Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Vitamin D Status and Bone Mineral Density in Children with Inflammatory Bowel Disease Compared to Those with Functional Abdominal Pain

Low vitamin D has been implicated in reduced bone mineral density (BMD) in children with inflammatory bowel disease (IBD). Our study aimed to evaluate differences in serum 25-hydroxyvitamin D (25[OH]D) and total body less head (TBLH) BMD z-scores in children with Crohn's disease (CD), ulcerative colitis (UC), and those with abdominal pain-related functional gastrointestinal disorder (AP-FGID) as the control group. We also examined the correlation between serum 25(OH)D and TBLH BMD z-score, and factors that affect each of these parameters. A total of 105 children were included and divided into 3 groups: AP-FGID (n = 45), CD (n = 43), and UC (n = 17). Among the 3 study groups, TBLH BMD z-scores were found to be significantly different (0.5 ± 0.8 in CD vs. 0.1 ± 0.8 in UC vs. −0.1 ± 1.1 in FGID; P = 0.037), despite similar levels of serum 25(OH)D. Within each study group, correlation between serum 25(OH)D and TBLH BMD z-score was not observed. Factors found to affect the TBLH BMD z-score were sex (P = 0.018), age (P = 0.005) and serum hemoglobin (P = 0.041), while factors influencing serum 25(OH)D were sex (P = 0.018), CD with reference to AP-FGID (P = 0.020), and serum phosphorus (P = 0.018). Based on our results, vitamin D is a relatively small contributor to bone loss in pediatric IBD and clinicians should consider female sex, older age, and low hemoglobin as risk factors for low BMD in children with IBD.

Age, Predisposing Diseases, and Ultrasonographic Findings in Determining Clinical Outcome of Acute Acalculous Inflammatory Gallbladder Diseases in Children

We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.

Vitamin D Status and Bone Mineral Density in Obese Children with Nonalcoholic Fatty Liver Disease

Whether nonalcoholic fatty liver disease (NAFLD) is related to vitamin D and bone health in obese children is unknown. The aim of this study was to evaluate vitamin D status and bone mineral density (BMD) in obese children according to their condition within the NAFLD spectrum. Anthropometric data, laboratory tests, and abdominal ultrasonography were obtained from 94 obese children. The subjects were divided into three groups according to NAFLD spectrum: normal liver, simple steatosis, and nonalcoholic steatohepatitis (NASH). Although there were no differences in vitamin D levels between the three groups, these groups showed significant differences in highly sensitive C-reactive protein (P=0.044), homeostasis model assessment of insulin resistance (HOMA-IR) (P=0.02), hepatic fibrosis scores (P<0.05), and trunk fat percentage (P=0.025). Although there were significant differences in BMDs, the age-matched BMD z-scores were not significantly different between the three groups. Serum vitamin D levels were negatively correlated with age (r=-0.368, P=0.023), serum uric acid levels (r=-0.371, P=0.022), fibrosis 4 (FIB4) (r=-0.406, P=0.011), and HOMA-IR (r=-0.530, P=0.001) in obese children with NASH. Multiple regression analysis for vitamin D in the NASH group revealed age and HOMA-IR as significant factors. In conclusion, inflammatory markers, hepatic fibrosis scores, trunk fat, and insulin resistance may reflect the spectrum of NAFLD in obese children, whereas vitamin D levels and BMD may not. In patients with NASH, however, low serum vitamin D is associated with hepatic fibrosis and insulin resistance, but not with bone health status.

Hemophagocytosis in the pleural fluid of a patient with hemophagocytic lymphohistiocytosis

No abstract available.

The Impact of Fluid Therapy Strategies on Nonoliguric Hyperkalemia in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study was to characterize the changes in the incidence and clinical characteristics of nonoliguric hyperkalemia (NOHK), together with plasma potassium levels, according to the fluid therapy strategies for extremely low birth weight infants (ELBWIs) during the first few days of life. METHODS: This retrospective study enrolled ELBWIs. We analyzed the occurrence of NOHK, plasma potassium levels, other biochemical data, and fluid balances according to historically controlled strategies such as conventional limited-volume supply and low-dose calcium supplementation (P1), increased-volume supply and high-dose calcium supplementation (P2), and early aggressive nutrition (EAN) and high-dose calcium supplementation (P3). RESULTS: The incidence of NOHK and the plasma potassium levels in P2 (127 ELBWIs) were not different from those in P1 (39 ELBWIs). However, arrhythmia and fatality significantly decreased in P2 compared to those in P1. In P3 (68 ELBWIs), the incidence of NOHK after 24 h and the plasma potassium levels after 36 h of life were significantly reduced compared to those in P1 and P2. Neither arrhythmia nor fatality developed in P3. CONCLUSION: EAN combined with high-dose calcium supplementation could be a potential strategy for the prevention of NOHK along with consequent arrhythmia and fatality in ELBWIs.

Lupus Anticoagulant Titer Changes in Children with Prolonged In Vitro Coagulation Time by Lupus Anticoagulant / 임상소아혈액종양

BACKGROUND: This study was conducted in order to examine the duration of lupus anticoagulant (LA) presence in serum after it was first detected in children in association with infection. In addition, the effect of LA on coagulation time was evaluated.METHODS: We included 14 children who had an accompanying high titer of LA and prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). The titer of LA and PT/aPTT were examined until LA titer normalized serially after an interval of approximately 10 days.RESULTS: None of the subjects showed any evidence of bleeding or thrombosis during conduct of the study. LA titer had normalized in none of the subjects within approximately 10 days later, and only 28.6% within 20 days later. However, LA titer had normalized in 85.7% of subjects within approximately 30 days, and all subjects showed the normal range of LA titer at 40 days from the first examination. LA titer had a statistically significantly effect on the PT and aPTT (P<0.05, P<0.01, respectively).CONCLUSION: The prolongation of PT or aPTT observed in children with high titer of LA after infectious diseases was not related to any bleeding or thrombotic problem. The elevated titer of LA and prolonged aPTT normalized within approximately 40 days. However, the number of subjects in this study was too small; therefore, conduct of a larger cohort study will be required in order to clarify that elevated LA is related to clinical problems.

Lupus Anticoagulant Titer Changes in Children with Prolonged In Vitro Coagulation Time by Lupus Anticoagulant / 임상소아혈액종양

BACKGROUND: This study was conducted in order to examine the duration of lupus anticoagulant (LA) presence in serum after it was first detected in children in association with infection. In addition, the effect of LA on coagulation time was evaluated. METHODS: We included 14 children who had an accompanying high titer of LA and prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). The titer of LA and PT/aPTT were examined until LA titer normalized serially after an interval of approximately 10 days. RESULTS: None of the subjects showed any evidence of bleeding or thrombosis during conduct of the study. LA titer had normalized in none of the subjects within approximately 10 days later, and only 28.6% within 20 days later. However, LA titer had normalized in 85.7% of subjects within approximately 30 days, and all subjects showed the normal range of LA titer at 40 days from the first examination. LA titer had a statistically significantly effect on the PT and aPTT (P<0.05, P<0.01, respectively). CONCLUSION: The prolongation of PT or aPTT observed in children with high titer of LA after infectious diseases was not related to any bleeding or thrombotic problem. The elevated titer of LA and prolonged aPTT normalized within approximately 40 days. However, the number of subjects in this study was too small; therefore, conduct of a larger cohort study will be required in order to clarify that elevated LA is related to clinical problems.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.