The Epidemiological Trend of Rotavirus Gastroenteritis in Children in a Single Center from 2004 to 2012: A Retrospective Study / 소아감염

PURPOSE: This study was performed to investigate the epidemiological trend of rotavirus acute gastroenteritis (RV-AGE) in children. METHODS: A retrospective review was performed in patients (1 month to 18 years of age) with acute gastroenteritis at KEPCO Medical Center from September 2004 to August 2013. Comparative analyses were performed based on periods: pre-vaccine (2004-2006) and post-vaccine (2008-2012) in all patients; 2004-2006 (period A), 2007-2009 (period B) and 2010-2012 (period C) in patients under 5 years of age. RESULTS: Proportion of RV-AGE decreased from 25.0% (337/1,346) in pre-vaccine period to 20.8% (459/2,210) in post-vaccine period (rate ratio (RR), 0.83 [95% CI, 0.73-0.93]; P=0.0029). The median age of patients with RV-AGE in post-vaccine period (2.6 years) was significantly (P<0.0001) higher than that in pre-vaccine period (1.6 years). In patients hospitalized with AGE, proportion of RV-AGE was significantly reduced in patients 6 to 23 months old (RR, 0.62 [95% CI, 0.51-0.75]; P<0.0001). Significant decline in proportion of RV-AGE was observed in patients under 5 years of age: period A, 26.9% (308/1,144); period B, 22.7% (295/1,299); period C, 20.6% (186/902) (P=0.0007). After the introduction of rotavirus vaccine, a significant decreasing trend of RV-AGE proportion was observed in patients 6 to 11 months old (P=0.0018) and 12 to 23 months old (P=0.0152). CONCLUSION: Decrease in RV-AGE proportion and increase in age of patients with RV-AGE were observed after the introduction of rotavirus vaccine in this single center study. Continued and systematic surveillance is needed to assess the impact of rotavirus vaccine.

Blood Lead Levels in Umbilical Cord and Neonatal Neurobehavioral Status / 대한산업의학회지

OBJECTIVES: To investigate the relation between umbilical cord blood lead level lower than 10 microgram/dl and neonatal neurobehavioral performance. METHODS: Umbilical cord blood lead level, as an indicator for prenatal exposure to lead, and Brazelton neonatal behavioral assessment scale (NBAS), as an indicator for effect, were determined in 86 neonates in Gumi, Kyungpook, Korea. The blood levels were measured by graphite furnace atomic absorption spectrophotometer. Development was assessed by NBAS at birth in 86 neonates and at 1 month in 55 neonates. RESULTS: The mean cord blood lead levels of the 86 and 55 neonates were 3.90 +/- 0.71 microgram/dl (range 2.24 - 5.39 microgram/dl) and 3.88 +/- 0.70 microgram/dl (range 2.24~5.03 microgram/dl), respectively. We used the median value of 4 microgram/dl to divide into low- and high- lead level groups. There was a significant difference in the peak of excitement at birth, and in the animate visual, inanimate visual, inanimate auditory, activity level, peak of excitement, and liability of states at one month, between the two groups. For cluster scores, motor system and state organization scores showed significant differences between the two groups. For adjusting the potential confounding effect of intial difference, differences of the scores between the two groups at one month were analysed with ANCOVA. The results of ANCOVA showed the significant difference between the two groups. CONCLUSIONS: The findings suggest that prenatal low-level lead exposure, even lower than 10 microgram/dl, might affect the neonatal neurobehavioral development.

Two Cases of Cervical and Mediastinal Emphysema / 소아알레르기및호흡기학회지

Spontaneous pneumomediastinum is rare in children, mainly affecting male adolescents. It usually occurs secondary to alveloar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The most frequent triggers in the pediatric age group are asthma, vomiting of any cause, situations reproducing the Valsalva maneuver (e.g., shouting, coughing), and intense sport activities. We report two cases of pneumomediastinum, occuring in a patient with vigorous coughing and pneumonia and in a patient with dyspnea and pneumonia. We describe the clinical and radiologic findings of two cases. In addition, we have made a comprehensive review of the literature on spontaneous pneumomediastinum in children.

A Case of Adams-Oliver Syndrome which was Observed in Two Brothers

Adams-Oliver syndrome is characterized by the presence of scalp aplasia cutis congenita with distal limb anomalies. Cutis mammorata and dilated scalp veins are additional frequent manifestations of the condition. In almost all reported patients with Adams- Oliver syndrome, the trait of inheritance was autosomal dominant. Only three reports suggested autosomal recessive inheritance characterized by multiple affected offsprings in unaffected parents. But a number of sporadic cases have been described. We have experienced a boy with this syndrome, who showed large congenital scalp defect with exposed dural membrane and bony defect beneath it, cutis mammorata on whole body, equinovarus, and no metatarsal ossification center of left foot. His brother also had these symptoms, but their parents were not affected. He was complicated by bacterial meningitis, and cured with antibiotics. The skin defect was closed spontaneously with atrophic scar. We report this case with the brief review of literature.

Intra-arterial Blood Pressure Changes in Very Low Birth Weight Infants During the First Seven Days of Life

PURPOSE: We aimed to assess the influence of perinatal factors on intra-arterial mean blood pressures of very low birth weight infants during the first seven days of life and the association of intra-arterial mean blood pressures on the common morbidities and neonatal death of very low birth weight infants. METHODS: The retrospective study on intra-arterial mean blood pressures over the first seven days of life in 103 very low birth weight infants who admitted to the neonatal intensive care unit at the Dankook University Hospital from Jan. 1996 to Dec. 2000 was done. Trend data for each infants were assessed in 9 time periods until seven days of age. Perinatal factors that might influence intra-arterial mean blood pressures and the association of intra-arterial mean blood pressures on neonatal death and common morbidities were assessed. RESULTS: Intra-arterial mean blood pressures of very low birth weight infants increased with birth weight and gestational age (P<0.05), and significantly increased with postnatal age over the seven day periods from 35.0+/-4.9 mmHg (period 1) to 44.2+/-6.5 mmHg (period 9). Intra-arterial mean blood pressures of infants weighing less than 1,000 g were significantly lower than infants weighing 1,000 to 1,499 g at all each time periods (P< 0.05). Intra-arterial mean blood pressures were found to correlate significantly with antenatal steroid (P<0.005), and correlate inversely with PDA (P<0.001), pulmonary hemorrhage (P<0.005) and ROP (P<0.05). CONCLUSION: Intra-arterial mean blood pressures in very low birth weight infants during the first seven days were found to correlate significantly with postnatal age, gestational age, birth weight and antenatal steroid and probably correlate with some common morbidities of very low birth weight infants. It is therefore important to maintain adequate blood pressure ranges during the first seven days of life that are the most critical periods of illness for the majority of very low birth weight infants.

Changes in the Levels of Eicosanoids and Isoprostane (8-iso-PGF2alpha) in the Newborn Rat Brain after Hypoxic-Ischemic Injury

PURPOSE: The changes in the levels of eicosanoids and isoprostane (8-iso-PGF2alpha) were investigated in brain tissue of 7 day-old rats after hypoxic-ischemic (HI) injury. METHODS: The 7 day-old newborn rats underwent right unilateral common carotid artery ligation followed by exposure to hypoxia with 8% oxygen for 150 minutes. There after, the pups were decapitated during reoxygenation 21% period of 0, 1, 6, 24, and 72 hours and their cerebral hemisheres were dissected through sagittal plane. Ipsilateral and contralateral cerebral hemesheres to common carotid artery ligation were used to determine the water content for estimation of severity of brain edema (n=5) and to measure the levels of eicosanoid and isoprostane (n=7). The levels of 6-keto-PGF1alpha, TXB2, and PGE2 were measured by RP-HPLC (reversed-phase high-performance liquid chromatography) and the levels of isoprostane (8-iso-PGF2alpha) were measured by enzyme immunoassay. The changes of eicosanoid and isoprostane levels during reoxygenation period were observed and comparisons between ipsilateral and contralateral hemispheres were done. RESULTS: The edema of ipsilateral cerebral hemesheres to common carotid artery ligation was more severe than that of contralateral cerebral hemisheres (P<0.05). The levels of 6-keto-PGF1alpha, TXB2, and PGE2 were found to increase during the early period of reoxygenation after HI insult, peak at 1 hour, and then decrease to the control levels at 72 hour (P<0.05). But, the levels of 8-iso-PGF2alpha did not significantly increase during the period of reoxygenation. The levels of 6-keto-PGF1alpha, TXB2, and PGE2 of ipsilateral hemispheres had a tendency to be higher than those of contralateral hemispheres during the initial 6 hour reoxygenation period, but the levels of 8-iso-PGF2alpha of ipsilateral hemispheres were significantly higher than those of contralateral hemispheres during the relatively later reoxygenation period (P<0.05). CONCLUSION: Reoxygenation after hypoxic-ischemic injury increased the levels of 6-keto-PGF1alpha, TXB2, and PGE2 in 7 day-old rat brain during the early period of reoxygenation, but the levels of isoprostane (8-iso-PGF2alpha) were not significantly increased during the reoxygenation period after HI injury.

Monitoring of Peak Expiratory Flow Rates during Asthmatic Children's Winter Camp / 소아알레르기및호흡기학회지

PURPOSE: It is important in asthmatic children to encourage ordinary physical activity. However physical activities in winter are limited excessively by their parents for fear of bronchospasm by cold air and exercise. Children's asthma camps help them to learn about asthma management, make new friends with other asthmatic children, have positive attitude about the disease and have a more active lifestyle. But there have been few asthma camps and appropriate asthma camp programs have not been developed in Korea. Our study was done to see how camp programs influenced on asthma patient by measuring of PEFR during camp programs and thereby to have the data be used for future development of asthma camp programs. METHODS: From January 19th to 22th 1998, we recruited for camp 17 asthmatic patients and 31 normal children who had no history of admission due to respiratory infection. The main camp programs consisted of skiing and sledding. PEFR was checked 5 times a day and we analyzed variation of PEFR in relation to daily activities, temperature, humidity of atmosphere. RESULTS: 1) The mean age was 8 years with a range of 5 years to 11 years with male predominance (male/female : 2.4/1) in asthma group and the mean age was 10 years with a range of 5 years to 16 years with female predominance (male/female: 1/2) in control group. 2) The mean PEFR (% predicted) was checked early morning, prior to breakfast, lunchtime, supper and at the end of the day's activities (before sleeping) were 90.43+/-24.15%, 93.48+/-19.42%, 98.99+/-25.89%, 96.77+/-21.23%, 100.9+/-20.86% in asthma group and 93.69+/-16.41%, 94.49+/-17.13%, 94.15+/-17.28%, 96.84+/-16.44%, 96.52+/-16.24% in control group. All values were within normal range and there was no significant change of the mean PEFR value in relation to daily activity. The values of PEFR were low at early morning. We have observed a significant difference of PEFR between early morning and before sleeping in asthma group (P<0.05). 3) In the asthma group, 2 cases had respiratory difficulty prior to lunchtime but symptoms were resolved after bronchodilator nebulization. CONCLUSION: We recommend ski or sledding to be safe as one of the programs for asthma camp but control of asthma attack is needed because lung function is decreased at night and appropriate warming up is needed before cold air sports.