• 제목/요약/키워드: Pediatric intervention

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Management strategies for congenital isolated hydronephrosis and the natural course of the disease

  • Jung, Jiwon;Lee, Joo Hoon;Kim, Kun Suk;Song, Sang Hun;Moon, Dae Hyuk;Yoon, Hee Mang;Cho, Young Ah;Park, Young Seo
    • Childhood Kidney Diseases
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    • v.26 no.1
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    • pp.1-10
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    • 2022
  • Congenital isolated hydronephrosis encompasses a spectrum of physiologic states that spontaneously resolve and pathologic obstruction that necessitates surgical intervention. Distinguishing patients whose condition will resolve, those who will require stringent follow-up, and those who will eventually need surgical intervention present a challenge to clinicians, particularly because no unified guidelines for assessment and follow-up have been established. The recognition of the natural course and prognosis of hydronephrosis and a comprehensive understanding of the currently proposed consensus guidelines may aid in multidisciplinary treatment and in providing proper counseling to caregivers. In this review, we aimed to summarize the literature on the grading systems and management strategies for congenital isolated hydronephrosis.

Hemorrhagic Diathesis as the Presenting Symptom of Neonatal Cholestasis

  • Faverey, Liesbeth Claire;Vandenplas, Yvan
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.17 no.3
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    • pp.191-195
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    • 2014
  • A 4-week-old infant presented with a coagulation disorder resulting from a vitamin K deficiency. The vitamin K deficiency was caused by neonatal cholestasis due to biliary atresia. Jaundice, hepatomegaly and pale stools are the predominant presenting symptoms of biliary atresia, none of which were recognized in our patient before admission. However, the patient presented with bleeding caused by vitamin K deficiency. She was fully breastfed and had received adequate doses of vitamin K at birth and from the age of 1 week. In case of a hemorrhagic diathesis due to neonatal cholestasis, timely identification of treatable underlying disorders, in particular biliary atresia, is important because an early surgical intervention results in a better prognosis. Meticulous history taking and a thorough physical exam can be decisive for an early diagnosis and subsequent intervention.

The Effect of Early Removal of Mesiodens for the Correction of Central Incisor Rotation (정중과잉치 조기 발거에 따른 상악 영구중절치 회전의 개선)

  • Lee, Jueun;Kim, Youngjin;Kim, Hyunjung;Nam, Soonhyeun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.41 no.1
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    • pp.64-71
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    • 2014
  • Mesiodens is defined as a supernumerary tooth in the premaxillary region. It can cause several clinical manifestations in normal eruption and position of adjacent teeth, such as displacement and impaction. Although the mesiodens accompanied by a clinical complication is indicated for removal, the optimal time of mesiodens removal is still controversial. Some authors suggest immediate intervention defining the removal of mesiodens as soon as possible after the first detection. On the other hand, others recommend delayed intervention which denotes the removal of mesiodens after complete root development of adjacent teeth. This case report is presented with three cases of spontaneous correction and proper alignment of rotated maxillary central incisors by extraction of mesiodens when the crowns of rotated incisors were completely formed while the roots of them were at an early developmental stage.

Effective Behavioral Strategies for Pediatric Feeding Problems (섭식 문제 행동에 대한 효과적인 행동전략)

  • Chung, Kyong-Mee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.sup1
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    • pp.143-148
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    • 2008
  • It is relatively common to have various feeding problem during infancy and childhood, even for typically developing children. Treatment outcome studies for pediatric feeding disorder consistently reported that applied behavior analaysis (ABA), a type of behavior intervention, is very effective and efficacious. Interdisciplinary team approach is necessary for severe feeding problems, but similar methods could be used through parent training for moderate and mild feeding problems. This article introduced assessment procedure to identify feeding problems as well as specific methods to deal with diver feeding issues. Each strategy can be used effectively only when it is combined with several other strategies including environmental rearrangement and should be developed individually upon each child's feeding issues. In addition, systematic and continuous parent trainings are mandatory. At the end, several treatments related issues were addressed.

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GINGIVAL FIBROMATOSIS IN MIXED DENTITION (혼합 치열기 어린이의 치은 섬유종증)

  • Han, Hyo-Jeong;Kim, Jin;Kim, Seong-Oh;Son, Heung-Kyu;Choi, Byung-Jai
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.4
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    • pp.696-700
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    • 2004
  • Gingival fibromatosis is a non-inflammatory oral disease, characterized by slowly progress enlargement of the free and attached gingiva. Gingival fibromatosis may have familial tendency. Gingival enlargement usually begins with the eruption of the permanent dentition but can also develop with the eruption of the primary dentition. In this case, a 6-year-old female had gingival enlargement at birth. There was no familial, medical and pharmacologic history of gingival overgrowth. Treatment is gingivectomy with a rigorous program of oral hygiene. Recurrence of gingival fibromatosis may well be inevitable. Therefore there is no general aggrement as to the timing of surgical intervention. Generally the best time is when all the permanent teeth have erupted. However early intervention can improve oral function and esthetic and psychologic effect.

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Dosage-Related Prebiotic Effects of Inulin in Formula-Fed Infants

  • Oswari, Hanifah;Widodo, Ariani Dewi;Handayani, Frieda;Juffrie, Mohammad;Sundjaya, Tonny;Bindels, Jacques;Hegar, Badriul
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.1
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    • pp.63-71
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    • 2019
  • Purpose: The aim of this study was to identify the minimally meaningful dosage of inulin leading to a prebiotic effect in Indonesian infants. Methods: In a randomized controlled double-blinded, parallel, 3-arm intervention study, 164 healthy formula-fed infants aged 3 to 5 months first obtained formula-A (without inulin) during a 4-week adaptation period. Subsequently, 142 subjects were subjected to a 4-week feeding period by administering either formula-A (no inulin), formula-B (0.2 g/100 mL inulin) or formula-C (0.4 g/100 mL inulin). The primary outcome parameter was %-bifidobacteria in faecal samples determined using quantitative polymerase chain reaction analyses. Secondary outcome parameters were faecal %-lactobacilli, pH and stool frequency, and consistency. Growth and tolerance/adverse effects were recorded as safety parameters. Results: Typical %-bifidobacteria and %-lactobacilli at the end of the adaptation period in the study population were 14% and 2%, respectively. For faecal pH, significant differences between formula groups A vs. C and A vs. B were found at the end of the intervention period. Testing for differences in faecal %-bifidobacteria and %-lactobacilli between groups was hampered by non-normal data set distributions; no statistically significant differences were obtained. Comparisons within groups revealed that only in formula group C, all the three relevant parameters exhibited a significant effect with an increase in faecal %-bifidobacteria and %-lactobacilli and a decrease in pH. Conclusion: A consistent prebiotic effect along with a decrease in pH and increase in %-bifidobacteria and %-lactobacilli was found only in the group administered 0.4 g inulin/100 mL.

Congenital heart disease in the newborn requiring early intervention

  • Yun, Sin-Weon
    • Clinical and Experimental Pediatrics
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    • v.54 no.5
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    • pp.183-191
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    • 2011
  • Although antenatal diagnostic technique has considerably improved, precise detection and proper management of the neonate with congenital heart disease (CHD) is always a great concern to pediatricians. Congenital cardiac malformations vary from benign to serious conditions such as complete transposition of the great arteries (TGA), critical pulmonary and aortic valvular stenosis/atresia, hypoplastic left heart syndrome (HLHS), obstructed total anomalous pulmonary venous return (TAPVR), which the baby needs immediate diagnosis and management for survival. Unfortunately, these life threatening heart diseases may not have obvious evidence early after birth, most of the clinical and physical findings are nonspecific and vague, which makes the diagnosis difficult. High index of suspicion and astute acumen are essential to decision making. When patent ductus arteriosus (PDA) is opened Widely, many serious malformations may not be noticed easily in the early life, but would progress as severe acidosis/shock/cyanosis or even death as PDA constricts after few hours to days. Ductus dependent congenital cardiac lesions can be divided into the ductus dependent systemic or pulmonary disease, but physiologically quite different from each other and treatment strategy has to be tailored to the clinical status and cardiac malformations. Inevitably early presentation is often regarded as a medical emergency. Differential diagnosis with inborn error metabolic disorders, neonatal sepsis, persistent pulmonary hypertension of the newborn (PPHN) and other pulmonary conditions are necessary. Urgent identification of the newborn at such high risk requires timely referral to a pediatric cardiologist, and timely intervention is the key in reducing mortality and morbidity. This following review deals with the clinical presentations, investigative modalities and approach to management of congenital cardiac malformations presenting in the early life.

Recent advances in pediatric interventional cardiology

  • Kim, Seong-Ho
    • Clinical and Experimental Pediatrics
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    • v.60 no.8
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    • pp.237-244
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    • 2017
  • During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

Henoch-Sch$\ddot{o}$nlein Purpura in Pediatric Surgery (소아외과에서의 Henoch-Sch$\ddot{o}$nlein 자반증)

  • Kim, Dae-Yeon;Kim, Seong-Chul;Kim, In-Koo
    • Advances in pediatric surgery
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    • v.6 no.1
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    • pp.45-49
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    • 2000
  • Henoch-Sch$\ddot{o}$nlein purpura is a systemic vasculitis of unknown etiology that is probably related to an autoimmune phenomenon. Henoch-Sch$\ddot{o}$nlein purpura is characterized by a purpuric rash, arthralgia, nephritis, and gastrointestinal manifestations. We reviewed 169 children hospitalized with a diagnosis of Henoch-Sch$\ddot{o}$nlein purpura between 1989 and 1998. One-hundred thirty-nine (82.2 %) had gastrointestinal findings including abdominal pain, nausea, vomiting and gastrointestinal bleeding. Surgical consultations were obtained for ten children, and laparotomy was performed in five. Three children suspected of having appendicitis underwent appendectomy. None had appendicitis. One child thought to have been intestinal strangulation was found to have hemorrhagic edema of the proximal jejunum and of the distal ileum. Another child underwent resection for an hemorrhagic infarct of the distal ileum. A high index of suspicion of this disease entity in the differential diagnosis of abdominal pain in children can avoid unnecessary laparotomy in most cases. However, life-threatening gastrointestinal complications may occur in low percentage of cases. Prompt recognition and adequate radiologic evaluation of the abdominal manifestation of this entity is necessary for early surgical intervention.

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The Relationship of Stress, Coping and Partnership between Nurses and Parents of Children Hospitalized in the Pediatric Intensive Care Unit (병원 소아중환자실 환아 부모의 스트레스, 대처 및 부모·간호사와의 파트너십 상관관계)

  • Cho, In Young;Lee, Hye Jung
    • Journal of Korean Clinical Nursing Research
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    • v.19 no.2
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    • pp.195-207
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    • 2013
  • Purpose: This study was conducted to describe the relationship of parents' stress, coping, and partnership between nurse and parents whose children were hospitalized in the Pediatric Intensive Care Unit. Methods: A descriptive correlation study design was used. The participants were 81 parents whose children were hospitalized at S-hospital located in Seoul from October 18 to November 27, 2012. This study used the 'Parental Stress Scale: Pediatric Intensive Care Unit,' the coping scale, and 'Pediatric Nurse Parents Partnership Scale, PNPPS'. The data were analyzed using t-test, ANOVA and pearson correlation. Results: The parents of children hospitalized in pediatric intensive care unit were experiencing high level of stress ($3.22{\pm}0.82$). There was a significant positive correlation between parents' coping and nurse parents partnership (p<.001), however there was no relationship between parents' stress and coping, and parents' stress and nurse parents partnership. Conclusion: Nurse-parents partnership had significant relationship with parents' coping In the care of children hospitalized in pediatric intensive care unit. The results of this study provided a foundation to recognize importance of nurse parents partnership and to develop intervention program for nurses and parents to improve their partnership.