Erythropoietin Reduces Death and Neurodevelopmental Impairment in Neonatal Hypoxic-Ischemic Encephalopathy

Purpose@#Erythropoietin (EPO) is a promising neuroprotective drug. We investigated whether EPO has beneficial effects on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). @*Methods@#We retrospectively reviewed the data of 56 infants with HIE born at or after 35 weeks of gestation who were admitted to Inha University Hospital between 2012 and 2021. Patients were divided into two groups based on EPO use and compared. In the EPO group, patients were administered 1,000 U/kg of EPO on days 1, 2, 3, 5, and 7, starting within 24 hours after birth. The primary outcome was death or neurodevelopmental impairment (NDI) at the age of 12 months. @*Results@#EPO was administered to 38 infants, and 18 did not receive EPO. Only 37.5% of patients with HIE (21/56) and 60% of patients with moderate-to-severe HIE (21/35) received therapeutic hypothermia. Among all patients with HIE, death or NDI (21.1 % vs. 50.0%; odds ratio [OR], 0.09; 95% confidence interval [CI], 0.01 to 0.78; P=0.029) and brain injury on imaging (42.1% vs. 83.3%; OR, 0.16; 95% CI, 0.03 to 0.92; P=0.040) were significantly lower in the EPO group than in the control group. Among patients with moderate-to-severe HIE, brain injury on imaging (54.2% vs. 90.9%; OR, 0.04; 95% CI, 0.002 to 0.700; P=0.027) was significantly lower in the EPO group than in the control group. @*Conclusion@#EPO administration significantly reduced mortality and NDI in infants with HIE. EPO can be considered an adjunctive therapeutic agent for neonatal HIE.

Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation

Purpose@#Premature infants have immature respiratory control and cerebral autoregulation. We aimed to investigate changes in cerebral oxygenation during apnea with and without peripheral oxygen desaturation in premature infants. @*Methods@#This prospective observational study was conducted at Inha University Hospital. Near-infrared spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) and pulse oximeter-monitored peripheral oxygen saturation (SpO2) were assessed during the first week of life in 16 stable, spontaneously breathing preterm infants. Apneic episodes that lasted for ≥20 seconds or were accompanied by desaturation or bradycardia were included for analysis. The average rScO2 value during the 5-minute prior to apnea (baseline), the lowest rScO2 value following apnea (nadir), the time to recover to baseline (recovery time), the area under the curve (AUC), and the overshoot above the baseline after recovery were analyzed. @*Results@#The median gestational age and birth weight of the infants were 29.2 weeks (interquartile range [IQR], 28.5 to 30.5) and 1,130 g (IQR, 985 to 1,245), respectively. A total of 73 apneic episodes were recorded at a median postnatal age of 2 days (IQR, 1 to 4). The rScO2 decreased significantly following apneic episodes regardless accompanied desaturation. There were no differences in baseline, nadir, or overshoot rScO2 between the two groups. However, the rScO2 AUC for apnea with desaturation was significantly higher than that for apnea without desaturation. @*Conclusion@#Cerebral oxygenation can significantly decrease during apnea, especially when accompanied by reduced SpO2. These results add the evidence for the clinical utility of NIRS in monitoring premature infants.

Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation

Purpose@#Premature infants have immature respiratory control and cerebral autoregulation. We aimed to investigate changes in cerebral oxygenation during apnea with and without peripheral oxygen desaturation in premature infants. @*Methods@#This prospective observational study was conducted at Inha University Hospital. Near-infrared spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) and pulse oximeter-monitored peripheral oxygen saturation (SpO2) were assessed during the first week of life in 16 stable, spontaneously breathing preterm infants. Apneic episodes that lasted for ≥20 seconds or were accompanied by desaturation or bradycardia were included for analysis. The average rScO2 value during the 5-minute prior to apnea (baseline), the lowest rScO2 value following apnea (nadir), the time to recover to baseline (recovery time), the area under the curve (AUC), and the overshoot above the baseline after recovery were analyzed. @*Results@#The median gestational age and birth weight of the infants were 29.2 weeks (interquartile range [IQR], 28.5 to 30.5) and 1,130 g (IQR, 985 to 1,245), respectively. A total of 73 apneic episodes were recorded at a median postnatal age of 2 days (IQR, 1 to 4). The rScO2 decreased significantly following apneic episodes regardless accompanied desaturation. There were no differences in baseline, nadir, or overshoot rScO2 between the two groups. However, the rScO2 AUC for apnea with desaturation was significantly higher than that for apnea without desaturation. @*Conclusion@#Cerebral oxygenation can significantly decrease during apnea, especially when accompanied by reduced SpO2. These results add the evidence for the clinical utility of NIRS in monitoring premature infants.

Urine biomarkers for monitoring acute kidney injury in premature infants

Background@#Premature infants are at high risk for acute kidney injury (AKI). Serum creatinine (Cr) has limitations for evaluating kidney function in premature infants. We evaluated whether urine biomarkers could be used to monitor AKI in premature infants. @*Methods@#A prospective cohort study was conducted among infants born at < 37 weeks. Urine biomarkers and serum Cr were measured on postnatal days 1, 3, 5, 7, 10, and 14. Infants were divided into 3 groups according to gestational age (GA); < 28, 28 to < 32 and 32 to < 37 weeks. @*Results@#AKI occurred in 17 of 83 (20.5%) recruited infants at a median age of 7 (interquartile range 5–10) days. While the most common cause of AKI was hemodynamically significant patent ductus arteriosus (53.8%) in infants of GA < 28 weeks, necrotizing enterocolitis was the leading cause (50.0%) in infants of GA 28 to < 32 weeks. Urinary levels of neutrophil-gelatinase-associated lipocalin/Cr were higher and epidermal growth factor/Cr were lower in AKI group before the onset of AKI in infants of GA < 28 weeks. In infants of GA 28 to < 32 weeks, urinary interleukin-8/Cr levels were higher in AKI group at approximately the time of AKI onset. @*Conclusion@#Several urine biomarkers were significantly different between AKI and no AKI groups, and some had changed before the onset of AKI. These groups were distinct according to causative factors of AKI and GA. Urine biomarkers could be useful for monitoring the development of AKI in premature infants.

Glucose Variations in the First Day of Life of Newborns under Observational Surveillance

Purpose@#Nursing protocols for glucose management are well known for both healthy term newborns and high-risk newborns. However, for less risky newborns who are under only observation surveillance, hypoglycemia could be overlooked unless clinical symptoms develop. @*Methods@#A retrospective study was performed to explore factors influencing variations in glucose levels in 91 newborns who did not require any interventions, but were under nursing surveillance, at a level II neonatal intensive care unit. Data were retrieved from electrical medical records on glucose levels, demographic characteristics, and other clinical characteristics of newborns in their first day of life from January 2016 to May 2019. @*Results@#Glucose levels tended to stabilize within the normal range (60~80 mg/dL) as time passed during the first day of life. Cesarean section, multiple gestation, abnormal growth, and later preterm birth were associated with low glucose levels in the first 2 hours of life. Thirty-one newborns experienced a hypoglycemic episode (< 45 mg/dL) during the first 24 hours of life. @*Conclusion@#The findings of this study support the active encouragement of early feeding within 2 hours of birth and urgent adoption of a structural protocol for glucose surveillance in newborns with potential health problems immediately after birth.

Clinical impact of admission hypothermia in very low birth weight infants: results from Korean Neonatal Network / 소아과

BACKGROUND: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C–37.5°C. PURPOSE: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS: The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C–37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04–1.83), 1.44 (95% CI, 1.05–1.97) and 1.86 (95% CI, 1.22–2.82) for infants with admission temperatures of 36.0°C–36.4°C, 35.0°C–35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.

Clinical Characteristics of Infantile Colic

PURPOSE: To diagnose infantile colic from parent questionnaires, as well as investigating the risk factors and clinical course of infantile colic. METHODS: We retrospectively reviewed the medical records of 462 infants, with a corrected age of < 4 months at the time of visiting Inha University Hospital from January to December 2017. Parents responded to a 10-line questionnaire consisting of seven items relating to colic symptoms and three further items relating to underlying disease. The score was based on the number of days each symptom was evident during the preceding week. We defined infantile colic as the sum total being greater than seven points; if at least one of the three symptoms suggesting underlying disease was present, the infant was excluded from the diagnosis. RESULTS: One hundred and sixty-seven infants (36.1%) satisfied the criteria. The lower the gestational age, the more infantile colic they developed (P < 0.001). The prevalence of colic was higher in infants born with a birth weight < 2.5 kg (62.7% vs. 24.4%, P < 0.001) and in infants small for their gestational age, in the < 10th percentile (54.5% vs. 33.7%, P=0.003). The prevalence of colic was significantly different according to the type of feeding (P=0.001), being the lowest in breast-only feeding (29.8%), 32.8% in mixed feeding with breast milk and formula, and 49.7% in formula-only feeding. Colic symptoms improved by administering hydrolyzed formula (87.5%), low-lactose formula (47.1%), galactosidase (44.4%), and the probiotic Lactobacillus reuteri (34.5%). CONCLUSION: The prevalence of infantile colic was over 30%. Prematurity, lower birth weight, and small for gestational age were the risk factors of infantile colic. Clinical improvement was observed when active intervention was performed.

Hospital Visits from Respiratory Diseases of Early and Late Preterm Infants

PURPOSE: We aimed to evaluate the respiratory illness-related hospital visits (out-patient clinics, emergency room, and re-admission) of preterm infants, and compare them according to corrected age and prematurity. METHODS: We reviewed the medical records of preterm infants born at < 37 weeks of gestation admitted to the neonatal intensive care unit (NICU) at Inha University Hospital between January 2012 and June 2015. Infant follow-up appointments in both neonatology and pulmonology out-patient clinics occurred for at least 2 years after NICU discharge. RESULTS: The proportion of infants who visited the hospital due to any respiratory illness was as high as 50% until 12 months of corrected age, and subsequently decreased over time. Hospital admission was significantly higher in early preterm infants ( < 34 weeks of gestation) compared to late preterm infants (≥34 and < 37 weeks of gestation). The proportion of infants who were re-admitted due to lower respiratory tract illness was significantly higher until 6 months of corrected age compared to the later, and did not differ between early and late preterm infants. CONCLUSION: The proportion of hospital visits of preterm infants due to respiratory disease was high until 12 months of corrected age. Most notably, the re-admission proportion from lower respiratory tract illness was high under 6 months in both early and late preterm infants. Preterm infants within this age that are visiting the hospital with respiratory symptoms should be carefully observed and followed up.

The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty / 전남의대학술지

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31+/-2.79 mL) than did the ET group (3.05+/-1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

Flora Colonization and Oral Glucose Levels During the Early Postnatal Period in High-Risk Newborns

PURPOSE: A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth. METHODS: Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth. RESULTS: Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was 34.4±3.2 weeks and weight was 2,266±697.5 grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%) and Coagulase- Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was 29.2±23.0mg/dl~58.2±39.5mg/dl. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034). CONCLUSION: High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.

The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty / 전남의대학술지

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31+/-2.79 mL) than did the ET group (3.05+/-1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

The Characteristics of Severe Iron Deficiency Anemia in Children and Adolescents / 임상소아혈액종양

BACKGROUND: Severe iron deficiency anemia (IDA) can cause developmental and growth problems in children and disease severity is more than cognitive disorder or diabetic neuropathy according to the disability weight (DW).METHODS: Severe IDA is defined as serum hemoglobin (Hb) level less than 7.0 g/dL in younger than 4 years of age and less than 8.0 g/dL in older than 5 years, which has been caused by iron deficiency. Among 2,336 patients with IDA, 130 (5.6%) were diagnosed as severe IDA. The exclusion criteria were other hematologic diseases, history of preterm birth or low birth weight and acute blood loss due to trauma.RESULTS: The rate of severe IDA among IDA patients was higher in female than male. Patients from age 1 to 6 and adolescents over the age of 13 outnumbered others, and the majority of adolescent patients were female. Among weight groups, low weight-for-ages (less than 3rd percentile) was prevail (20%). There were no statistical differences between laboratory results of symptomatic patients and those of asymptomatic ones (25.4%). The common causes of severe IDA were; long-term exclusive breast feeding (13.0%), menorrhagia (10.0%), H. pylori gastritis (9.2%), upper GI bleeding (9.2%) and malnutrition (8.5%). All were treated with oral or intravenous iron replacement therapy and after 3 months, laboratory results were significantly improved. In cases of H. pylori gastritis, iron replacement therapy in conjunction with H. pylori eradication showed better efficacy in treatment.CONCLUSION: The importance of severe IDA should not be underestimated. Especially with female adolescents, H. pylori gastritis patients, and athletes, it is still more important to make prompt diagnosis and early treatment.

The Characteristics of Severe Iron Deficiency Anemia in Children and Adolescents / 임상소아혈액종양

BACKGROUND: Severe iron deficiency anemia (IDA) can cause developmental and growth problems in children and disease severity is more than cognitive disorder or diabetic neuropathy according to the disability weight (DW). METHODS: Severe IDA is defined as serum hemoglobin (Hb) level less than 7.0 g/dL in younger than 4 years of age and less than 8.0 g/dL in older than 5 years, which has been caused by iron deficiency. Among 2,336 patients with IDA, 130 (5.6%) were diagnosed as severe IDA. The exclusion criteria were other hematologic diseases, history of preterm birth or low birth weight and acute blood loss due to trauma. RESULTS: The rate of severe IDA among IDA patients was higher in female than male. Patients from age 1 to 6 and adolescents over the age of 13 outnumbered others, and the majority of adolescent patients were female. Among weight groups, low weight-for-ages (less than 3rd percentile) was prevail (20%). There were no statistical differences between laboratory results of symptomatic patients and those of asymptomatic ones (25.4%). The common causes of severe IDA were; long-term exclusive breast feeding (13.0%), menorrhagia (10.0%), H. pylori gastritis (9.2%), upper GI bleeding (9.2%) and malnutrition (8.5%). All were treated with oral or intravenous iron replacement therapy and after 3 months, laboratory results were significantly improved. In cases of H. pylori gastritis, iron replacement therapy in conjunction with H. pylori eradication showed better efficacy in treatment. CONCLUSION: The importance of severe IDA should not be underestimated. Especially with female adolescents, H. pylori gastritis patients, and athletes, it is still more important to make prompt diagnosis and early treatment.

Mosaic Turner syndrome associated with schizophrenia

Turner syndrome is a sex-chromosome disorder; occurring in 1 in 2,500 female births. There are sporadic few case reports of concomitant Turner syndrome with schizophrenia worldwide. Most Turner females had a 45,X monosomy, whereas the majority of comorbidity between Turner syndrome and schizophrenia had a mosaic karyotype (45,X/46,XX). We present a case of a 21-year-old woman with Turner syndrome, mosaic karyotype (45,X/46,XX), showing mental retardation, hypothyroidism, and schizophrenia. HOPA gene within Xq13 is related to mental retardation, hypothyroidism, and schizophrenia. Our case may be a potential clue which supports the hypothesis for involvement of genes on X chromosome in development of schizophrenia. Further studies including comorbid cases reports are need in order to discern the cause of schizophrenia in patients having Turner syndrome.

Weaning Food Practice in Low Birth Weight Infants with Iron Deficiency Anemia / 임상소아혈액종양

BACKGROUND: As improving of the techniques and equipments of NICU, the survival rate of low birth weight (LBW) infants has been increased. LBW babies have the risk for iron deficiency anemia (IDA) due to their rapid growth after birth and the low endowment of iron. We investigated weaning practices in LBW infants and their mother's knowledge about weaning with respect to iron nutrition.METHODS: The 112 infants born lower than 2,500 g brought to Inha University hospital from March 2000 to July 2012 were assigned to this study. The range of the age of the infants is from 5 to 24 months. We classified the infants to 2 groups, that is, IDA group (n=41) and non-IDA group (n=71). We compared the hematologic value-hemoglobin <11 g/dL and serum ferritin <10 ng/mL or transferring saturation <15%-of the 2 groups, and the questionnaire about feeding pattern, weaning practice and mother's nutritional knowledge about weaning.RESULTS: The IDA group showed significant lower level of hematological parameters than non-IDA group (P<0.05). The group diagnosed IDA before the first 6 months of life was tendency to breastfeed without iron-fortification (P<0.01). The starting time for weaning showed no significant difference in 2 groups. The groups started weaning at 6-6.6 months after the birth (P=0.66). Both Education level of mother and gestational age have no effect on the time of beginning weaning. The food with weaning start is mainly home-made rice soup (over 80%) on both group (P=0.55). Over 20% of the IDA group tended to be delayed in weaning course (over 4 month), compared to the non-IDA group. Only 17% of IDA infants took iron, whereas 88% of non-IDA infants did. There were no significant differences in knowledge about weaning.CONCLUSION: Most of the IDA infants did feeding just by maternal milk until 6 months without iron fortification. LBW infants revealed lower hematologic values about IDA, and IDA group had a higher tendency to be delayed over 4 months in completing weaning course. Therefore, we recommend that the LBW infants with maternal feeding should take iron supplements or high-iron containing foods earlier.

Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

PURPOSE: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects. METHODS: This retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate. RESULTS: Six serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy. CONCLUSION: Sterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.

Weaning Food Practice in Low Birth Weight Infants with Iron Deficiency Anemia / 임상소아혈액종양

BACKGROUND: As improving of the techniques and equipments of NICU, the survival rate of low birth weight (LBW) infants has been increased. LBW babies have the risk for iron deficiency anemia (IDA) due to their rapid growth after birth and the low endowment of iron. We investigated weaning practices in LBW infants and their mother's knowledge about weaning with respect to iron nutrition. METHODS: The 112 infants born lower than 2,500 g brought to Inha University hospital from March 2000 to July 2012 were assigned to this study. The range of the age of the infants is from 5 to 24 months. We classified the infants to 2 groups, that is, IDA group (n=41) and non-IDA group (n=71). We compared the hematologic value-hemoglobin <11 g/dL and serum ferritin <10 ng/mL or transferring saturation <15%-of the 2 groups, and the questionnaire about feeding pattern, weaning practice and mother's nutritional knowledge about weaning. RESULTS: The IDA group showed significant lower level of hematological parameters than non-IDA group (P<0.05). The group diagnosed IDA before the first 6 months of life was tendency to breastfeed without iron-fortification (P<0.01). The starting time for weaning showed no significant difference in 2 groups. The groups started weaning at 6-6.6 months after the birth (P=0.66). Both Education level of mother and gestational age have no effect on the time of beginning weaning. The food with weaning start is mainly home-made rice soup (over 80%) on both group (P=0.55). Over 20% of the IDA group tended to be delayed in weaning course (over 4 month), compared to the non-IDA group. Only 17% of IDA infants took iron, whereas 88% of non-IDA infants did. There were no significant differences in knowledge about weaning. CONCLUSION: Most of the IDA infants did feeding just by maternal milk until 6 months without iron fortification. LBW infants revealed lower hematologic values about IDA, and IDA group had a higher tendency to be delayed over 4 months in completing weaning course. Therefore, we recommend that the LBW infants with maternal feeding should take iron supplements or high-iron containing foods earlier.

Is It Possible to Predict the Iron Status from an Infant's Diet History? / 대한소아소화기영양학회지

PURPOSE: Iron deficiency remains a very common nutritional problem despite the improvement in nutrition and increased understanding of methods for its prevention. Thus, we try to create a new method for screening iron nutrition through infant nutrition history. METHODS: Among the children who visited Inha University Hospital from March 2006 to July 2012, 181 children with iron deficiency anemia (IDA) and 52 children without IDA ranging from 6 to 36 months of age were reviewed in this study. We used the age when they began to wean food, the type of sort weaning foods, the time required for successful weaning, iron content in weaning foods, and the duration of breastfeeding for scoring infant nutrition history based on a questionnaire. RESULTS: The mean score of the IDA group was 7.8+/-2.6 points, which was significantly higher than that of the control group (5.6+/-2.1) (p=0.000). If we set up the cutoff value at 6 points, this screening has 86.8% sensitivity and 36% specificity. In addition, as the IDA score increased, there was a falling trend of hemoglobin. CONCLUSION: The IDA score does not have high specificity or high sensitivity. However, this study conveys that those patients who record a high score have low hemoglobin. Therefore, we suggest this score system for screening more IDA patients via nonpainful techniques.

Serum glycated albumin as a new glycemic marker in pediatric diabetes

PURPOSE: Serum glycated albumin (GA) has been recently used as another glycemic marker that reflects shorter term glycemic control than glycated hemoglobin (HbA1c). Insulin secretory function and glycemic fluctuation might be correlated with the ratio of GA to HbA1c (GA/HbA1c) in diabetic adult patients. This study investigated the association of GA and GA/HbA1c ratio with the levels of fasting C-peptide, fasting plasma glucose in type 1 and type 2 pediatric diabetes. METHODS: Total 50 cases from 42 patients were included. The subjects were classified into type 1 diabetes mellitus (T1DM) (n=30) and type 2 diabetes mellitus (T2DM) (n=20) group. The associations among HbA1c, GA, and GA/HbA1c ratio were examined. The relationship between the three glycemic indices and fasting glucose, fasting C-peptide were analyzed. RESULTS: Mean values of GA, the GA/HbA1c ratio were significantly higher in T1DM than T2DM. GA (r=0.532, P=0.001), HbA1c (r=0.519, P=0.002) and the GA/HbA1c ratio (r=0.409, P=0.016) were correlated with the fasting plasma glucose. Fasting C-peptide level arranged 4.22+/-3.22 ng/mL in T2DM, which was significantly above the values in T1DM (0.26+/-0.49 ng/mL). There were no significant correlation between HbA1c and fasting C-peptide level. However, GA and the GA/HbA1c ratio exhibited inverse correlations with fasting C-peptide level (r=-0.214, P=0.002; r=-0.516, P<0.001). CONCLUSION: GA seems to more accurately reflects fasting plasma glucose level than HbA1c. GA, GA/HbA1c ratio appear to reflect insulin secretory function.

The Chracteristics of Hypoxic Ischemic Encephalopathy with Seizures in Children

PURPOSE: This study was aimed to evaluate the clinical features of hypoxic ischemic encephalopathy(HIE) in children with and without seizures. METHODS: Fifty five children who had been diagnosed as HIE at Inha University Hospital from June 1999 to December 2011 were enrolled in this study. Subjects were divided into two groups by the presence of seizures and their medical records were retrospectively analyzed. RESULTS: Among the 55 cases, 34 patients (61.8%) had seizures, while 17 patients (32.2%) did not have them. Male to female ratio was 1:1 for the 'seizure' group and 2.5:1 for the 'no seizure' group. The onset age was 9.7 months (range: 0-158 months) for the 'seizure' group and 10 months (range : 0-108 months) for the 'no seizure' group. The most common risk factor was birth asphyxia (17.7%) for the 'seizure' group, and prematurity (23.8%) for the 'no seizure' group. The most common symptom other than seizure was respiratory arrest for both groups. On radiologic imaging studies of the brain, main causative lesion was most commonly observed in the cerebral cortex in both groups. The neurologic deficits or death were detected in 67.7% of the 'seizure' group, and 76.3% of the 'no seizure' group. There were no statistically significant differences in risk factors between the two groups. CONCLUSION: Although the characteristics between patients with and without seizures from HIE revealed no significant differences, HIE still can result in death or permanent disability in children. Therefore, permanent brain damage may be minimized by early suspicion and treatment in these patients.