-3 days of life, although its etiology is unknown. Laboratory studies reveal marked hyperammonemia (>4,000 micromol/L). The degree of neurologic impairment and developmental delay in this disorder depends on the duration of hyperammonemic coma. Moreover, the infant may succumb to the disease if treatment is not started immediately and continued vigorously. Hyperammonemic coma as a medical emergency requires dialysis therapy. Here, we report a case of severe transient hyperammonemia in a preterm infant (35 week of gestation) presented with respiratory distress, seizure, and deep coma within 48 hours and required ventilatory assistance and marked elevated plasma ammonia levels. He survived with aggressive therapy including peritoneal dialysis, and was followed 2 years later without sequelae.

Comparison and analysis of the effectiveness to high dose of aspirin and ibuprofen in acute phase of Kawasaki disease / 소아과

PURPOSE: We evaluated the effectiveness of treatment and cardiac complications of replacing a high dose of aspirin with a high dose of ibuprofen for children in acute phase of Kawasaki disease. We also analyzed the possibility of replacing a high dose of aspirin with a high dose of ibuprofen to prevent complications such as Reye's syndrome caused by aspirin. METHODS: One hundred eight children with Kawasaki disease were admitted in the pediatrics department from January 1, 2004 to December 31, 2008. Echocardiography and laboratory tests were performed during diagnosis, and the children were followed-up at 6-8 weeks after the diagnosis. We retrospectively analyzed their characteristics and clinical results. RESULTS: The children were assigned to receive either a high dose of aspirin with intravenous immunoglobulin (IVIG) (aspirin group) or a high dose of ibuprofen with IVIG (ibuprofen group). A total of 55 and 53 children were included in the aspirin and ibuprofen groups, respectively. The mean defervescence period was 6.5+/-2.1 days in the aspirin group, and 6.9+/-1.9 days in the ibuprofen group (P=0.309). The number of failed treatments, during and after treatment, was 8 in the aspirin group and 10 in the ibuprofen group (P=0.547). There were 11 initial cardiac complications in the aspirin group, and 14 in the ibuprofen group, but children who showed improvement at follow-up was 7 and 13 in the aspirin and ibuprofen groups, respectively (P=0.133). Laboratory findings were also improved in both groups. CONCLUSION: We can be considered whether we will replace high dose of aspirin by high dose of ibuprofen in acute phase of Kawasaki disease. Therefore, we can prevent the severe complications of aspirin use, such as Reye's syndrome.

Intestinal obstruction caused by a duplication cyst of the cecum in a neonate / 소아과

Duplication cysts are rare congenital malformations, that may be detected anywhere along the alimentary tract, and they may communicate with the intestinal tract. Cystic duplication of the cecum is especially rare. About 80% of these cases are detected in the first 2 years of life as a result of an acute intestinal obstruction, which manifests as vomiting, recurrent abdominal pain, recurrent gastrointestinal bleeding and constipation. We report a case of intestinal obstruction secondary to a duplication cyst of the cecum in a neonate. The patient underwent surgery and was diagnosed subsequently, and is presently healthy.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.