• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.636-642
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• 2007

Purpose : Fluconazole prophylaxis for very low birth weight (VLBW) infants has been shown to reduce invasive fungal infection and its mortality. This study aims to evaluate the effect of fluconazole prophylaxis in VLBW infants on the incidence and mortality of fungal infection. Methods : VLBW infants with endotracheal intubation and central vascular access admitted to the Neonatal Intensive Care Unit (NICU) at Chonnam University Hospital were enrolled. Twenty eight infants of 7-month baseline period from January to July 2005 ('non-fluconazole group') were compared with 29 infants of a 7-month fluconazole period from January to July 2006 ('fluconazole group'). Results : Gestational age, birth weight, sex, mode of delivery, frequency of twin pregnancy, chorioamnionitis, antenatal steroid and rupture of membranes were similar between the fluconazole and non-fluconazole groups. The rate of extremely low birth weight (ELBW) infants, frequency and duration of prophylactic antibiotics, total parenteral nutrition and umbilical catheters, duration of intralipid, mechanical ventilation and nasal continuous positive airway pressure (CPAP) were also not significant. However, frequency of percutaneous central venous catheterization (PCVC) and intralipid administration, and duration of PCVC were significant between the two groups. The overall incidence and mortality of fungal infection were not different between the two groups. Although the Malassezia infection was increased in the fluconazole group (P<0.05), candida was significantly decreased compared to the non-fluconazole group (P<0.05). Conclusion : Fluconazole prophylaxis in high risk VLBW infants decreased the candida infection significantly. Antifungal prophylaxis is recommended in terms of cost effectiveness, but further study is needed to clarify the reason for the increase of Malassezia infection.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1315-1319
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• 2008

Purpose : We aimed to examine the effect of rooming-in care on newborn infants emotional stability by comparing them with those cared for in a nursery. Methods : Forty-eight full-term newborn infants born at Cheil General Hospital between July 1 and October 31, 2007, were enrolled. Twenty-four newborn infants were roomed-in in their mothers rooms (rooming-in group), and 24 newborns were cared for in the hospital nursery (the nursery group) for the first 3 days of their lives. Those with perinatal problems that required medical treatment were excluded. By using Brazeltons neonatal behavior assessment scale, we measured irritability and self-quieting as well as the duration of crying after heel-stick puncture for the newborn metabolic screening test. Results : The rooming-in group had a higher irritability score than the nursery group ($6.8{\pm}1.7$ vs. $4.2{\pm}2.1$, P<0.001), thereby suggesting stable behavior against external irritation; the former also had a higher self-quieting activity score ($5.9{\pm}0.3$ vs. $4.5{\pm}1.8$, P=0.001), thereby suggesting that stability was reached quickly from the irritated state. Time taken to stop crying after the heel-stick puncture was significantly shorter in the rooming-in group than in the nursery group ($17{\pm}15.1$ seconds vs. $115.3{\pm}98.5$ seconds, P<0.001). Conclusion : These results show that newborn infants in the rooming-in group exhibit more stable behavior against external irritation and can be stabilized from an irritated state more quickly than infants cared for in the nursery, even after a few days of rooming-in care.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.178-185
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• 2008

Purpose : Our aim was to investigate the predictive factors for detecting grade III-V vesicoureteral reflux(VUR) in young infants less than 3 months with urinary tract infections (UTI). Methods : Data of infants who underwent ultrasonography and VCUG between January 2004 and September 2007 were reviewed. Age, gender, incidence of bacteremia, C-reactive protein(CRP) and imaging studies were compared between group I(grade III-V VUR) and group II (normal or grade I and II VUR) retrospectively. Sensitivity, specificity, positive and negative predictive values, odds ratio, and likelihood ratio of ultrasonography for high grade VUR were evaluated. Results : Among 54 enrolled infants(41 males, 13 females), 14 infants were group I and 40 infants were group II. In the group I, CRP level was significantly higher(6.11$\pm$5.18 vs. 3.27$\pm$3.45, P=0.025), and there were more ultrasonographic abnormal findings(71.4%, vs. 22.5%, P=0.002) compared with group II. However, ultrasonography was the only significant factor after adjusting with logistic regression(P=0.002). Incidence of bacteremia and abnormal DMSA findings were not significantly different in two groups. Sensitivity, specificity, and odds ratio of ultrasonography was 71.4%, 77.5%, 6.9 respectively. Negative predictive value was 88.6% and negative likelihood ratio was 0.37. Ultrasonography had significant negative likelihood ratio for grade III-V VUR, but missed 4 infants with grade III VUR. Conclusion : We could not find any alternative predictive factors to reduce VCUG in detecting high grade VUR. Therefore, VCUG must be considered in young infants less than 3 months with UTI.

• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.150-156
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• 2006

Purpose : The aims of this study included assessment of molecular-epidemiologic features during an outbreak of colonization of extended spectrum ${\beta}$-lactamase producing Klebsiella pneumoniae(ESBL-KPN) and re-evaluation of their colonized status one year later. Methods : Rectal swab cultures for ESBL-KPN from all hospitalized infants and newly admitted infants were obtained during the outbreak of colonization from July to December, 2000. The pattern of XbaI-digested chromosomal DNA of isolates were analyzed by pulsed-field gel electrophoresis. Weekly rectal swab cultures were obtained during the outbreak until patients were either discharged or decolonized. Patients discharged after being colonized had follow up stool cultures a year later. Results : A total of 80 patients(28.5 percent) were colonized. Of those, 53 whose pulsed-field gel electrophoresis(PFGE) was possible only once, were ESBL-KPN grouped into six cluster clones and 10 single clones : 28 patients(52.8 percent) were colonized with type A, the most common clone, followed by type B in 11 patients(20.8 percent). Of those 12 patients in whom serial PFGE was done more than twice, type A was predominant. Narrowed-down in strains occurred from types A, B, C, D and three single clones at initiation of the study into types A and type B after three months of strict infection control. Among 75 patients(93.7 percent) who were sent home after being colonized, 30 patients were re-called for stool cultures a year later : All of them were decolonized. Conclusion : This study demonstrates the importance of infection control as the diversity of ESBL-KPN strains could be narrowed into fewer strains. Colonization of ESBL-KPN could be reversed upon return to the community.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1263-1272
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• 2002

Purpose : Rett syndrome(RTT) is an X-linked dominant neurodevelopmental disorder affecting 1 per 10,000-15,000 female births worldwide. It was initially described by Andreas Rett in 1966. RTT involves developmental regression characterized stereotypic hand movements, tremors, gait apraxia, seizures, deceleration of head growth after the age of 6-18 months. The disease-causing gene was identified as MECP2 on chromosome Xq28. We carried out mutational analysis of MECP2 genes in RTT patients. Methods : Whole blood(5 cc) of 34 sporadic RTT patients was collected in EDTA-anticoagulated tubes. Genomic DNA was extracted from peripheral blood using the E.Z.N.A. blood DNA kit. Four exons of the MECP2 gene were amplified by PCR in 34 Korean with RTT. We carried out PCR divided the exon three into two parts and the exon four into five parts. Primer sequences designed by Amir et al. in 1999 were almost used(AF030876). Sequencing primers used were the same as PCR. DNA sequencing reactions were performed using an ABI 377 DNA sequencer and ABI PRISM dye terminator cycle sequencing reaction kit(Perkin-elmer). The results were compared with the normal DNA sequence(X99686). To confirm the change of sequence on novel mutations, RFLP analysis was performed. Results : The MECP2 mutations were detected in 23(67.6%) of the 34 patients. The mutations consisted of 12 different types including nine missense and three nonsense mutations. Of these, three (L100V, G161E and T311M) mutations were newly identified. Most of the mutations discovered are located within MBD(39.1%) and TRD(39.1%). In this study, three(T158M, R270X, R306C) mutations were identified high frequency. Conclusion : MECP2 gene was also an important cause of Korean RTT patients. MECP2 gene study is an important tool for diagnosis of Korean RTT patients.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1213-1218
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• 2002

Purpose : Hydronephrosis constitutes a great portion of fetal anomalies screened by prenatal sonogram. The present authors made an attempt to access its natural courses through follow up neonatal hydronephrosis diagnosed by prenatal sonogram. Methods : The study was composed of 23 neonates(36 renal units) who were diagnosed with hydronephrosis through prenatal sonogram screening and confirmed 3-7 days after birth with sonographic evaluation at Kyung Hee University Hospital. The neonates were closely monitored for 12-24 months with renal sonogram, diuretic renogram, intravenous pyelography(IVP) and voiding cystoureterography(VCUG). Results : The underlying diseases were composed of 16 cases(44%) of functional abnormalities, 14 cases(39%) of ureteropelvic junction(UPJ) obstruction, three cases(8%) of vesicoureteral reflux (VUR) and on case each of multicystic dysplastic kidney, UPJ obstruction with ureteral stenosis and ureterovesical junction(UVJ) obstruction with VUR. The degree of hydronephrosis was divided into three classes according to its severity. In 30 renal units with UPJ obstruction and functional abnormalities, 26(87%) showed mild hydronephrosis, while four(13%) were moderate. During the follow up period, six cases(20%) showed natural resolution of hydronephrosis, 15 cases(50%) showed improvement while two cases(7%) were aggravated with improvement only after surgery of the underlying disease. The cases which showed natural resolution were all mild hydronephrosis at diagnosis and the cases which underwent surgery due to continuous aggravation were mild one case and moderate one case. Conclusion : Those with cases of mild hydronephrosis show rapid natural improvement. On the other hand, in some cases, follow up monitoring reveal aggravation of the situation, emphasizing the necessity for thorough follow up for a long period of time.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.654-658
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• 2002

Purpose : Endocrine and immune systems are connected and interdependent. Adrenal glands play an important role in this network and control the balance between serum levels of dehydroepiandrosterone sulfate(DHEAS) and cortisol. These steroids have an antagonistic effect on the T cell progression into Th1 and Th2 cells and on the induction of correlated interleukins. Therefore we evaluated the role of adrenal androgen and cortisol as immune modulators in Kawasaki disease( KD) with changes of T cell immunity. Methods : From April to August in 2001, we examined serum DHEAS and 24 hour urine free cortisol(F) before administration of immunoglobulin and steroids by radioimmunoassay in 14 KD patients. It's clinical severity was determined by Harada score and coronary lesion. Results : The age of the patient group ranged from 4 months to 4 years; its average age was 2.3 years. Three patients(21.4%) were below 1 year, 2(14.3%) between 1 and 2 years, 5(35.7%) between 2 and 3 years, 4(28.6%) between 3 and 4 years of age. Male to female ratio was 1:1.3. DHEAS was significantly decreased in patients($11.1{\pm}6.0{\mu}g/dL$) more than controls($81.6{\pm}13.3{\mu}g/dL$)(P<0.05). Twenty-four hour urine free cortisol was significantly increased in patients($36.9{\pm}21.9{\mu}g/dL$) more than controls($13.6{\pm}5.5{\mu}g/dL$)(P<0.05). Ratio of DHEAS/F was decreased remarkably in patients($0.33{\pm}0.20$) more than controls($6.65{\pm}2.56$)(P=0.016). There was no difference between ratio of DHEAS/F and Harada score, but its ratio was very low in patients with coronary aneurysm. Conclusion : These data demonstrate that there are changes of DHEAS and cortisol in acute stage of KD and the dis-equilibrium between two steroids may be relevant in the T cell immune response induction of Kawasaki disease. These changes support the use of DHEAS/F ratio as one of the predictive factors of coronary arteries complication.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.629-636
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• 2002

Purpose : Our study was aimed to investigate the characteristics of seizures as well as to determine whether the expression of neuronal nitric oxide synthase expression(nNOS) of hippocampus has an affect in the hyperthermic seizure in developing rat. Methods : Hyperthermic seizures were repeatedly induced twice a week for four weeks in 20-day old Spraque-Dowley rats. Fifty two rats were used as a hyperthermic group and 30 rats used as a normothermic control group. Hyperthermic seizures were induced in a water bath at $45^{\circ}C{\pm}1$ for 4 min. The characteristics of seizures were recorded. Using western blot, hippocampal nNOS expression was measured in normothermic control, hyperthermic non-seizure, and hyperthermic seizure groups, respectively. Results : Eighty seven percent of hyperthermia exposed rats showed generalized tonic-clonic seizure most frequently. The duration of seizure was ranged from 12 to 145 sec(mean 55 sec) and the latency to seizure ranged from 158 to 240 sec(mean 204 sec). The duration of seizure was prolonged but there was no significant difference in the seizure latency as the rat exposed more number of hyperthermia. Interestingly, the expression level of hippocampal nNOS in hyperthermic seizure and hyperthermic non-seizure groups was not different from each other, however, the expression in these groups was lower than that of the control group. Conclusion : Our results indicate that nNOS do not have an affect in this repeated hyperthermic seizures. Further studies are required to clarify a role of nNOS in hyperthermic seizure.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.615-621
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• 2002

Purpose : The neonatal cardiac catheterization and angiogram for transcatheter therapy are still essential methods in congenital heart disease, so we reviewed our experience with neonatal cardiac catheterization over 10 years at a single institution. Methods : A retrospective review of all 139 neonatal catheterizations from January 1991 to December 2000 at Sejong Heart Institution was performed. The purpose of the catheterizations, ages, body weights and the complications by the exam was surveyed. Results : The mean age of our 139 patients was 14.9 days and the mean body weight was 3.3 kg. As for the diagnosis : TGA in 49 patients, PAIVS in 26 patients, DORV in 14 patients, PS in 14 patients, PAVSD in 11 patients. For the cardiac catheterization, general anesthesia was performed in 65% of total and fluoroscopy time was $20.1{\pm}14.5$ minutes during cardiac catheterization. In the interventional cardiac catheterization which was 75% of the total, the age and body weight were statistically the same but the irradiation time was longer than the diagnostic catheterization( P=0.001). There were 48 cases of atrial septostomy, 16 cases of balloon pulmonary valvuloplasty and 25 cases of transcatheter pulmonary valvotomy. Complications of cardiac catheterization were found in 16.3%, but there was no difference between interventional catheterization and diagnostic catheterization. Conclusion : Therapeutic cardiac catheterization in neonates is a relatively safe and effective method in congenital heart disease.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.307-313
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• 2010

Purpose : Results of the Korea National Health Screening Program for Infants and Children, which was launched in November 2007, were evaluated for future research and policy development. Methods : Data from a total of 2,729,340 cases were analyzed. Five visiting ages, such as 4, 9, 18, 30, and 60 months, were included. Several parameters such as stunting, obesity, and positive rate of developmental screening were also analyzed. Telephone survey was performed in 1,035 users. For the provider survey, 262 doctors participated in our study. Results : The overall participation rate of users was 35.3%. This participation rate showed a decrement tendency to old age and low income. Only 6.9% of users participated in oral screening. Health screening was performed mainly in private clinics (82.6%). The recall rate of 4 months program users at the age of 9 months was 57.3%. The positive rate of screening was 3.1%, and was higher in the low-income group. By telephone survey, users reported that questionnaires were not difficult (94%) and overall satisfaction was good (73%). Longer duration of counseling was related with more satisfied users. Counseling and health education were helpful to users (73.2%). Doctors agreed that this program was helpful to children (98.5%). Conclusion : Korea National Health Screening Program for Infants and Children was launched successfully. Participation rate should be improved, and a quality control program needs to be developed. More intensive support following this program for children of low-income families may lead to effective interventions in controlling health inequality. Periodic update of guidelines is also needed.