Ultrasonographic Bladder Parameters for Successful Suprapubic Bladder Aspiration / 소아과

PURPOSE: Suprapubic bladder aspiration(SBA) is a widely accepted method of obtaining sterile urine for culture in neonates but has a relatively low success rate and a few serious complications during SBA procedure. To improve the chance of obtaining urine, we determined the ultrasonographic bladder parameters(diameters and volume) to confirm that the bladder is adequately distended for successful aspiration of urine. METHODS: In 94 newborn infants who required sterile collection of urine, ultrasonographic examination and SBA procedure were carried out. On the patient's suprapubic area, the maximal cephalocaudal and anteroposterior diameters were measured by sagittal scanning, and the maximal anteroposterior and transverse diameters by transverse scanning. Bladder volume was calculated using the formula for elliptic volume, and then urine was aspirated to maximum of 10 mL and the amount of urine aspirated was recorded. RESULTS: Sufficient urine for culture(>1 mL) was obtained by SBA in 86(91.5%) of 94 infants. In the sagittal view, when the cephalocaudal diameter of the bladder was greater than 20 mm and the anteroposterior diameter was greater than 15 mm, the success rate was 100%. The cephalocaudal diameter of the bladder in sagittal view showed a more significant positive correlation with aspirated urine amount(r=0.65, P<0.001). CONCLUSION: The ultrasonographic sagittal view improved the success rate of SBA in neonates. A SBA was more likely to be successful when the cephalocaudal diameter of the bladder was above 20 mm and the anteroposterior diameter was above 15 mm.

Transplacental transfer and age-related levels of serum IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae types 14 and 19 in Korea

Little is known about the prevalence of naturally acquired IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae (pneumococcal IgG) in Korea. In the present study, we investigated transplacental transfer and age-related levels of pneumococcal IgG to provide background seroepidemiologic data for S. pneumoniae in Korea. One hundred thirty eight sera were assayed by ELISA for IgG to pneumococcal polysaccharide capsular serotypes 14 and 19, the predominant serotypes for under 15 yr of age in Korea. The subjects were divided into 7 subgroups according to age. The cord/maternal geometric mean titer of pneumococcal were 4.47+/-5.88/5.21 +/- 5.88 for serotype 14, and 4.68 +/- 5.55/6.55 +/- 6.92 for serotype 1 9 (mean +/- standard deviation, microg/mL). After birth, the geometric mean titers of pneumococcal IgG for serotypes 14 and 19 expressed in microg/mL were 1.18+/-2.12 and 1.41+/-2.17 in the 0-6 months group, 0.27+/-0.19 and 0.69+/-0.93 in 7-12 months, 0.21+/-0.22 and 0.64+/-1.32 in 1-2 yr, 0.69+/-0.78 and 2.65+/-2.46 in 3-6 yr, 2.52+/-2.72 and 8.29+/-4.24 in 7-10 yr, respectively. In conclusion, reduced transplacental transfer and very low serum concentrations of pneumococcal IgG may contribute to the susceptibility of neonates, infants, and young children to S. pneumoniae infection.

The Use of Ultrasonography in the Suprapubic Bladder Aspiration in Neonates

PURPOSE: Suprapubic bladder aspiration (SBA) of urine is an acceptable method to obtain sterile urine in the newborn infants. But the main problem with this technique is the low success rate of the procedure. We undertook a randomized, prospective study to determine whether a portable ultrasound examination could improve the success rate of SBA in the newborns. METHODS: In the ultrasound group, 46 newborns underwent SBA if ultrasound revealed sufficient urine (10x20 mm) in the bladder. In the control group, 32 newborns underwent SBA without an ultrasound examination. After each attempt, the number of needle punctures, volume of urine obtained and any complications of the procedures were recorded. RESULTS: 1) Success rate of SBA in this study was 91.3% (42/46) in the ultrasound group compared with 68.8% (22/32) in the control group (P<0.05). The mean number of punctures in the ultrasound group was less than in the control group (P<0.001). 2) The mean number of punctures and the frequency of hematuria were less in the success group of SBA (P<0.05). CONCLUSION: Portable ultrasonography can improve the success rate of SBA and reduce the number of passes and complications.

A clinical survey of prolonged Q-T syndrome among Korean children with congenital deafness

The clinical symptom complex characterized by syncopal attacks and sudden death in patients with electrocardiographic anomalies, especially a prolonged Q-T interval is known as the Romano-Ward syndrome. When a similar symptom complex is accompanied by congenital deafness, it is called Jervell and Lange-Nieisen syndrome. This study was undertaken to investigate the investigate the incidence of the latter syndrome in the Seoul area. A total of 1,013 children with congenital deafness who attend schools for the deaf were studied by analyzing their electrocardiograms. A corrected Q-T interval of> or =0.44 seconds was defined as a prolonged Q-T interval. The overall incidence of long Q-T syndrome observed in the deaf in the Seoul area was 0.49% as compared to 0.25% reported from elsewhere in the world. The mean age of patients with long Q-T syndrome was 11.3+/-5.9 years and the first syncopal attacks was 4.6+/-1.1 per patient. A valsalva maneuver and exercise tests in the test group were associated with significant changes in T wave configuration and prolonged Q-T intervals while similar changes were not observed in the control group. A larger survey is needed to derive more statistically significant conclusions.