• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.462-468
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• 2007

Purpose : The purpose of this study was to analyze the changes of the late potential of Signal- averaged electrocardiography (SAECG) and Electrocardiography (ECG) parameters during follow up of those who had taken surgical repair of Tetralogy of Fallot (TOF). Methods : Nine patients who had taken surgical repair of TOF since 1985 checked SAECG and standard 12 leads ECG twice in 1999 and 2005 in Kyungpook national university hospital. We evaluated changes of QRS duration, QT interval and JT interval, QRS dispersion, QT dispersion and JT dispersion of standard 12 leads ECG and Filtered QRS (f-QRS), High frequency low amplitude potential (HFLA), Root mean square in terminal 40 ms (RMS) and Mean voltage in terminal 40 ms (MV) of SAECG between in 1999 and 2005. Results : There were significant decrease of JT dispersion ($101.11{\pm}50.11$ vs $71.11{\pm}22.61ms$, P< 0.05) and significant increase of HFLA ($24.67{\pm}13.19$ vs $32.89{\pm}14.21ms$, P<0.05). But there were no significant changes in other parameters. Conclusion : In repaired TOF patients, we evaluated ECG and SAECG to detect possible late complications such as tricuspid regurgitation, right ventricular enlargement, ventricualar arrythmia and sudden death. And there were significant changes of ECG and SAECG in some parameters (JT dispersion, HFLA). But to see the relationships between the changes of these parameters and the long term prognosis, we need to check more patients and longer follow-up.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.468-473
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• 2008

Purpose : Iron-deficiency anemia (IDA) is still one of the most common nutrient deficiency disorders, despite improvements in general health and nutrition. This study was designed to investigate the diagnostic values of hematological profiles, including the level of ferritin, and to evaluate the knowledge of mothers on weaning practices for infants and young children with IDA. Methods : This study was conducted on 111 infants and young children from six to 40 months of age with IDA. Their parents completed a questionnaire. IDA was defined as a level of hemoglobin <11.0 g/dL, the presence of microcytosis, a level of ferritin <10.0 ng/dL, transferrin saturation <15%, or an 1 g/dL increase in the level of hemoglobin after iron administration. The questionnaire made inquiries into their weaning practices. Results : In 111 infants and young children aged from six to 40 months, the average level of Hb was $9.5{\pm}1.0g/dL$. The prevalence of ferritin level (>10 ng/dL) was 48.6%, in spite of IDA. Seventy-four infants (66.7%) began to wean between four and six months, and 37 infants (33.3%) after seven months of age. The main food given after weaning was rice gruel. The weaning periods showed a significant relationship to the severity of anemia (P<0.05). There was no significant difference in the severity of anemia in terms of the educational levels of the mothers. Fifty-five mothers (49.5%) gave a wrong answer to a questionnaire describing that breast-fed infants aged over four months need to be fed with iron-sufficient food. Of all mothers, 49.6% took one month or more to complete the weaning process and 20% took three months or more. Conclusion : Many infants and young children with IDA have been provided with non-iron fortified foods and inadequate weaning. To improve nutritional status, especially among infants with iron deficiencies, nutritional education for mothers with infants at the weaning age must be increased and related programs must be implemented effectively.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.518-522
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• 2008

Purpose : The purpose of this study was to investigate the prevalence of enuresis in association with voiding habits and socioeconomic status in elementary school children. Methods : A dynamic survey was done of 1,514 students from two elementary schools in Suwon, Korea in December 2006. Data regarding gender, age, height and weight, voiding habits, and monthly family incomes were gathered and analyzed to discover any correlation with the incidence of enuresis. The percentile value of height or weight was extrapolated from the standard population curve. Results : Among 1,514 children, 1,063 (70.2%) answered and returned the questionnaires. Overall, the prevalence of enuresis was 8.7% and there was no difference between the public (8.8%) and private school (8.7%). The family incomes of the students from the two schools differed greatly from each other, but there was no difference in the prevalence of enuresis between the two schools. Children with a habit of void-holding showed a higher prevalence of enuresis. No significant correlation was found between the prevalence of enuresis and the height and weight percentile of children. Experience with hospital visits was low among enuretic children (20.8%), suggesting that Korean parents tend to neglect treatment of enuresis for their children. The prevalence of enuresis decreased by 2.0% each year, as school children aged. Conclusion : The overall prevalence of enuresis among elementary school children in Suwon district was 8.7%. The 12.1% prevalence of enuresis at the seven years came down gradually, to be nil at the age of 13. Infrequent urination or void-holding was assumed to be one of the important factors causing enuresis in elementary school children.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1378-1384
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• 2005

Purpose : We hypothesized dexrazoxane(DXR) and pentoxifylline(PTX) may prevent myocardial damage in adriamycin(ADR)-induced cardiomyopathic rat model. We also investigated their effects on the myocardial apoptosis and fibrosis in ADR induced cardiomyopathy. Methods : The six-week old female Spregue-Dawley rats were divided into control group(CNT, n=4), ADR group(n=6), ADR+DXR group(DXR, n=5), ADR+PTX group(PTX, n=6), ADR+DXR+PTX group(DXPT, n=5). ADR(5 mg/week, twice) was administrated intravenously to rats except CNT group to induce cardiomyopathy. The PTX(50 mg/kg/day) was administered daily from day-0 to Day-21. The DXR(100 mg/kg) was administered 30 minutes before each ADR injection. On day 21, the rats were sacrificed and the degree of histopathologic changes of hypercontraction band necrosis, cytoplasmic vacuolar change and fibrosis were scored. Immunohistochemical staining for Bcl-2 expression and RT-PCR for $TNF-{\alpha}$ and CTGF were performed. Results : Histopathological scores of myocardial damage were significantly higher in ADR rats than CNT rats(P<0.05), and significantly lower in DXPT rats than ADR rats(P<0.01). Myocardial fibrosis was prevented in both PTX rats and DXPT rats. The expression of Bcl-2 was weaker in ADR rats than that in CNT rats(P<0.05), and stronger in both DXR and DXPT rats than that in ADR rats (P<0.05). $TNF-{\alpha}$ concentration of ADR rats was not different from that of treated groups. Conclusion : DXR prevented myocyte apoptosis with increased Bcl-2 expression, and PTX prevented myocardial fibrosis in ADR induced cardiomyopathic rats. The combination therapy of DXR and PTX showed prevention of cardiomyopathy in ADR induced cardiomyopathy rat model.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1362-1369
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• 2005

Purpose : This study aimed to investigate the correlation between the plasma level of N-terminal pro-B-type natriuretic peptide(pro-BNP) and several known risk factors influencing outcomes after Fontan operations, and to assess whether pro-BNP levels can be used as predictive risk factors in Fontan operations. Methods : Plasma pro-BNP concentrations were measured in 35 patients with complex cardiac anomalies before catheterization. Cardiac catheterization was performed in all subjects. Mean right atrium pressure, mean pulmonary artery pressure(PAP), and ventricular end-diastolic pressure(EDP) were obtained. Cardiac output and pulmonary vascular resistance were calculated by Fick method. Results : Plasma pro-BNP levels exhibited statistically significant positive correlations with mean PAP(r=0.70, P<0.001), pulmonary vascular resistance(r=0.57, P<0.001), RVEDP(r=0.63, P<0.001), LVEDP(r=0.74, P<0.001), and cardiothoracic ratio(r=0.71, P<0.001). The area under the ROC curve using pro-BNP level to differentiate risk groups in Fontan operations was high : 0.868(95 percent CI, 0.712-1.023, P<0.01). The cutoff value of pro-BNP concentrations for the detection of risk groups in Fontan operations was determined to be 332.4 pg/mL(sensitivity 83.3 percent, specificity 82.7 percent). Conclusion : These data suggest that plasma pro-BNP levels may be used as a predictive risk factor in Fontan operations, and as a guide to determine the mode of therapy during follow-up after Fontan operations.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1330-1336
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• 2005

Purpose : It has been suggested that changes in cerebral blood flow by ventilator care could be a risk factor in periventricular leukomalacia(PVL) and severe periventricular-intraventricular hemorrhage(PV-IVH). The study aims to assess the relationship between perinatal clinical events, including ventilator care, and the development of PVL and severe PV-IVH; especially, whether ventilator care could be causers of PVL and severe PV-IVH as an individual risk factor. Methods : Among 255 very low birth weight infants who survived in the Fatima neonatal intensive care unit from January 1999 to December 2003, 15 infants with PVL and eight infants with severe PV-IVH were classified as a study group, while 231 infants were enrolled as a control group. The analysis was performed retrospectively with medical records. Results : Twenty four infants were diagnosed with PVL or severe PV-IVH. Asphyxia, recurrent apnea, sepsis, acidosis and ventilator care were significantly increased in the PVL goup. Asphyxia, recurrent apnea, RDS, acidosis and ventilator care were significantly increased in the severe PV-IVH group. Conclusion : Infants with PVL or severe PV-IVH may have multiple perinatal risk factors including asphyxia, recurrent apnea, sepsis, acidosis, RDS and ventilator care. Because most patients with ventilator care have multiple perinatal risk factors, ventilator care does not cause PVL and severe PV-IVH independently. Therefore, incidences of PVL and severe PV-IVH can be decreased by not only gentle ventilation, but also more professional antenatal care.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1324-1329
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• 2005

Purpose : The aim of this study was to evaluate recent improvements in the survival rate of extremely low birth weight (ELBW) infants and to identify perinatal and management factors that are associated with improved survival. Methods : Two groups of ELBW infants who were admitted to our neonatal intensive care unit (NICU) during two distinct eras : November 1994-December 1999 (Period 1 : n=100) and January 2000-April 2004 (Period 2 : n=166) were retrospectively reviewed. Results : Despite the younger gestational age and smaller birth weight of the ELBW infants in period 2, not only did their survival rate increased to 75 percent from 60 percent in period 1, but their incidence of morbidities such as bronchopulmonary dysplasia, confimed sepsis and intraventricular hemorrhage (${\geq}$Grade III) also declined. Factors significantly associated with improved survival included the use of antenatal steroids, a longer duration of nasal continuous positive airway pressure and the absence of intraventricular hemorrhage (${\geq}$Grade III). Conclusion : We believe that optimized clinical practice, that emphasized less invasive care, contributed to the recent improvements in the survival rate of ELBW infants.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1370-1377
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• 2005

Purpose : Delineation of serum lipid and lipoprotein values in children after Kawasaki disease(KD) is important because of the predilection of this disease for the coronary arteries. Methods : The KD group was composed of 51 patients who were hospitalized from Jan. 2002 to Dec. 2003. Control was 25 patients with non-KD febrile illness. The levels of total lipid, phospholipid, triglyceride, HDL-cholesterol(HDL-C), LDL-cholesterol, total cholesterol, apolipoprotein A1(apo A1), apolipoprotein B, and Lipoprotein(a) were measured and compared with Echocardiographic findings. Measurements were obtained in four time periods: acute febrile, subacute, convalescent phase and 1 year after KD. Results : HDL-C($33.64{\pm}7.49mg/dL$ vs $50.43{\pm}14.41mg/dL$, P<0.01) and apo A1($99.75{\pm}6.39mg/dL$ vs $113.34{\pm}11.35mg/dL$, P<0.05) were decreased more in the acute febrile period of KD than in the control, but these changes were not correlated with cardiac complications. All lipid profiles were markedly elevated in the subacute stage and normalized in the convalescent stage; there were no changes until 1-year follow up. There were no significant differences in the changes of lipid profiles, including Lp(a) and coronary dilatation, in any time periods. Conclusion : KD is associated with important abnormalities in lipid metabolism, but these changes were transient and appear to be due to the disease itself. These data lead us to infer that KD dose not cause such permanent changes in lipid abnormalities as to be considered a risk factor for atherosclerosis, beyond that caused by the disease itself.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.790-795
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• 2006

Purpose : This study was performed to compare the therapeutic effects according to duration of medium-dose aspirin(50-60 mg/kg/day) therapy at the acute stage of Kawasaki disease(KD). Methods : Total 87 patients with KD were enrolled in this study. We performed retrospective analysis of clinical characteristics and echocardiographic findings based on medical records. Patient were randomly divided into 2 groups according to the duration of aspirin therapy at the acute stage of KD. Long-term group(LG, n=55) was administered medium-dose aspirin for 2 weeks after diagnosis of KD, and short-term group(SG, n=32) for 48 hours after intravenous immunoglobulin(IVIG) administration. The parameters of therapeutic effects were duration of fever after IVIG administration, incidence of unresponsive patients to single administration of IVIG, and development of transient dilatation or aneurysm of coronary arteries. Results : There was no significant difference in the duration of fever after IVIG between the both group(LG $1.7{\pm}1.1$ days, SG $1.8{\pm}1.1$ days; P=0.588). The incidences of unresponsive patient to the single administration of IVIG were 5.5 percent, 6.3 percent in the each group. Transient dilatation of coronary arteries occurred at 18.2 percent(10/55) in the LG, and 15.6 percent(5/32) in the SG(P=0.761). Prevalence of coronary aneurysm after subacute stage were 7.3 percent(4/55) in the LG, and 9.4 percent(3/32) in the SG(P=0.728). Conclusion : There was no significant difference in the therapeutic effects between long-term(2 weeks) and short-term(48 hours) administration of medium-dose aspirin at the acute stage of KD.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.784-789
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• 2006

Purpose : $Henoch-Sch{\ddot{o}}nlein$ purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid. Methods : From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively. Results : Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was $5.61{\pm}4.9$ days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference($12.8{\pm}7.6$ days vs. $13.2{\pm}7.8$ days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant($8.8{\pm}8.1$ days vs. $14.8{\pm}16.9$ days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy. Conclusion : IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.