• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.917-921
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• 2009

Purpose : Although renal ultrasonography (USG) has improved the detection rate of hydronephrosis (HN), its clinical courses and postnatal management remains controversial. Here, we reviewed the clinical features of patients with HN according to the grades. Methods : We retrospectively studied 207 patients who were regularly followed-up among 367 patients with HN detected by renal USG postnatally between April 1998 and December 2007. These patients were grouped into four groups, grades 1-4, according to renal pelvic diameter (RPD). For analysis, each group was merged into two categories (mild: grade 1, 2; severe: grade 3, 4). Results : During follow-up, 128 episodes of urinary tract infection (UTI) occurred in 91 patients. According to grades from 1 to 4, 35/89 (39.3%), 41/88 (46.5%), 11/22 (50%), and 4/8 (50%), respectively, had UTI, without any significance between the mild and severe groups. However, the severe group presented a higher risk in cumulative episodes of UTI per year (P=0.041). The spontaneous resolution of HN was observed in 103 (58.8%) of the 175 mild group patients and in 3 (10.7%) of the 28 severe group patients (P<0.001). Furthermore, the detection rate of prenatal HN by prenatal USG was much higher in patients with severe RPD (P<0.001). Conclusion : We found that the severer the grade of HN, the lower was the rate of spontaneous resolution and higher was the frequency of UTI. Therefore, the establishment of guidelines for managing treatments such as antibiotic prophylaxis for patients with HN is needed to improve renal prognosis.

• Clinical and Experimental Pediatrics
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• v.51 no.6
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• pp.616-621
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• 2008

Purpose : This study was undertaken to identify factors that influence 17-OHP levels in preterm infants and to suggest a reasonable follow-up schedule of screening for congenital adrenal hyperplasia (CAH) in preterm infants. Methods : The 17-OHP concentrations in filter paper blood spots of 427 preterm infants were obtained. The effects of gestational age (GA), systemic diseases, and antenatal dexamethasone on screening and follow-up 17-OHP values were investigated. Results : The screening 17-OHP values were markedly variable (range: 0.1-143.3 ng/mL). The screening 17-OHP levels were negatively correlated with GA (r=-0.535, P<0.01). In infants with GA<32 weeks, the screening 17-OHP levels were significantly higher in sick infants or infant with hypotension than in healthy infants. The screening values of prenatal dexamethasone-treated infants had a tendency to be low. In infants with initial 17-OHP values ${\geq}20ng/mL$, the intervals until rescreening 17-OHP <10 ng/mL or serum 17-OHP <20 ng/mL were negatively correlated with GA (r=-0.541, P<0.01) and were prolonged in infants with bronchopulmonary dysplasia (P<0.01). None of the preterm infants were confirmatively diagnosed with CAH. Conclusion : The 17-OHP values of preterm infants were influenced by GA, prenatal dexamethasone, and postnatal diseases. Because the 17-OHP values of preterm infants were markedly variable, a follow-up schedule should be developed considering both 17-OHP values and clinical status.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.722-728
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• 2008

Purpose : This study was designed to examine the effects of adiponectin, leptin, insulin, insulin-like growth factor (IGF)-I and IGF binding protein (BP)-3 levels in cord blood on weight, length, and adiposity at birth in healthy term infants. In addition, we evaluated the mechanism to change the hormone levels in appropriate for gestational age (AGA) during the first month. Methods : We collected cord blood from 200 term neonates (109 males, 91 females) with no perinatal problems, and measured the hormone levels and anthropometric parameters including weight, length, and skin-fold thickness. Term neonates were divided into 3 groups as follows: birth weight appropriate for gestational age (AGA) (n=132), birth weight less for gestational age (SGA) (n=29), and birth weight more for gestational age (LGA) (n=39). Venous blood samples of 15 fullterm healthy neonates were obtained at 3, 7, and 30 d after birth. Results : The adiponectin, insulin, and IGF-I levels were significantly lower in the SGA group than in the AGA and LGA groups. The leptin levels were significantly higher in the LGA group than in the AGA and SGA groups. Cord blood adiponectin, leptin, insulin, IGF-I, and IGFBP-3 levels correlated significantly and positively with birth weight and the sum of the skin-fold thickness. A significant positive correlation was observed between adiponectin, leptin, and IGF-I levels and birth weight. Adiponectin level correlated significantly with that leptin level (r=0.191, P=0.038), but not with insulin, IGF-I and IGFBP-3 levels. IGF-I levels were higher in females than in males. At 7 d after birth, the leptin level decreased along with physiologic weight loss, and then increased. IGF-I, also decreased at 3 d, significantly increased 1 month later. Conclusion : We suggest that adiponectin, leptin, insulin, IGF-I, and IGFBP-3 play an important role in regulating fetal growth. Adiponectin may be involved in regulating fetal growth through mechanisms different from those mediated by insulin or IGF-I. High levels of IGF-I in female neonates indicates a gender difference which serves as evidence for in utero sexual dimorphism. It is likely that IGF-I has a more important role than that of hormones in postnatal growth.

• Development and Reproduction
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• v.12 no.1
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• pp.97-105
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• 2008

Vinclozolin (VCZ) is a systemic fungicide commonly used in fruits, vegetables and the wine industry. VCZ and its metabolites, butenoic acid (M1) and enanilide (M2) derivatives, act as anti-androgens through actions on the androgen receptor. Although there is growing body of evidence that VCZ's action as an endocrine disrupting chemical (EDC) in male reproductive physiology and pathphysiology, no evidence on the VCZ's EDC action in female is available yet. Previously we found that the prepubertal VCZ exposures could effectively delay the onset of puberty in female rats, suggesting the postponed or weakened activities of hypothalamus-pituitary-ovary (H-P-O) reproductive hormonal axis. The present study was performed to examine whether the VCZ administration affects the transcriptional activities of reproductive hormone-related genes in the same animal model. VCZ (10 mg/kg/day) was administered daily from postnatal day 21 (PND 21) through the day when the first vaginal opening (V.O.) was observed. To determine the transcriptional changes of reproductive hormone-related genes in hypothalamus and pituitary, total RNAs were extracted and applied to the semiquantitative reverse transcription polymerase chain reaction (RT-PCR). As a result, treatment with VCZ significantly lowered the transcriptional activity of nitric oxide synthase-2 (NOS-2) which is known to adjust gonadotropin-releasing hormone (GnRH) secretion in the hypothalamus (p<0.01). Similarly, the mRNA levels of KiSS-1, G protein-coupled receptor 54 (GPR54) and GnRH were significantly decreased in hypothalamus (p<0.01) from VCZ-treated group. As expected, the transcriptional activities of luteinizing hormone-${\beta}$ (LH-${\beta}$) and follicle stimulating hormone-${\beta}$ (FSH-${\beta}$) in the anterior pituitary from VCZ-treated group were also significantly lower than those from the control group. The present study indicates that(i) the inhibitory effect of VCZ exposure on the onset of puberty in immature female rats could be derived from the reduced transcriptional activities of gonadotropin subunits and their upstream modulators such as GnRH and KiSS-1 in hypothalamus-pituitary neuroendocrine axis, and (ii) these inhibitory effects could be mediated by NO signaling pathway.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.488-494
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• 2005

Purpose : To outline the aspects of extubation by birth weight and find the predictors for success/failure at the first extubation in extremely low birth weight infants. Methods : One hundred thirteen extremely low birth weight infants(<1,000 g) who were admitted to NICU at Samsung Seoul Hospital between Jan. 2000 and Jun. 2004 were enrolled. Clinical characteristics that are thought to be related with extubation success or failure were compared with the success and the failure of the first extubation. Results : As the birth weight decreased, extubation success day was significantly delayed : $16{\pm}3day(d)$ in 900-999 g; $20{\pm}3d$ in 800-899 g; $35{\pm}4d$ in 700-799 g; $37{\pm}9d$ in 600-699 g; $49{\pm}12d$ in ${\leq}599g$. 25 out of 113 infants(22%) failed the first extubation. Preterm premature rupture of membrane was associated with extubation success, and air leak was associated with extubation failure, with a borderline significance. Postnatal and corrected age and body weight at the first extubation, nutritional status, and ventilator settings were not associated with extubation success or failure. Extubation success day was significantly delayed, and the incidence of late-onset sepsis and mortality was significant higher in the failure of the first extubation. Conclusion : We could not find significant predictors for success/failure at the first extubation. The failure of the first extubation had an increased risk of late-onset sepsis and death. Further studies are needed to find the predictors for extubation success/failure.

• Clinical and Experimental Pediatrics
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• v.46 no.8
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• pp.769-776
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• 2003

Purpose : The survival rate of very low birth weight infants(VLBWI) has improved by virtue of specialized neonatal care. This study was performed to analyze the changes in incidence, survival rate and morbidity of VLBWI who admitted to Chonnam National University Hospital from 1996 to 2001. Methods : We enrolled 565 VLBWI, and compared the incidence and the survival rate according to the birth weight or gestational weeks between period I(1996 to 1998) and period II(1999 to 2001). The mortality rate according to the postnatal age, cause of death, morbidity and days of hospital stay were also compared. Morbidity is categorized into 'short term' which is curable until discharge, and 'long term' causing any types of sequelae after discharge. Results : Incidence of VLBWI significantly increased in period II over period I(6.0% vs. 11.0%, P< 0.001). The survival rate also increased in period II(71.8% vs. 80.1%, P<0.05), especially in 1,000 to 1,249 gm of birth weight(P<0.001) and in 28 to 30 weeks of gestation(P<0.001). The most common cause of death was respiratory distress syndrome in period I; however it was sepsis in period II. Although overall and short term morbidity rate increased, long term morbidity and days of hospital stay didn't increase in period II. Conclusion : Although the incidence of VLBWI significantly increased and the survival improved in period II compared to period I, especially in 1,000 to 1,249 gm of birth weight and 28 to 30 weeks of gestation, 'long term' morbidity rate and hospital days didn't increase.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.984-990
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• 2009

Purpose : Being small for gestational age (SGA) is a risk factor of short stature in children. Genetic background such as mid-parental height (MPH) is known to influence growth of children born SGA. We studied the relationship between growth of children born SGA and MPH and studied the effects of insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) on postnatal growth in children born SGA according to MPH. Methods : Forty-nine neonates born SGA were included in this study. We defined corrected height standard deviation score (cHtSDS) by modified height SDS (HtSDS) based on their MPH. We categorized subjects into group 1 consisting of children with cHtSDS ${\geq}0$ (n=35) and group 2 consisting of children with cHtSDS <0 (n=14), and compared IGF-I and IGFBP-3 between the two groups. Results : The HtSDSs and cHtSDSs in groups 1 and 2 were $0.06{\pm}1.05$ vs. $-0.95{\pm}0.85$ (P=0.000) and $0.78{\pm}0.93$ vs. $-0.46{\pm}0.67$ (P=0.000), respectively. IGF-I SDS was higher in group 1 than in group 2 ($2.82{\pm}3.69$ vs. $0.23{\pm}2.42$, P=0.012). Total cHtSDS ($0.42{\pm}1.03$) was significantly higher than HtSDS ($-0.22{\pm}1.10$) (P=0.000). Conclusion : Our results show that cHtSDS differs significantly from HtSDS. Growth assessment by standardized growth curve does not uniformly show effects of genetic factors. A more accurate assessment of growth uses a personalized corrected growth curve that considers the genetic factor measured by MPH.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.848-854
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• 2007

Purpose : The present study examined the etiology and risk factors of the early breast-feeding jaundice and the usefulness of auditory brainstem response test as early predictor of kernicterus. Methods : Medical records of neonatal jaundice in newborn admitted to Daegu Fatima Hospital between September 2005 and May 2006 were analyzed prospectively. Infants were grouped according to feeding method : breast feeding group (breast feeding only, n=23), mixed feeding group (breast feeding mainly plus addition of fomula feeding, n=13). Results : There were no significant differences in gestational age, birth weight, sex, duration of phototherapy, serum bilirubin and hemolytic evidence between the two study groups. First visiting day of life at out patient department was significantly delayed in breast feeding group ($8.7{\pm}3.6day$) compared to mixed feeding group ($6.0{\pm}1.9$) (P=0.009). Weight loss was significantly severe in breast feeding group compared to mixed feeding group (P<0.05). In auditory brainstem response test, loss of Wave V in 3 cases was observed and recoverd after blood exchange transfusion in follow up test.Wave III latency had significant correlation to serum bilirubin in auditory brainstem response test (70 dB) (P=0.002). Conclusion : Our study suggest that further education about breast feeding and follow up within the first postnatal week would be necessary for early detection and prevention of early breast-feeding jaundice. Test of serum bilirubin and auditory brainstem response would be helpful in determination of blood exchange transfusion.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.882-890
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• 2007

Purpose : Preterm very low birth weight infant have high rate of adverse neurodevelopmental sequale. Recently, there have been lots of reports that human umbilical cord blood transplantation ameliorates functional deficits in animal models as hypoxic ischemic injury. This pilot study was undertaken to determine the clinical efficacy and safety of autologous umbilical cord blood cell transplantation for preventing neurodevelopmental sequale in perterm VLBW. Methods : Subjects were 26 preterm infants whose birth weight are less than 1,500 g and delivered under the intrauterine period 34 weeks. Autologous umbilical mononuclear cells (about $5.87{\times}10^7/kg$) were injected to neonate via the umbilical vein on the postnatal 24-48 hour. The therapeutic efficacy was assessed by numbers of nucleated RBC, urinary uric acid/creatinine ratio, concentration of neuron specific enolase (NSE), interleukin 6 (IL6), interleukin-$1{\beta}$ ($IL-1{\beta}$), and glial cell derived neurotrophic factor (GDNF) in serum and cerebrospinal fluid on day 1 and 7. Results : There were no significant differences in the numbers of the nucleated RBC, urinary uric acid/creatinine ratio, concentration of creatine kinase between the transplanted infants and controls. But the nucleated RBC is more likely to be rapidly discharged in the transplanted group. In the transplanted group, the concentrations of IL6, $IL-1{\beta}$, and GDNF were no significant difference between day 1 and 7, although GDNF seemed to be elevated. Serum NSE concentration was significantly elevated after transplantation, but not in CSF. Conclusion : It is suggested that autologous umbilical cord blood transplantation in preterm very low birth weight infant is safe to apply clinical practice. Long term follow up study should be needed to evaluate the potential therapeutic effect of umbilical cord blood transplantation for neuroprotection.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.1
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• pp.15-22
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• 2009

Objectives : Prevalence of postpartum depressive disorders reaches approximately 10-15% of childbearing women. This preliminary study was intended to explore the relationships between postpartum depressive disorders and family adaptability and cohesion. Methods : Childbearing women(n=24) were assessed for risk factors for postpartum depression before and after childbirth prospectively. At gestational age between 36th and 40th week, the questionnaire about various factors before childbirth, Edinburgh postnatal depression scale(EPDS), Family adaptability-cohesion evaluation scale (FACES), and Beck anxiety inventory(BAI) were assessed. After childbirth, for the diagnosis of postpartum depressive disorders, a structured diagnostic interview according to MINI International Neuropsychiatric Interview was performed, furthermore, the questionnaire about various factors after childbirth, EPDS, and BAI were assessed at 4-6 weeks postpartum. Results : Among various factors and scales, family adaptability and cohesion, mood symptom and change during pregnancy were associated with postpartum depressive disorder in comparison with non-postpartum depressive disorder subjects. In addition, low family adaptability and cohesion and mood change during pregnancy were significantly associated factors with postpartum depressive disorder using logistic regression analysis. Conclusion : The results suggest the postpartum depressive disorder could be related with prenatal low family adaptability and cohesion. This preliminary study, however, includes only a few subjects, so that further large-sized study will be needed to replicate our results.