• Korean Institute of Interior Design Journal
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• v.24 no.4
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• pp.152-160
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• 2015

This paper proposes high quality of healthcare environments for a user-oriented children's hospital by identifying the user needs according to residential characteristics of the child, especially the hospitalization period. Caregivers, mostly parents of children in a children's hospital, participated in a questionnaire survey. The user's demands, satisfaction and hospital environment assessment were measured. A total of 103 copies of the questionnaire were finally collected and analyzed. The data was processed statistically using SPSS WIN 18.0 Version software. The results and conclusions are as follows. 1)The participants were categorized into three groups according to the hospitalization period of the child (less than 7 days, 7-20 days, and more than 21 days). 2)When the patients stayed longer in the hospital, their satisfaction was lower and their demands were higher. The long-term group required a more spacious bathroom for the child inpatients and their caregivers as well as sufficient individual storage spaces that are appropriate for the length of stay. 3)The longer they were hospitalized, the more negative they evaluated the hospital environment. These results suggest that the period of hospitalization is one of the crucial factors that impact the user's satisfaction and demands. Therefore, it is necessary to identify the design factors such as territoriality, privacy, accessability, and aesthetics to improve the satisfaction of the long-term child inpatients and their caregivers.

• Pediatric Infection and Vaccine
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• v.15 no.1
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• pp.59-67
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• 2008

Purpose : According to the 2008 WHO report, incidence, prevalence, and mortality of tuberculosis are decreasing globally. The 7th National Tuberculosis Survey of 1995 in Korea showed that the prevalence of tuberculosis was also decreasing. This study was performed to review the hospitalized childhood tuberculosis in a children's hospital over a 20 year period. Methods : Medical records of children <16 years of age hospitalized with the diagnosis of tuberculosis at the Seoul National University Children's Hospital between 1988 and 2007 were reviewed retrospectively. Changes in number of patients and involved sites were also analyzed by four 5-year periods. Results : Out of the 186 hospitalized patients, 59.1% were male. Median age at diagnosis was 5.5 years old (range, 10 days-15 years). The main involved sites included the lung (n=54, 29%) or pleura (n=12, 6.5%), central nervous system (n=49, 26.3%), lymph node (n=15, 8.1 %), bone and joint (n=9, 4.8%), gastrointestinal tract (n=5, 2.7%) or peritoneum (n=5, 2.7%), pericardium (n=2, 1.1%) and others (n=3, 1.6%). Total 32 patients (17.2%) showed miliary pattern. The proportion of hospitalization with newly diagnosed tuberculosis among all cause hospitalization decreased from 0.61% to 0.09%, comparing the period of 1988-1992 and 2003-2007 (P<0.001) and the incidence of hospitalized tuberculosis of any involved organs also decreased with a statistical significance. Conclusion : The data from a single children's hospital suggest that the number of hospitalized childhood patients with tuberculosis has decreased over a 20 year period in Korea.

• Pediatric Infection and Vaccine
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• v.25 no.3
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• pp.156-164
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• 2018

Purpose: We aimed to identify the epidemiology and the clinical characteristics of human parainfluenza virus type 4 (HPIV-4) infection compared to HPIVs 1-3 infections in Korean children. Methods: We reviewed medical records of children with HPIV infection who visited Seoul National University Children's Hospital from 2015 to 2017. Detection of respiratory viruses was performed using real time-polymerase chain reaction (rt-PCR), which could differentiate HPIVs 1-4. Diagnosis was classified as a febrile illness, upper respiratory tract infection (URI), croup, bronchiolitis, or pneumonia. The epidemiology, demographic features, and clinical characteristics among HPIV types were compared. The clinical data were analyzed only for the previously healthy children. Results: Of the 472 children diagnosed with HPIV infection, 108 (22.9%) were previously healthy: 24 (22.2%), 19 (17.6%), 39 (36.1%), and 26 (24.1%) in HPIV types 1, 2, 3, and 4, respectively. The median age of children with HPIV-4 infection was 11 (0-195) months: the proportion of children aged < 2 years and 2 to < 5 years were 65.4% and 19.2%, respectively. Clinical diagnoses of HPIV-4 infection were bronchiolitis (38.5%), pneumonia (30.8%), and URI (30.8%). Croup was the most prevalent in HPIV-2 (21.1%) and none in HPIV-4 infection (P=0.026). Hospital admission rates among HPIV types were not significantly different (P>0.05). Conclusions: We observed seasonal peak of HPIV-4 infection in 2015 and 2017. HPIV-4 was a common respiratory pathogen causing lower respiratory tract infection in hospitalized children.

• Pediatric Infection and Vaccine
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• v.27 no.3
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• pp.158-170
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• 2020

Purpose: We evaluated the incidence and characteristics of Clostridioides difficile infection (CDI) in Korean children. Methods: Medical records of patients aged 2-18 years and diagnosed with CDI at a tertiary hospital between 2009 and 2018 were analyzed. The patients were classified into three CDI groups: community-acquired (CA), community onset-health care facility-associated (CO-HCFA), and healthcare facility onset (HO). Results: The incidence of CDI increased from 1.00 to 10.01 cases per 10,000 admissions from 2009 to 2018 (P<0.001). As compared to the CA group, the HO group had a higher frequency of operation and malignancy as predisposing factors (40.4% vs. 0.0%, P=0.001; and 27.7% vs. 0.0%, P=0.027, respectively), frequency and number of previous antibiotic use (97.9% vs. 31.3%, P<0.001; and 2 vs. 0, P<0.001, respectively), and median postdiagnosis hospital stay (13 vs. 5 days, P=0.008). The CO-HCFA group had a lower median age and higher frequency of malignancy than the CA group (5 vs. 13 years, P=0.012; and 30.8% vs. 0.0%, P=0.030, respectively). As compared to the HO group, the CA group had a higher frequency of abdominal pain and hematochezia (56.3% vs. 10.6%, P=0.001; and 50.0% vs. 10.6%, P=0.002, respectively), inflammatory bowel disease (68.8% vs. 2.1%, P=0.001), and intravenous metronidazole treatment (37.5% vs. 2.1%, P=0.001). Conclusions: With the increasing incidence of pediatric CDI, awareness regarding its epidemiology and clinical characteristics is important to manage nosocomial infections.

• Advances in pediatric surgery
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• v.1 no.2
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• pp.133-139
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• 1995

Because rectal prolapse in pediatric age was known to have a self-limitting natural history in weeks to years, this disease is prone to be regarded as a minor condition to the most of surgeons. But to the children and the parents who have to be suffered each time could be a heavy distress. Even though operative or nonoperative methods can be applicable for treatment, the main problem is in surgeon's side, whose preference is based on the experiences of adult patients. The authors have experienced 16 cases of ano-rectal prolapse for 9 years since 1986. Eleven of them were true rectal prolapses. In 7 cases of true type, injection therapy has been tried. One ml of five percent phenol in glycerine was injected into the submucosal layer of the ano-rectal angle level at both lateral and posterior sides. After first trial of each cases, 5 of them were cured completely so far. Recurrences were in two cases, but one of them was temporary to be subsided afterward. Complete bowel cleansing and adequate sedations were required as preoperative preparations. Two days' oral antibiotics and two weeks' laxatives for free of defecation straining were recommended after the procedure. The safety of sclerosis was supported by the experimental histology. In pediatric rectal prolapse, sclerosis seems to be a safe and effective treatment of choice without any significant morbidity.

• Pediatric Infection and Vaccine
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• v.20 no.3
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• pp.161-167
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• 2013

Purpose: This study was performed to describe the clinical manifestations of hospitalized children due to varicella-zoster virus (VZV) infection Methods: This study included 40 children who were hospitalized for varicella or herpes zoster at Seoul National University Children's Hospital, 2009-2012. Diagnosis of VZV infection was confirmed by VZV PCR or culture from vesicular fluid. Medical records were reviewed to collect clinical features and outcome, antiviral treatment, history of varicella vaccination, and underlying diseases. Results: Sixteen patients with varicella and 24 patients with herpes zoster were included. Their median age was 10.5 years (16 days-19 years). Thirty-five (87.5%) patients had underlying diseases. Among 24 patients with herpes zoster, 11 patients had previous history of varicella and 1 had herpes zoster. Twenty patients (50%) had a history of varicella vaccination, and 19 immunocompromised patients had VZV infection despite of vaccination. Most (95%) patients were treated by intravenous or oral acyclovir, and no treatment failure of intravenous acyclovir was found. The median duration of fever was 4.4 days (1-10 days), and that of antiviral treatment was 12 days (7-23 days) in immunocompromised patients. Immunocompromised patients received longer duration of antiviral treatment than imunocompetent patients (P=0.014). Eleven (27.5 %) immunocompromised patients had postherpetic neuralgia, 2 (5%) had proven co-infection by Streptococcus pyogenes and Klebsiella oxytoca, and 1 (2.5%) complicated with pneumonia. Conclusion: Immunocompromised children require longer duration of treatment and are at risk of severe complication associated with VZV infection. Early initiation of antiviral therapy and close monitoring are necessary for those in immunocompromised conditions.

• Pediatric Infection and Vaccine
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• v.23 no.3
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• pp.180-187
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• 2016

Purpose: This study described the post-exposure prophylaxis (PEP) and secondary varicella infection in children inadvertently exposed to varicella zoster virus (VZV) in the hospital. Methods: We retrospectively analyzed data from patients with VZV infection who were initially not properly isolated, as well as children exposed to VZV at the Seoul National University Children's Hospital between January 2010 and December 2015. The PEP measures were determined by the presence of immunity to VZV and immunocompromising conditions. Patient clinical information was reviewed via medical records. Results: Among 147 children hospitalized between 2010 and 2015, 13 inadvertent exposures were notified due to VZV infection. Five index children had a history of VZV vaccination. Eighty-six children were exposed in multi-occupancy rooms and 62.8% (54/86) were immune to VZV. The PEP measures administered to 27 exposed patients included varicella zoster immunoglobulin and VZV vaccination. Four children developed secondary varicella, which was linked to a single index patient, including one child who did not receive PEP and three of the 27 children who received PEP. The rates of secondary varicella and prophylaxis failure were 4.7% (4/85) and 11.1% (3/27), respectively. The secondary varicella rates were 1.9% (1/54) and 9.7% (3/31) among immunocompetent and immunocompromised children, respectively. Conclusions: Delayed diagnosis of VZV infection can lead to unexpected exposure and place susceptible children and immunocompromised patients at risk for developing varicella. The appropriateness of the current PEP strategy based on VZV immunity may require re-evaluation.

• Pediatric Infection and Vaccine
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• v.27 no.3
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• pp.147-157
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• 2020

Purpose: We investigated the trend of antibiotic susceptibility of Haemophilus influenzae over 5 consecutive years. Methods: We analyzed the antibiotic susceptibility of H. influenzae isolated from children aged <18 years, who were admitted to the Asan Medical Center Children's Hospital from March 2014 to April 2019. Antibiotic susceptibility of H. influenzae was determined by the disk diffusion test according to the European Committee on Antimicrobial Susceptibility Testing guidelines. Results: Excluding duplicates, 69 isolates were obtained over the past 5 years. The median age of the patients was 5 years (range, 2.8-8.6 years). The antibiotic susceptibility patterns were as follows: ampicillin (AMP)-susceptible/amoxicillin-clavulanate (AMC)-susceptible (AS/ACS; n=15 [21.7%]), AMP-resistant/AMC-susceptible (AR/ACS; n=21 [30.4%]), and AMP-resistant/AMC-resistant (AR/ACR; n=33 [47.8%]). The prevalence of isolates with AR/ACR phenotype tended to increase from 42.1% in 2014-2015 to 54.5% in 2018-2019 (P=0.342). Compared to 2014-2015, the resistance rates to cefuroxime and ceftriaxone in 2018-2019 increased from 31.6% to 77.3% and from 0.0% to 59.1%, respectively (P=0.003 and P<0.001, respectively). Conclusions: Over the last 5 years, H. influenzae isolates with AR/ACR phenotype and ceftriaxone resistance were frequently observed at our institute. The incidence of resistance to cefuroxime and ceftriaxone has increased significantly.

• Pediatric Infection and Vaccine
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• v.25 no.2
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• pp.91-100
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• 2018

Purpose: This study investigated the factors affecting the use of empirical antibiotics in febrile infants from 1 month to less than 3 months. Methods: We retrospectively reviewed the medical records of hospitalized previously healthy infants with fever in Pusan National University Children's Hospital from January 2010 to December 2016. Clinical features, laboratory findings and antibiotic therapy were analyzed. Respiratory viruses were identified by multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and were reported after 1-3 days. Enterovirus were identified by real time polymerase chain reaction (PCR) and were reported in several hours. Results: The 129 of 366 subjects used empirical antibiotics and 237 patients didn't used empirical antibiotics. Empirical antibiotics were used more frequently when the fever was longer before admission, respiratory symptoms and ill being appearances were present and C-reactive protein was elevated. The rate of readmission was low in the group not used empirical antibiotics. Most of the patients detected by enterovirus PCR in cerebrospinal fluid didn't used empirical antibiotics. The results of respiratory virus multiplex RT-PCR showed no difference in the use of empirical antibiotics. Conclusions: In our study, empirical antibiotic prescriptions were affected not respiratory virus multiplex RT-PCR but enterovirus PCR. If multiplex RT-PCR were reported more rapid turn around time, it will affect antibiotic use.

• Pediatric Infection and Vaccine
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• v.19 no.3
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• pp.131-140
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• 2012

Purpose : This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. Methods : A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. Results : A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9 %). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6 % vs. 22.0%, P=0.04). Conclusion : This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.