Medical Litigation and the Care of Newborns

PURPOSE: Recently, legal disputes resulting from medical accidents have been increasing annually. The purpose of this study is to determine the causes and characteristics of medical disputes brought as a result of neonatal accidents and to suggest measures to reduce the number of medical malpractice suits. METHODS: Twenty-eight medical malpractice lawsuits brought as a result of neonatal accidents between 2005 and 2009 were analyzed. RESULTS: The average time taken to resolve these lawsuits was approximately 4.4 years. The average gestational age and birth weight of the newborns in these cases were 35.3+/-4.2 weeks and 2,668+/-931 g, respectively. Twelve cases (42.9%) were concluded partially in favor of the plaintiffs, while in 10 (35.7%) cases the plaintiffs lost. In 11 of the 12 cases that were concluded partially in favor of the plaintiffs, the defendants were found guilty of violating their duty of care. Medical accidents resulted in death in 10 cases and physical disability in 18 cases, and cerebral palsy and blindness were the most common physical disabilities. The average compensation amount ordered as damages was KRW 161,389,291+/-12,636,454. CONCLUSION: In medical litigation, the standard of judgment is whether appropriate medical practices were performed based on the patient's symptoms. Thus, to comply with the medical treatment rules is paramount in securing patients' safety and protecting doctors themselves. Individual effort is necessary, but not sufficient to prevent medical accidents; multilateral, systemic reform is also required if the number of neonatal medical accidents is to be reduced.

Clinical Manifestation of Eosinophilic Meningitis in Korean Children: A Single Institution's Experience

PURPOSE: The aim of this study was to investigate the clinical manifestations and laboratory characteristics of eosinophilic meningitis in Severance Children's Hospital. METHODS: We examined 6,335 children under the age of 18 years old who had visited the tertiary hospital in Seoul, Korea, and had received cerebrospinal study results between January 2007 and July 2012. The medical records of the patients identified as eosinophilic meningitis were retrospectively reviewed. RESULTS: Eosinophilic meningitis was diagnosed in 39 patients (0.6%). The mean age was 6 years (range 0-18 years) and the sex ratio was 1.3:1 (22 males and 17 females). The underlying diseases and past history were neurologic disease (n=36, 92%). Eosinophilic meningitis was diagnosed in thirty-five patients who had undergone postoperation neurosurgery (90%). The most common symptoms were fever (50%), headache (20%), vomiting (15%), seizure (10%), and dizziness (5%). The average duration for recovery was five days, and intravenous antibiotics or steroids were used. CONCLUSIONS: Manifestations of eosinophilic meningitis are similar to other types of meningitis. The most common cause of eosinophilic meningitis in children was neurosurgery. Eosinophilic meningitis should be considered for patients showing fever and headache after neurosurgery. Through careful investigation, use of improper antibiotics could be avoided.

A Case of Subdural Empyema Caused by Sinusitis in a Child / 소아감염

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.

Proton-Pump Inhibitor-Induced Hypocalcemia and Hypomagnesemia

A 7-day-old female neonate who visited emergency depar tment due to generalized tonic seizure. Laboratory test results showed hypocalcemia (5.7 mg/dL), hypomagnesemia (0.55 mmol/L), low parathyroid hormone (7.5 pg/mL), and normal 25(OH) vitamin D3. Symptom and metabolic abnormalities were normalized with intravenous calcium gluconate and magnesium sulfate. Discharged with supplement of oral calcium, vitamin D, phenobarbital, and lansoprazol, she was re-admitted with hypocalcemia (4.8 mg/dL) with normal level of parathyroid hormone (12.3 pg/mL). Hypocalcemia was resolved with discontinuation of proton pump inhibitor. We report a case of recurrent hypocalcemia and hypomagnesemia due to proton-pump inhibitor.