• Clinical and Experimental Pediatrics
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• 제52권1호
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• pp.56-60
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• 2009

목적 : 본 연구에서는 로타바이러스와 관련된 신생아 괴사성 장염(RV+NEC)이 로타바이러스와 연관되지 않은 신생아 괴사성 장염(RV-NEC)과 서로 다른 경과 및 예후를 보이는지 알아보고자 하였다. 방 법 : modified Bell stage II 이상의 환아들을 monoclonal antibody-based enzyme immunoassay (EIA) 결과를 통해 8명의 RV+NEC군과 22명의 RV-NEC군으로 분류하였고 이 두군의 임상양상과 방사선소견 및 치료 결과를 후향적으로 조사하여 비교하였다. 결 과 : RV+NEC군에서 RV-NEC군보다 재태주령과 출생체중이 통계적으로 유의하게 더 높았다($33.5{\pm}3.3$ 주 vs $29.3{\pm}4.4$ 주; P=0.01). 두 군간의 C-반응성 단백질의 최고치, 혈소판 감소증, 장벽 내 공기와 장 천공의 비교에서는 차이가 없었으나 문맥 정맥 내 공기의 빈도는 RV+NEC군에서 유의하게 많았다(88% vs 9%; P<0.01). III 이상의 병기와 수술율 그리고 합병증과 사망률을 비교한 결과에서는 두 군 간에 차이를 보이지 않았다. 결 론 : 로타바이러스와 관련된 신생아 괴사성 장염은 로타바이러스와 연관되지 않은 신생아 괴사성 장염에 비해 더 높은 재태주령과 출생체중을 가지나 질환의 중증도와 결과 면에서는 차이가 없었다.

• Neonatal Medicine
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• 제17권1호
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• pp.44-52
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• 2010

목 적 : 경구 내독소와 저산소 자극을 이용하여 신생쥐에서 실험적 괴사성 장염(necrotizing enterocolitis, NEC)을 유발하고 그 병태생리에서 세포자멸사의 역할을 알아본다. 방 법:신생쥐에 경구로 내독소(5 mg/kg)를 투여하고 8% 저산소 자극을 주어 NEC를 유발하고 성공적으로 NEC가 유발된 군에 caspase 억제제를 전처치하고 비교하였다. 장 조직의 병리학적 분석은 hematoxylin-eosin 염색한 슬라이드로 하였고 세포자멸사는 TUNEL 염색과 장 조직 caspase-3 활성으로 분석하였다. IEC-6세포주에 내독소와 저산소를 처리한 후 세포자멸사와 Bax, Bcl-2, Fas, FasL의 발현을 분석하였다. 결 과:경구 내독소(5 mg/kg)와 반복적으로 60분간 2회 투여된 8% 저산소 자극에 의해서 NEC와 유사한 장병변이 신생쥐에서 유발되었다. 장 조직은 세포자멸사와 caspase-3 활성의 증가를 보여주었다. Caspase 억제제 전처치에 의해서 세포자멸사와 NEC의 중증도가 모두 감소하였다. IEC-6 세포주도 내독소와 저산소 자극에 의해서 세포자멸사와 caspase-3 활성의 증가를 보여주었으며 Bax/Bcl-2 ratio가 유의하게 증가하였다. 결 론:경구 내독소와 저산소를 이용한 본 NEC 신생쥐 모델은 caspase-3 활성에 의해 매개되는 장 상피세포의 세포자멸사가 병태생리에 관여함을 보였다. 본 동물모델은 임상에서 흔히 접할 수 있는 자극을 적용하였기 때문에 그 병태생리와 치료적 시도의 연구에 더욱 유용하리라고 본다.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.13-16
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• 2015

Portal vein gas and pneumatosis cystoides intestinalis are uncommon conditions and have been associated with poor prognosis. They are most commonly caused by necrotizing enterocolitis but may have other causes, and they can be associated with necrotizing and ischemic colitis, intra-abdominal abscess, small bowel obstruction, diverticulitis, colon cancer, and acute pancreatitis. With the more frequent use of computed tomography (CT) scans, portal vein gas and pneumatosis cystoides intestinalis have been increasingly detected in recent years. Because of its high mortality rate, necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis may be treated with emergent exploratory laparotomy. We report a case of necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis in a 47-year-old man treated with intensive medical management and delayed operation due to unstable condition and surgical mortality. He had good clinical results without complications after the delayed operation.

• Advances in pediatric surgery
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• 제12권1호
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• pp.1-10
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• 2006

Recent advances in neonatal management have resulted in a dramatic increase in survival of very low birth weight infants. These critically ill infants, however, continue to pose significant challenges in management and ethics. There is little information on the outcome of the micropremie (birth weight less than 800 g) that require surgery. The records of 171 micropremies treated over a 15 year period (beginning in 1989) at Asan Medical Center was reviewed retrospectively. Forty-one (24.0 %) infants required surgical interventions by pediatric surgeons. There were 90 boys and 81 girls. The smallest infant, weighed 396g at birth, had esophageal atresia and died before surgery. The smallest survivor, birth weight 645 g, received anenterostomy for necrotizing enterocolitis at the weight of 590 g. The gestational age of the group rangedfrom 21 to 36 weeks. The most common surgical problem was inguinal hernia. There were 20 inguinal hernias, and repairs were performed on17 infants. Excluding 2 cases, hernia repair was performed at the time of discharge. There was only one recurrence of adirect inguinal hernia. Necrotizing enterocolitis developed in 17 patients, 11 were operated upon, two had peritoneal drainages, and 9 had enterostomies. Five of 11 surgical infants died after operation and three of the nonsurgical infants died of various complications. Although micropremies have potentially high risks of serious complications and death, the outcome can improve with careful surgical observation and judgment.

• Neonatal Medicine
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• 제25권2호
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• pp.78-84
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• 2018

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

• Clinical and Experimental Pediatrics
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• 제49권5호
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• pp.489-493
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• 2006

목 적 : 본 연구의 목적은 만삭아에서 신생아 괴사성 장염의 위험인자를 알고자 함이다. 방 법 : 1998년 1월 1일부터 2005년 8월 1일까지 본원 소아과 신생아실에 입원한 환아 중 신생아 괴사성 장염으로 진단된 20례와 각각의 경우에 대해 짝짓기 방식으로 선정된 건강한 만삭아 40례를 대상으로 병력지 검토를 통하여 후향적으로 조사되어 졌다. 결 과 : 괴사성 장염군의 평균 재태연령과 출생 체중은 38.42주와 2,915 g이었고 대조군은 38.61주와 3,148 g이었다. 대조군과 비교 하였을 때 신생아 괴사성 장염군 환아들에서 모체의 융모 양막염, 지연된 설사, 1분 아프가 점수 <7, 호흡기 문제, 선천성 심질환의 빈도가 유의하게 높았다(유의수준 <0.05). 반면 전자간증, 모체의 당뇨, 모체의 약물 남용, 태변 착색된 양수, 다혈구증, 교환 수혈의 빈도에는 유의한 차이가 없었다. 결 론 : 만삭아들의 대부분은 괴사성 장염이 발생하기 전에 선행하는 인자가 있다. 본 연구에서는 여러 가지 유발인자들 중에 지연된 설사가 가장 큰 관련성이 있는 것으로 나타났다.

• Advances in pediatric surgery
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• 제9권1호
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• pp.19-23
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• 2003

Necrotizing Enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002, and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease: one of who had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<$5.0{\times}10^9/L$), seven had thrombocytopenia (<$100{\times}10^9/L$), and three severe thrombocytopenia (<$50{\times}10^9/L$). Laparotomy was required in 10 of the 13 patients. Indications for operation in the acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operations for intestinal stricture and fistula. There were no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count ($50{\times}10^9/L$) (p<0.05). Congenital heart disease and Rota viral infection are associated with NEC in term infants and thrombocytopenia and leucopoenia may be surgical indications.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.800-804
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• 2006

괴사성 장염은 미숙아에서 외과적 응급 수술을 요하는 가장 흔한 질환이며 여전히 높은 이환율과 사망률을 차지하고 있다. 괴사성 장염의 치료로는 전통적으로 천공성 괴사성 장염인 경우 개복술이 시행되어 왔으나 미숙아에서 일차적 복강 배액술이 시도된 이후 초극소 저출생 체중아에서도 양호한 결과를 보인 사례들이 보고되고 있다. 저출생 체중아에서 천공성 괴사성 장염치료시 일차적 복강 배액술과 개복술 중 어느 시술이 더 우수한 결과를 보이는지에 대한 연구는 아직 진행 중에 있으나 일차적 복강 배액술은 전신 마취나 수술을 시행하기에는 불안정한 환자상태인 경우에 시행을 고려할 수 있다. 저자들은 초극소 저출생 체중아에서 천공성 괴사성 장염으로 인한 세균성 복막염 치료로 환아 상태상 전신 마취 및 수술을 바로 시행하기에는 어려워 일차적 복강 배액술을 시행 후 호전된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Food Science and Biotechnology
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• 제14권6호
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• pp.875-877
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• 2005

Presence of Enterobacter sakazakii, occasional pathogen of powdered infant formula causing rare, but life-threatening diseases such as neonatal meningitis, bacteremia, necrotizing enterocolitis, and necrotizing meningoencephalitis after ingestion was examined in 45 powdered infant formula products manufactured in Korea using chromogenic Druggan-Forsythe-Iversen (DFI) medium, and isolates were identified with API 20E. Ent. sakazakii was isolated from three products. Ent. sakazakii isolates were genotyped by RAPD-PCR using two random primers, and their banding patterns were compared.

• Clinical and Experimental Pediatrics
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• 제62권8호
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• pp.287-291
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• 2019

Fecal calprotectin (FC) is a calcium- and zinc-binding protein of the S100 family, mainly expressed by neutrophils and released during inflammation. FC became an increasingly useful tool both for gastroenterologists and for general practitioners for distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome. Increasing evidences support the use of this biomarker for diagnosis, follow-up and evaluation of response to therapy of several pediatric gastrointestinal diseases, ranging from IBD to nonspecific colitis and necrotizing enterocolitis. This article summarizes the current literature on the use of FC in clinical practice.