• Nutrition Research and Practice
• /
• v.14 no.1
• /
• pp.12-19
• /
• 2020

BACKGROUND/OBJECTIVES: Vitamin D is a pleiotropic hormone that affects various body organ systems. We evaluated the prevalence of a vitamin D deficiency (VDD) and its potential role in the clinical condition of critically ill Korean children. SUBJECTS/METHODS: Patients under 18 years old with a 25(OH) vitamin D measurement on the first day of PICU admission were included from among the children admitted to the pediatric intensive care unit (PICU) of our tertiary children's hospital between October 2017 and January 2019. RESULTS: A total of 172 pediatric patients were enrolled. The mean 25(OH) vitamin D level was 17.5 ± 12.8 ng/mL. There was a 65.1% prevalence of VDD (25(OH) vitamin D level < 20 ng/mL). VDD was associated with age at PICU admission, gastrointestinal/hepatobiliary disorders, International Society of Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH DIC) score, pediatric multiple organ dysfunction syndrome (pMODS) score and with several laboratory test findings including hemoglobin, platelet, C-reactive protein, serum albumin, total bilirubin, prothrombin time, and anti-thrombin III levels. Most of these parameters also showed significant linear correlations with the 25(OH) vitamin D level (P < 0.05). However, no statistically meaningful association was found between VDD and other clinical conditions such as the need for a mechanical ventilator, requirement for vasoactive drugs, duration of the PICU and hospital stays, or PICU mortality. CONCLUSION: There is a high prevalence of VDD in critically ill Korean children. There were significant associations between the 25(OH) vitamin D level and gastrointestinal/hepatobiliary disorders, the pMODS score and with coagulation related factors. Further large-scale studies with more specific subgroup analyses are required to more precisely assess the clinical implications of VDD in critically ill pediatric patients.

• Korean Journal of Clinical Pharmacy
• /
• v.30 no.3
• /
• pp.161-168
• /
• 2020

Background: Recently, a study comprising adult patients with sepsis admitted in the intensive care unit (ICU) was conducted. The patients were treated with high doses of intravenous ascorbic acid, thiamine, and hydrocortisone; the clinical outcomes demonstrated significant therapeutic benefits. The mortality rate in children with sepsis is approximately 25%. However, the effects of additional treatment with ascorbic acid and thiamine ("vitamin protocol") in children are rarely investigated. Methods: A retrospective analysis was performed using medical records of patients diagnosed with sepsis and admitted to the pediatric ICU (PICU) between September 2016 and June 2019. The control group received treatment only as per sepsis protocol, whereas the treated group received both sepsis protocol and the vitamin protocol. The primary endpoint was change in Vasoactive-Inotropic Score (VIS) for 5 days. The secondary endpoints included the length of stay in the PICU, duration of using mechanical ventilators and vasopressors, and mortality rate. Results: The number of patients in the treated and control groups was 33 and 24, respectively. The treated group showed greater decrease in their VIS for 5 days than the control group (44.4 vs 18.6); however, the difference was not statistically significant. The length of stay in the PICU was significantly longer for the treated group than for the control group [10.0 days (Interquartile range (IQR), 6-18) vs 4.5 days (IQR, 4-10.3); p=0.004]. Conclusions: No significant treatment benefits were observed following vitamin protocol administration to the pediatric patients with sepsis. Further studies are necessary for improving the efficacy and safety of the vitamin protocol.

• Child Health Nursing Research
• /
• v.25 no.2
• /
• pp.103-111
• /
• 2019

Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, $x^2$ test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age ($x^2=14.10$, p=.007), admission type ($x^2=7.40$, p=.007), use of physical restraints ($x^2=26.11$, p<.001), RASS score ($x^2=14.80$, p=.001), need for oxygen ($x^2=5.31$, p=.021), use of a mechanical device ($x^2=9.97$, p=.041), feeding ($x^2=7.85$, p=.005), and the presence of familiar objects ($x^2=29.21$, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.

• Clinical and Experimental Pediatrics
• /
• v.64 no.7
• /
• pp.364-369
• /
• 2021

Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections. Purpose: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children. Methods: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients. Results: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2-14] years vs. 4 [2-6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more frequently in influenza patients than in COVID-19 patients (22.1% vs. 8.5%, P=0.029; 17.6% vs. 5.6%, P=0.013; and 13.2% vs. 5.6%, P=0.048, respectively). Both groups showed significantly elevated monocyte levels in the complete blood count (70.4% vs. 69.9%, P=0.511). Major chest x-ray findings in COVID-19 patients included mild diffuse ground-glass opacity and right lower lobe infiltrates. There were no statistically significant intergroup differences in hospitalization or mortality rates; however, the intensive care unit admission rate was higher among COVID-19 patients (2.4% vs. 0.5%, P=0.045). Conclusion: In this study, pediatric COVID-19 patients showed a wide range of clinical presentations ranging from asymptomatic/mild to severe illness. We found no intergroup differences in hospitalization rates, oxygen requirements, or hospital length of stay; however, the intensive care unit admission rate was higher among COVID-19 patients.

• Archives of Plastic Surgery
• /
• v.38 no.6
• /
• pp.761-764
• /
• 2011

Purpose: Pediatric facial laceration takes a huge part of patients visiting emergency room and generates social attention for its proper emergency care. So much more attention should be paid to the proper treatment at emergency care unit, and furthermore, thorough survey of background information of the pediatric facial laceration may offer more proper prevention. Methods: According to annual reports of 2009 and 2010, out of 5149 facial laceration patients who were given primary medical care at our clinic, 1452 patients were aged under 15 years old. Retrospective analysis of each pediatric facial lacerations were evaluated according to gender, age, periodic table, cause of injury, place of injury, sites of injury and so on. Results: Pediatric facial laceration was found to occur mostly at 1 year old as they learn to walk and explore their environment. Evaluated analysis revealed that pediatric facial accidents occurred mostly on forehead region (75%), on Sundays, from 5 p.m. to 8 p.m., at home (61.5%). Most common cause of injury was collision (54.5%). Conclusion: In large group of pediatric facial laceration cases provided us with an surprising fact that accidents most commonly occur under parental supervision. This fact gives an actual understanding regarding pediatric facial laceration and more realistic approach in its prevention strategy.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.19 no.2
• /
• pp.83-90
• /
• 2019

Dexmedetomidine is a highly selective ${\alpha}2$-adrenoceptor agonist with a vast array of properties, making it suitable for sedation in numerous clinical scenarios. Its use was previously restricted to the sedation of intensive care unit patients. However, its use in pediatric dental sedation has been gaining momentum, owing to its high suitability when compared with conventional pediatric sedatives. Its properties range from sedation to anxiolysis to analgesia, due to its sympatholytic properties and minimal respiratory depression ability. Because dexmedetomidine is an efficacious and safe drug, it is gaining importance in pediatric sedation. Thus, the aim of this review is to highlight the properties of dexmedetomidine, its administration routes, its advantages over the commonly used pediatric sedatives, and especially its role as an alternative pediatric sedative.

• Perspectives in Nursing Science
• /
• v.7 no.1
• /
• pp.43-49
• /
• 2010

Purpose: Rapid and accurate assessment of impaired consciousness is very important, especially for critically ill patients. Therefore, the Glasgow coma scale (GCS) has been widely adopted in the assessment of adult and pediatric comas. But the GCS should not be used for small children who show various normal responses according to their developmental stage. Therefore, the objectivity of pediatric coma measurements was verified by applying the modified GCS to patients in a pediatric intensive care unit (PICU) at a university hospital in Korea. Methods: The level of consciousness was evaluated for 200 cases who were admitted to a PICU from July 4, 2009 to September 18, 2009 and could show a verbal response, with our modified GCS for children. In addition, and we confirmed the frequency analysis and Kappa statistics with SPSS/WIN 17.0. Results: Kappa statistics which show inter-observer reliability were very good for all components (eye opening, verbal, and motor score) and was good for total GCS scores. Conclusion: It is concluded that our modified GCS is reliable. Therefore, reliable assessment for the level of consciousness is clinically practicable if enough training is supported.

• Journal of Chest Surgery
• /
• v.47 no.3
• /
• pp.211-219
• /
• 2014

Background: Our objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity. Methods: We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up. Results: Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively. Conclusion: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.22 no.4
• /
• pp.350-357
• /
• 2019

Purpose: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. Methods: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. Results: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75-1). Conclusion: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75-1). This cut-off may be used in combination with clinical judgment to diagnose CD.

• Journal of Korean Academy of Nursing
• /
• v.26 no.3
• /
• pp.515-530
• /
• 1996

A descriptive study was conducted to describe the content of nursing interventions and incoming telephone calls from the parents whose child was discharged to home or who has planned immunization during the period from March 15, 1995 to November 30, 1995. Detailed notes on 145 telephone calls and 243 nursing interventions were recorded by head nurses on pediatiric nursing units were entered to data collection and content analysis. The results of the study are as follows : 1. Six analysis categories for the records on incoming telephone calls were identified judgement-dependence, dependent -coping, self-initiated coping, support, adjustment and intermediation need. 2. Five analytic categories for the records on telephone interventions were identified : guidance, mediation, facilitating self -care abilities, support, instrumental use. 3. Problems related to physical signs and symptoms, medication, immunization, and vital signs were most often cited as concerns by parents and caregivers. 4. Instruction, suggestion, provision knowledge and information, reassurance related to physical problems, medication, immunization and clinic visits were most often used as an nursing interventions by head nurses on pediatric nursing units. In spite of the fact that the telephone calls were initiated by the parents, dependency of parents during the telephone calls was remarkable. The dependency of parents on judgement and decision making of the pediatric nurses should be understood in terms of the psychosocial content as well as cultural characteristics. Therefore, it is suppested that telephone interventions focus on facilitating the self-care ability of the parents whose children have chronic conditions. The results of this study will be useful as an essential reference in providing effective for children and their families after discharged from the hospital. The results can also be used as reliable data for extended pediatric nursing service in the health care delivery system as well as for the development of telephone intervention service program in responding to the current health care environment.