Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and Neurodevelopment

Background@#There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children. @*Methods@#This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months.Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date. @*Results@#The median age at the index date was 3.8 (95% confidence interval [CI], 1.7–5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5–17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30–1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ. @*Conclusion@#Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

Personal Exposure to Total VOC Is Associated With Symptoms of Atopic Dermatitis in Schoolchildren

Background@#The urinary levels of volatile organic compound (VOC) metabolites provide individual exposure levels compared to data obtained by measuring these compounds in ambient air. We aimed to investigate the association between personal urinary concentrations of VOC metabolites and symptoms of atopic dermatitis in schoolchildren. @*Methods@#Nine urinary VOC metabolites were analyzed from urine samples of 149 children. Diagnosis of atopic dermatitis was determined using standardized questionnaires. Pediatricians visited the schools and rated the severity of symptoms using the SCORing Atopic Dermatitis (SCORAD) in all children. @*Results@#Forty-five children (30.2%) had atopic dermatitis based on the International Study of Asthma and Allergies in Childhood (ISAAC) results and 35 children (23.8%) had symptoms of atopic dermatitis with positive SCORAD index values (defined as SCORAD ≥ 5). Children with benzylmercapturic acid detected in personal urines were associated with presence of atopic dermatitis and positive SCORAD index values. Children in the highest quartile of mandelic acid concentration were associated with presence of atopic dermatitis and positive SCORAD results. @*Conclusion@#Personal exposure to VOCs, as indicated by urinary levels of VOC metabolites, was associated with presence of atopic dermatitis and the SCORAD index value.

Association of Sensitization to Different Aeroallergens With Airway Function and Nasal Patency in Urban Children

PURPOSE: Children with sensitization to aeroallergens have decreased lung function and nasal patency. Our purpose was to determine the association of sensitization to different aeroallergens with airway function and nasal patency. METHODS: Four hundred and eighty-six randomly selected 11 year-old children who lived in Seongnam City were examined. Serum specific immunoglobulin E (IgE) levels against 6 common allergens (Dermatophagoidesfarinae, birch, cat, dog, Japanese hop and Alternaria), impulse oscillometry (IOS) results for the evaluation of airway dysfunction, and acoustic rhinometry for the determination of nasal airway patency were obtained. RESULTS: IOS indicated that children sensitized to Alternaria (n = 38, 7.8%) and dog dander (n = 69, 14.2%) had decreased lung function, based on resistance at 10 Hz (Rrs10; aβ = 0.0072; 95% CI, 0.017, 0.127; P = 0.010) and 1 Hz (Rrs1; aβ = 0.038; 95% CI, 0.001, 0.074; P = 0.042). Children sensitized to D. farinae (n = 281, 57.8%) had decreased post-decongestant nasal volume at 0 to 5 cm (aβ = −0.605; 95% CI, −1.005, −0.205; P = 0.003), but normal IOS results at all measured frequencies (P > 0.05). Increased serum eosinophil level was associated with Rrs1 (P = 0.007) and Rrs2 (P = 0.018) and post-decongestant nasal volume at 0 to 5 cm (aβ = −0.885; 95% CI, −1.331, −0.439; P < 0.001). CONCLUSIONS: Sensitivity to specific aeroallergens, serum eosinophil count and total IgE level had different associations with upper and lower airway dysfunction in urban children.

Clinical characteristics and genetic variation in respiratory syncytial virus isolated from infants hospitalized due to acute bronchiolitis in Korea during winter season 2016–2017

PURPOSE: Circulating patterns of predominant respiratory syncytial virus (RSV) genotypes in the community may be helpful in understanding molecular epidemiology and predicting future outbreaks of the RSV genotype. We investigated the association of genetic variations in RSV with acute severe bronchiolitis in infants. METHODS: We reviewed medical records of infants younger than 1 year of age hospitalized due to acute bronchiolitis between November 2016 and February 2017. Subjects were classified as severe or mild based on the use of mechanical or noninvasive ventilation. The associations between severity of the disease, sex, age at admission, oxygen saturation at admission and laboratory test results were analyzed. RSV sequence analysis was performed in the severe group. RESULTS: Among 114 infants, 80 underwent respiratory viral polymerase chain reaction using nasopharyngeal swab; of these, 53 (66.3%) showed positive for RSV. Of the 53 RSV-positive samples, 9 were categorized as the severe group and 44 were categorized as the mild group. Male sex, young age, longer duration of admission, minimum SaO2 at admission and bronchiolitis severity score were significantly correlated with disease severity in the severe group than in the mild group (all variables, P < 0.001). Phylogenetic and sequence analysis in the severe group revealed 8 RSV-A, ON1 genotype and 1 RSV-B, BA4 genotype. CONCLUSION: Phylogenetic types of RSV in subjects of the severe group were RSV-A, ON1 genotype or RSV-B, BA4 genotype which were prevalent in the Korean community at the same time. Our study showed that disease severity was not significantly associated with RSV genotypic evolution or antigenic drift in Korea during winter season 2016–17.

Serum Periostin Is Negatively Correlated With Exposure to Formaldehyde and Volatile Organic Compounds in Children

Epidemiological studies have shown that exposure to tobacco smoke causing irritation and inflammation in the airways tends to reduce serum periostin concentrations in adults. We now investigate prospective cross-sectional study on 135 Korean students aged 7 years in the first grade who were participating in the Seongnam Atopy Project for Children's Happiness 2016 (SAP2016) cohort. To the best of our knowledge, this is the first study to show significant inverse correlations between serum periostin concentration and exposure to xylene and formaldehyde in children. Our findings suggested the need for caution in using the serum periostin level as a marker for allergic diseases, since exposure to volatile organic compounds and formaldehyde may confound the interpretation of these results.

Erratum: Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups

This erratum is being published to correct the printing error on page 517 of the article. Corrections for Fig. 1 and main text in page 519 are needed. The authors apologize for any inconvenience that this may have caused.

Allergen sensitization and clinical characteristics in young children with atopic dermatitis

PURPOSE: Few studies have demonstrated the effects of aeroallergen sensitization on the development of atopic dermatitis (AD) in young children. This study aimed to investigate the sensitization rate of food and aeroallergens in AD patients under 2 years of age and to compare clinical characteristics between IgE- and non-IgE-mediated AD patients. METHODS: Children aged less than 2 years who had visited CHA Bundang Medical Center from 2013 through 2016 were enrolled. Allergen sensitization was measured by specific IgE levels for common allergens. Detailed information was obtained using an atopy questionnaire. RESULTS: A total of 173 patients were examined, 118 (68.2%) were male patients. The prevalence of aeroallergen sensitization under 1 year of age was 4.8% and increased to 19.5% for children aged 2 years (P=0.005). The mean age (13.6±6.3 months vs. 9.0±5.1 months, P=0.003) and the proportion of children born prematurel (15.4% vs. 2.3%, P=0.013) were higher in the aeroallergen-sensitized group than in nonsensitized group. Sensitization to food allergens between children aged less than 1 year and 2 years appeared to be similar (61.1% vs. 57.1%, P=0.651). There were no significant differences in clinical characteristics between food allergen IgE-mediated and non-IgE-mediated AD children. CONCLUSION: Aeroallergen sensitization increased markedly in AD patients aged 2 years which is about 4 times that of the general population. However, there were no significant differences in clinical manifestations between allergen IgE-mediated and non-IgE-mediated AD children in both food and aeroallergens.

Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children

PURPOSE: Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children. METHODS: This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done. RESULTS: The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022). CONCLUSIONS: A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

Therapeutic Response for Functional Abdominal Pain in Children with Occult Constipation: Laxatives versus Prokinetic Drugs

The relationship between functional abdominal pain (FAP) and occult constipation (OC) in children who did not meet the Rome III criteria for constipation has rarely been reported. This study aimed to estimate the prevalence of OC in patients with FAP and to compare the effectiveness of prokinetic drugs and laxatives for FAP and OC. Pediatric outpatients (n = 212; aged 4–15 years) who satisfied the Rome III criteria for childhood FAP were divided into 2 groups based on Leech scores: group 1 < 8; group 2 ≥ 8. Group 2 received either prokinetic drugs or laxatives and pain severity was assessed after 2 weeks, 1 month, and 3 months. A total 52.4% (111/212) of patients had OC in this study. More patients who received laxatives had reduced pain scores compared with those who received prokinetic drugs. Those treated with laxatives in group 2 had a better response than those treated with prokinetic drugs throughout the study period (P < 0.001, P < 0.001, and P = 0.002 after 2 weeks, 1 month, and 3 months, respectively). OC was frequently encountered in children with FAP. Laxatives can be more effective than prokinetic drugs for relieving symptoms of FAP in children with a Leech score ≥ 8 and suspected OC.

Prevalence of respiratory virus infection with regard to age, sex, and seasonality factors: A single center experience against children hospitalized during the 10 years

PURPOSE: It is well known that respiratory viral infection has epidemiological characteristics, including season. This study aimed to investigate the patterns of the prevalence of common respiratory viruses during a period of 10 years with regard to age, sex, and season in Korean children. METHODS: From June 2006 to November 2016, we obtained 11,798 specimens from patients aged less than 18 years who were admitted with lower respiratory infections. Ten respiratory viruses were detected using multiplex reverse transcription-polymerase chain reaction. RESULTS: Of 11,798 specimens, at least 1 virus was detected in 4,845 (41.1%). Respiratory syncytial virus (RSV, 18.9%) was the most common virus detected, followed by human rhinovirus (HRV, 14.8%), adenovirus (9.5%), and human bocavirus (HBoV, 7.4%). The detection rate of HRV was higher in male subjects (male 60.0% vs. female 40.0%, P=0.004), but the other viruses had no significant differences with regard to sex. The subjects who were positive for RSV test were youngest (median, 10.5 months; interquartile range, 3.0–25.0 months), followed by human coronavirus (median, 13.0 months), HRV (median, 14 months), and parainfluenza (median, 14 months). HBoV was most commonly detected in spring (29.3%), enterovirus in summer (25.8%), HRV in fall (22.6%), and RSV in October and winter (22.6%). CONCLUSION: We found that the prevalence of respiratory viruses in Korean children during a period of 10 years was associated with age, sex, and season when the infection occurred. Further nationwide data is warranted to infer clinical implication of our results.

Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups

PURPOSE: Seasonal variations in asthma exacerbation (AE) are associated with respiratory virus outbreaks and the return of children to school after vacation. This study aims to elucidate the period, phase, and amplitude of seasonal cycles of AE in 5 different age groups with regard to rhino- and influenza virus epidemics in Korea. METHODS: The number of daily emergency department (ED) visits for AE in all age groups of Korea and the nationwide weekly incidence of rhino- and influenza virus, were obtained for 2008-2012. Fourier regression was used to model rhythmicity, and the Cosinor method was used to determine the amplitude and phase of the cycles in each age group. The cross-correlation function (CCF) between AE and the rhino- and influenza virus epidemics was also calculated. RESULTS: There were 157,559 events of AE (0.62 events/1,000 individuals/year) during the study period. There were spring and fall peaks of AE in children and adults, but only 1 winter peak in the elderly. The amplitude of the AE peak in infants was higher in spring than in fall (9.16 vs 3.04, P<0.010), and the fall peak was approximately 1 month later in infants than in school children (October 11 vs November 13, P<0.010). The association between AE and rhinovirus was greatest in school children (rho=0.331), and the association between AE and influenza virus was greatest in those aged ≥60 years (rho=0.682). CONCLUSIONS: The rhythmicity, amplitude, and phase of the annual cycle of AE differed among different age groups. The patterns of AE were related to the annual rhino- and influenza virus epidemics.

Dietary habits and gastroesophageal reflux disease in preschool children / 소아과

PURPOSE: To identify the relationship between dietary habits and childhood gastroesophageal reflux disease (GERD) in preschool children. METHODS: We performed a questionnaire study to analyze the relationship between dietary habits and GERD in 85 preschool children with GERD and 117 healthy children of the same age. RESULTS: Irregular and picky eating were more p–revalent in the GERD group than in the control group (odds ratio [OR], 4.14; 95% confidence interval [CI], 1.37–12.54 and OR, 4.96; 95% CI, 1.88–13.14, respectively). The snack preferences and the late night eating habits were significantly more prevalent in the GERD group than in the control group (OR, 3.83; 95% CI, 1.23–11.87 and OR, 9.51; 95% CI, 2.55–35.49, respectively). A preference for liquid foods was significantly more prevalent in the GERD group (OR, 9.51; 95% CI, 2.548–35.485). The dinner-to-bedtime interval was significantly shorter in the GERD group than in the control group (157.06±48.47 vs. 174.62±55.10, P=0.020). In addition, the time between dinner and bedtime was shorter than 3 hours in 47 children (55.3%) of the GERD group and 44 (37.6%) of the control group. This difference was statistical significance (P=0.015). CONCLUSION: Dietary habits such as picky and irregular eating, snack preference, a preference of liquid foods, late night eating, and a shorter dinner-to-bedtime interval had a significant correlation with GERD. Further large-scale studies are necessary to confirm our results.