Iron Parameters and Soluble Transferrin Receptor in Neonates

PURPOSE: Serum soluble transferrin receptor (sTfR) is a marker of iron deficiency and erythropoiesis. The purpose of this study is to evaluate the changes of iron parameters and sTfR in neonates by gestation; and to determine whether cord blood parameters for iron status and erythropoiesis are influenced by maternal iron deficiency or anemia. METHODS: Cord sTfR, iron and ferritin concentrations, hemoglobin (Hb), reticulocyte counts and total iron binding capacity were analyzed in 20 preterm and 60 term newborns. In term neonates, maternal iron status was classified by Hb and serum ferritin as anemic group (n=18; Hb or = 11 g/dl and ferritin < 12 microgram/l) and control (n=21, non anemic and non iron deficient). RESULTS: 1) Cord serum iron of preterm neonates was significantly lower than that of fullterm and the reticulocytes were significantly higher in preterm neonates. 2) The concentrations of cord serum iron were correlated positively with the gestational age, but other iron parameters and sTfR concentrations were not related to gestational age. The sTfR concentrations were correlated positively with cord blood hemoglobin. 3) Cord sTfR concentrations were significantly lower in newborns of anemic group compared with those of non-anemic group (P=0.03), or control (P=0.02). CONCLUSION: Cord sTfR was influenced by maternal iron deficiency aenmia, but not by maternal iron deficiency alone. Since sTfR reflects fetal erythropoietic activity, we speculate that low sTfR in newborns of iron deficiency anemic mother could suggest decreased fetal erythropoiesis by maternal anemia caused by iron depletion.

Age of Spontaneous Regression of Congenital Hydronephrosis in Children / 대한비뇨기과학회지

PURPOSE: It is difficult to anticipate the prognosis of hydronephrotic kidneys in children. Therefore, the progress of hydronephrosis detected after birth were investigated prospectively according to the ultrasonographic findings. MATERIALS AND METHODS: The study included 36 patients (51 kidneys) who were diagnosed with hydronephrosis caused by a ureteropelvic junction stricture. The patients' age ranged from newborn to 9.8 years (mean, 10.2 months). There were 26 boys (72.2%) and 10 girls (27.8%). 4 cases (11.1%) were in the right kidneys, 17 cases (47.2%) were in the left kidneys and 15 cases (41.7%) in both. The patients were divided into three groups; the spontaneous regression group (SR), the no change group (NC) and the operation group (OP). The average age of each group were 1.5 months, 2.4 months, and 53 months, respcetively. Regression was defined as a decrease in the anteroposterior diameter (APD) of less than 4mm or more than 50% of the initial diameter during the follow up period. RESULTS: The SR group had 21 cases (27 kidneys, 52.9%). The NC group included 10 cases (14 kidneys, 27.5%) and the OP group had 8 cases (10 kidneys, 19.6%). In the SR group (N=27 kidneys), the APDs of the renal pelvis decreased abruptly from 8.6mm to 1.3mm by the average age of 5.9 months. However, in NC group (N=14 kidneys), there was no significant interval change (from mean 10.1mm to 10.3mm) in the APDs of the renal pelvis by 10.4 months of average age. CONCLUSIONS: The congenital hydronephrosis, which was caused by a ureteropelvic junction stricture and was identified after birth, regressed spontaneously in 52.9% of cases and it had usually occurred by 5.9 months of age. Therefore, it is supposed that age is an important factor in the follow-up and management of hydronephrosis in children.

Sequential Analysis of Hepatitis Be Antigen Status in Infants Born to Hepatitis Be Antigen-Positive Mothers

PURPOSE: The objectives of this study are to evaluate the significance of HBeAg positivity in infants born to HBeAg and HBsAg positive mothers. METHODS: The HBeAg status of 22 HBeAg positive, HBsAg negative infants born to HBeAg and HBsAg positive mothers from December 1996 to March 1999 were evaluated by enzyme immunoassay. RESULTS: The number of HBsAg positive carrier mothers was 213(4.9%) out of 4,338 pregnant women. HBeAg was positive in 76(41.5%) out of 183 HBsAg positive mothers. Only 49 infants born to 76 HBeAg positive mothers could be evaluated; 36 infants were HBeAg positive and HBsAg negative. Laboratory follow up was possible in 22 infants. HBeAg disappeared in 7 cases within two months and in 20 cases within 12 months(over 90%). Ultimately, twenty-two babies who were HBsAg-negative and HBeAg-positive became negative for HBeAg, however, one showed HBsAg in follow up of 6 months of age. CONCLUSION: HBeAg positivity in infants born to HBeAg positive mothers may result from the maternofetal transmission and this HBeAg eventually disappeared without clinical significance.

Single Clone of Toxic Shock Syndrome Toxin 1-Producing Methicillin-Resistant Staphylococcus Aureus Isolated from a Neonatal Intensive Care Unit Patients / 대한임상미생물학회지

BACKGROUND: Six babies infected with Staphylococcus aureus occurred in a neonatal intensive care unit (NICU) over a period of 2 months, which was successfully controlled with the aid of moleculartyping of the isolates. METHODS: We examined the staphylococcal toxins, mecA and tst gene PCR, and repetitive-element PCR (rep-PCR) typing in S. aureus isolated from the clinical specimens of infected babies, nasal swabs of the patients and medical personnels in a NICU, and environmental equipments. RESULTS: Among all S. aureus isolates tested, they were toxic shock syndrome toxin 1 (TSST-1)- producing methicillin-resistant S. aureus (MRSA) who have mecA and tst gene, and one identical rep- PCR pattern all, except 3 MRSA isolated from the nasal swabs of 2 non-infected patients and 1 medical personnel. CONCLUSIONS: It was demonstrated that TSST-1 producing MRSA became epidemic in the NICU as a result of the spread of a single clone.

A Case of Severe Hypertension associated with Growth Hormone Therapy / 대한소아내분비학회지

The use of recombinant DNA technology to produce human growth hormone has resulted in a marked increase in availability of Growth Hormone(GH) to treat short stature due to GH deficiency and other conditions, such as Turner syndrome, familial short stature, chronic renal insufficiency and intrauterine growth retardation (IUGR). But, the GH therapy may result in the adverse events such as sodium and water retention, pseudotumor cerebri, slipped capital femoral epiphysis, growth of nevi, recurrence of tumor. We experienced a case of severe hypertension associated with GH therapy in a 14-year-old male who presented high blood pressure up to 190/100 mmHg and normalized at 2-3 weeks after discontinuation of GH. Therefore, we think that the blood pressure should be carefully monitored during GH therapy.

Nitroblue Tetrazolium(NBT) Test as a Screening Test of Urinary Tract Infection in Children

PURPOSE: It has been reported that the Nitroblue Tetrazolium(NBT) test is more accurate than the urine pH, leukocyte esterase and nitrite test as a screening test of urinary tract infection (UTI). The purpose of this study is to compare the NBT test with other screening tests and evaluate the clinical usefulness of the NBT test as a screening test. METHODS: We selected 298 results out of the 304 urine cultures which were performed from March, 1999 to July, 1999 and compared them with screening tests such as NBT, urine pH, leukocyte esterase and nitrite tests. We interpreted those results as the urinary tract infection when the screening results were urine NBT(+), pH(>6.5), leukocyte esterase(>or=++) and nitrite(+). RESULTS: Urine NBT, pH and leukocyte esterase tests showed the statistical significance in comparison with the urine culture results(chi-square tests; P<0.001, <0.05, <0.001), while urine nitrite tests did not show statistical significance. As time passing, the sensitivity of 10 min, 30 min, 60 min NBT test was increased to 35%, 72%, 80% respectively but the sensitivity of urine pH and leukocyte esterase was as low as 33%, 16% respectively. But, the specificity of NBT test was reduced from 93% to 53% as the time went by, while the specificity of urine pH and leukocyte esterase tests were as high as each 79%, 96% respectively. Urine NBT tests at 10 min and 30 min showed a higher positive and negative predictive value than those of the other screening tests. CONCLUSION: Urine NBT test as a screening test for UTI was more accurate than the urine pH, nitrite and leukocyte esterase tests. But we think that we should develop a more quick and precise screening test in the future, because of the long time it requires to perform it.

Changes in Pulmonary Interleukin-6 and Pulmonary Pathology in Neonatal Mice After Exposure to Hyperoxia and Ascorbate Treatment

PURPOSE: Levels of proinflammatory cytokines such as IL-1, IL-6 and TNF-alpha have been shown to be increased in the lung of adult mice after exposure to hyperoxia. Ascorbate, a non-enzymatic antioxidant, might have a protective effect against oxygen-induced lung injury. We examined effects of hyperoxia and ascorbate treatment on pulmonary IL-6 levels and pathology in the lungs of newborn mice. METHODS: Neonatal mice were exposed to hyperoxia (95% O2) or room air (control) for 24 h or 48 h. Other groups, exposed to hyperoxia for up to 48 h, were injected intraperitoneally preventive doses (0.1 mg/10 g mouse weight) or therapeutic doses (1 mg/10 g mouse weight) of ascorbate or distilled water (placebo control) twice, immediately before and at 24 h of exposure to hyperoxia. IL-6 concentrations in the supernatant of minced lungs were measured by ELISA. RESULTS: There were no pathologic changes in the lungs except mild emphysema and alveolar hemorrhage. The median pulmonary IL-6 concentration was significantly higher in mice exposed to hyperoxia for 24 h (P<0.05) and for 48 h (P<0.001) than room air controls. There was no difference in pulmonary IL-6 concentration between hyperoxia-exposed (48 h) mice treated with either preventive or therapeutic doses of ascorbate and placebo controls. CONCLUSION: Neonatal mice exposed to hyperoxia for 24 h and 48 h showed higher pulmonary IL-6 concentrations than room air controls. Preventive or therapeutic doses of ascorbate had no effect on pulmonary IL-6 concentrations nor pulmonary pathology of neonatal mice exposed to hyperoxia for 48 h.

A Case of Hemolytic Disease in the Newborn Due to Anti-Dia Antibody

The Diego blood group is expressed as Dia antigen and Dib antigen. The frequency of Dia antigen expression in Korean is estimated to be 6-15%. We report the first case of severe hemolytic disease caused by anti-Dia antibody in Korea. Full-term male infant was admitted due to hyperbilirubinemia on the first day of life. Total bilirubin level was elevated to 20 mg/dL at 20 hours of age and exchange transfusion was performed. Total bilirubin decreased to 12.7 mg/dL after exchange transfusion, but increased to 19.0 mg/ dL at 43 hours of age. After second exchange transfusion, total bilirubin was 6.0 mg/dL. The blood group of mother was type A, Rh D (+ and that of newborn was type O, Rh D (+. The direct antiglobulin test showed strong positive, and anti-Dia antibody was eluted from the baby's red blood cell. Due to higher incidence of Dia antigen expression in oriental population, we suggest that the Diego positive cell panel should be included in the diagnosis of hemolytic disease of the newborn.

A Case of Facial Nerve Palsy Associated with Epstein-Barr Virus Infection in a Child / 대한소아신경학회지

Facial palsy is a rare complication of infectious mononucleosis of Epstein-Barr virus infection, which can be easily overlooked by clinicians if one is unnoticed about it. We report a 2 year and 11 month old boy who was diagnosed by facial nerve palsy caused by Epstein-Barr virus infection. Pseudothrombocytopenia was also associated with him. Steroid (prednisolone 2mg/kg) was administered daily for 2 weeks and then maintained with alternative tapering schedule (2mg/kg at once QOD) in order to decompress facial nerve. He was completely recovered at 2 months of follow-up.

A Recurred Case of Subacute Necrotizing Lymphadenitis(Kikuchi's Disease) During Childhood

Subacute necrotizing lymphadenitis, or Kikuchi's disease, primarily affects the cervical lyrnph nodes of lung adults and has a self-limited clinical course. Differential diagnoses are malignant lymphoma and systemic lupus erythematosus. Recurrence rate is low as 3.3%, and there have been a few reports describing the recurrence of the disease. The symptoms in almost all recurrent cases were similar to those of the early stages of the disease. The etiology of the disease remains unknown, but various viral infections and autoimmune processes have been postulated to be the cause. A 6-year-old boy presented with a fever of approximately 40C degrees, painless lumps on both sides of the neck, and intermittent abdominal pain for 2 weeks. Subacute necrotizing lymphadenitis was diagnosed 3 years before admission, which was reported by us in 1996. Diagnosis of recurred subacute necrotizing lymphadenitis was confirmed by histological examination of the lymph node. We report a recurred case of subacute necrotizing lymphadenitis during childhood.

A Case of Dieulafoy's Disease in a Child / 대한소아소화기영양학회지

Dieulafoy's disease, a vascular anomaly mainly in the upper stomach, is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. Pathogenesis is still controversial, but the most accepted theory is that a persistent caliber vessel in the submucosa is exposed by a small mucosal erosion leading to massive bleeding. The bleeding site is usually within 6 cm of the esophagogastric junction in the cardia or fundus of the stomach. The treatment of choice is therapeutic endoscopy or surgery. The age of patients reported is mainly between 50 and 70 years, and patients of pediatric age are extremely rare. We are reporting a 5-year-old male patient who had Dieulafoy's disease which was diagnosed by emergency upper gastrointestinal endoscopy. Endoscopic finding was a nodular lesion with an adherent clot on the lessor curvature of the stomach 2 cm below the esophagogastric junction. Epinephrine and Beriplast(R) was injected in the lesion. On the second day after endoscopic sclerotherapy, the patient had recurred massive hematemesis and accompanying shock. So we performed gastrotomy and ligation. After the operation, he showed an improved general condition and was discharged at the 12th hospital day.

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

A Follow-up Study of DMSA Renal Scan in Chidren with Acute Pyelonephritis and Vesicoureteral Reflux

Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck region. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread air space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or projected in spindly fashion. Almost all tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.