• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.649-654
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• 2007

Purpose : The objective of this study was to clarify the presentation, associated preceding illness, pathologic organisms, treatment and outcome of deep neck abscess in children according to age and location. Methods : We retrospectively reviewed the in-patient charts of children treated at our hospital for deep neck abscess. Thirty-five such patients were identified as having been treated from March 1990 to December 2005. Results : A total of 35 were enrolled in our study: 25 boys and 10 girls. Their ages ranged from 11 months to 15 years. Presenting symptoms included mass, fever, irritability, trismus and dysphagia. The most commonly known associated preceding illness was viral upper respiratory infection (53%). The most common site of infection was the submandibular space (37%). Bacteria was identified in 16 patients. The most common pathogen was Staphylococcus aureus. Thirteen (37%) children recovered from the infection with conservative treatment and twenty-four (68%) children received surgical drainage. The duration of hospitalization was longer in the group who underwent surgery than in the group who were managed with conservative treatment. No complication occurred. Conclusion : Unexplained torticollis, trismus or irritability in children were suggestive of deep neck abscess. Our results demonstrate that deep neck abscesses in children is respond well to conservative treatment if diagnosed early.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1201-1205
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• 2005

Purpose : The purpose of this study is to evaluate the clinical characteristic changes of acute poststeptococcal glomerulonephritis(APSGN) in recent. The cases of APSGN occurred for the last ten years were divided into group I and II by the unit of 5 years and clinical manifestations and laboratory findings of each groups were analyzed. Methods : Total of 74 cases of APSGN, diagnosed at the department of Pediatrics, Chungnam National University Hospital from January 1995 to August 2004 were divided into group I(31 cases from January 1995 to December 1999) & II(43 cases from January 2000 to August 2004). In addition, the clinical records of each group were reviewed retrospectively and compared. Results : In both groups, the prevalence rate was much higher in males than females, the seasonal prevalence rate was higher in winter, the upper respiratory infection was most frequent predisposing illness, and one to two weeks of latent period was the highest. However, the average age for group II were younger than group I. The prevalence rate of gross hematuria was higher in group II, but there was no significant difference between two groups. In the course of clinical symptoms, edema and hypertension were relieved within two weeks in both groups. In group II, the prevalence rate of proteinuria was higher, and the duration of proteinuria and gross hematuria were longer than group I. Conclusion : In this comparative study, the average age became younger. Clinically the duration of gross hematuria and proteinuria became longer, and the prevalence rate of proteinuria increased in recent 5 years. However, there was no difference between two groups in clinical courses and prognosis.

• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.639-643
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• 2010

Purpose: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. Methods: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. Results: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. Conclusion: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.295-301
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• 2003

Glutaric aciduria type 1(GA1) is an autosomal recessive disorder of the lysine, hydroxylysine and tryptophan metabolism caused by the deficiency of mitochondrial glutaryl-CoA dehydrogenase. This disease is characterized by macrocephaly at birth or shortly after birth and various neurologic symptoms. Between the first weeks and the 4-5th year of life, intercurrent illness such as viral infections, gastroenteritis, or even routine immunizations can trigger acute encephalopathy, causing injury to caudate nucleus and putamen. But intellectual functions are well preserved until late in the disease course. We report a one-month-old male infant with macrocephaly and hypotonia. In brain MRI, there was frontotemporal atrophy(widening of sylvian cistern). In metabolic investigation, there were high glutarylcarnitine level in tandem mass spectrometry and high glutarate in urine organic acid analysis, GA1 was confirmed by absent glutaryl-CoA dehydrogenase activity in fibroblast culture. He was managed with lysine free milk and carnitine and riboflavin. He developed well without a metabolic crisis. If there is macrocephaly in an infant with neuroradiologic sign of frontotemporal atrophy, GA1 should have a high priority in the differential diagnosis. Because current therapy can prevent brain degeneration in more than 90% of affected infants who are treated prospectively, recognition of this disorder before the brain has been injured is essential for treatment.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.977-986
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• 2008

Purpose : This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. Methods : The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. Results : The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. Conclusion : Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.146-151
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• 2010

Purpose : The purpose of this study was to evaluate the timing of puberty and the factors inducing advanced puberty in elemental school students of low grades. Methods : The 1st, 2nd, and 3rd grade elemental students from the Goyang province were randomly selected, and their sexual maturation rate was assessed by physical examination. After obtaining an informed consent, a questionnaire was administered to the parents; eating habits, lifestyle, use of growth-inducing medication, and present illness of the students were evaluated to determine the factors that induced advanced puberty. The data were statistically analyzed. Results : We selected 170 children and the girls:boys sex ratio was 1.2:1. Two 9-year-old boys were in genital stage 2. Two (14.3%) 6-year-old girls, 6 (19.4%) 7-year-old girls, 15 (39.6%) 8-year-old girls, and 4 (57.1%) 9-year-old girls were in breast stage 2. The average pubertal timing predicted for girls was $9.11{\pm}1.86$ years. The main factors influencing pubertal timing were obesity scale, frequency of eating fast food, and the use of growth-inducing medication. A high rating on the obesity scale and high frequency of eating fast food indicated advanced stage of puberty. Growth-inducing medication induced puberty through obesity. Conclusion : We proposed that predictive average pubertal timing in girls was 9.11${\pm}$1.86 years, which was consistent with the previously reported findings from abroad. The significant influencing factors in advanced puberty were obesity scale and frequency of fast food.

• Journal of Korean Academy of Nursing
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• v.22 no.3
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• pp.297-315
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• 1992

Caring has been identified as the essence and unifying domin of nursing(Leininger). Many nurses believe that the art of nursing is comprised of actions that are predominantly caring in nature. Although caring has been the traditional ideology of nurses, it is only now beginning to emerge as the central construct for the development of nut sing research, theory and practice. The problem addressed by this study was to identify how hospitalized children and their nurses express the meaning of caring, how they think nurses should care for children and to describe their experiences of being cared for. The purpose was to provide theoretical understanding of caring as perceived in Korea to contribute to the development of Korean nursing knowledge. The subjects were 76 hospitalized children admitted to pediatric units in five teaching hospitals and 66 nurses who were caring for these children. In this descriptive study, data were collected from Nov 11, 1991 to Jan 30, 1992 by interviews and an open-ended questionnaire and analysed by van Kaam's method. Caring themes perceived by the children and their nurses were classified into eight categories, -helping, comfort, love, warmth(only by children), recovery from illness, health maintenance (only by nurses), presence, nurturance and responsibility. Ideal caring behaviors perceived by the children and their nurses were six categories, -to give help, provide comfort, give love, stay with, treat warmly and aid recovery. Subcategories of giving help were promptness and competence, detailed explanations and support and encouragement. Other subcategories of giving help reported only by nurses were individualizing care, recognizing needs and providing a familiar enviornment. Subcategories of maintaining comfort were making comfortable, alleviating pain ; one subcategory reported only by children was consolating. A subcategory of giving love was concern, two subcategories reported only by nurses were compassion and respect. Subcategories of staying with were playing with and touching : only nurses reported empathy, Subcategories of treating warmly were tenderness and kindness. In the experience of caring, there were 4 categories, -to give help, stay with, show concern and provide comfort. Both the hospitalized children and their nurses had experienced caring primarily from their mothers. Mothers' caring behaviors were direct, personal, basic, supportive nursing acts. On the other hand, nurses caring behaviors were task oriented skilled procedures and medically delegated acts. This study contributes understanding of the complexity of caring, more specifically the meaning and experience of caring and ideal caring behaviors. Research may be able to move into verification when instruments are developed to measure the complexity of caring beliefs, values and behaviors in Korea and other cultural settings.

• Clinical and Experimental Pediatrics
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• v.50 no.10
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• pp.982-986
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• 2007

Purpose : Intravenous immunoglobulin (IVIG) is effective for the treatment of idiopathic thrombocytopenic purpura (ITP) in children. Recently, several reports have been published that show its impact on the absolute neutrophil count. The present study was performed to confirm these findings. Methods : Data on 26 ITP patients were analyzed. Patients with febrile illness or increased C-reactive protein levels at presentation, which would influence the neutrophil counts, were excluded to determine the sole impact of IVIG. In addition, patients who received steroid treatment were also excluded. Results : Sixteen boys and ten girls were analyzed. For patients who received an IVIG dose of 0.4 g/kg/day (n=17), the absolute neutrophil count (ANC) measured next day was significantly decreased. For patients who received an IVIG dose of 1 g/kg/day (n=9), the ANC measured the next day was also significantly decreased. However, the decrease was more profound in the high-dose group compared to the low-dose group. Among six cases with profoundly decreased ANC greater than $1,000/mm^3$, four patients (67%) received IVIG at a dose of 1 g/kg/day. All four cases with increased ANC were treated with IVIG dose of 0.4 g/kg/day, and three cases (75%) among them had a febrile reaction during IVIG administration. None of the cases with decreased ANC had a febrile reaction. No cases had infectious complications reported. Conclusion : IVIG treatment for ITP patients appears to suppress the ANC. This decrease of ANC was more pronounced when a higher dose of IVIG was used. Some cases with increased ANC counts after IVIG use were found only in low-dose IVIG group, and was associated with febrile reactions during IVIG use.

• Clinical and Experimental Pediatrics
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• v.50 no.4
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• pp.376-380
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• 2007

Purpose : Febrile seizures occur in childhood associated with a febrile illness not caused by infections of the central nervous system. Provoked seizures are identified with seizures in association with infections that do not usually affect the brain such as gastroenteritis, except criteria for other febrile seizures in this study. We studied seizures provoked by minor extracranial infections, to contrast them with febrile and provoked seizures. Methods : We retrospectively studied one hundred and twenty children with provoked and febrile seizures who visited Chungbuk National University hospital from January, 2000 to December, 2004. Among these children, 36 patients were determined as provoked seizures and 84 patients as febrile seizures. We compared the distribution of minor infections between the patients with provoked seizures and those with febrile seizures, and studied risk factors of subsequent unprovoked seizures after febrile and provoked seizures associated with minor infections. Results : We analyzed the records of 120 children aged from 1 month to 15 years. The common etiologies of minor infections were gastroenteritis and respiratory infections. In the group of febrile seizures, there was a significantly greater proportion of patients with respiratory infections (58.3%) and a lesser proportion of those with gastroenteritis (25.0%). But there was a higher incidence of gastroenteritis (50.0%) in the provoked group. Comparing the distribution of etiologies between the patients with provoked seizures and those with febrile seizures seemed a significant difference. But, there were no difference between the provoked seizures and febrile seizures in the risk for subsequent unprovoked seizures. Conclusion : In conclusion, the leading cause except brain involvement is gastroenteritis in patients with provoked seizures, and respiratory infection in those with febrile seizures. Thus we need prompt recognition of, and medical attention given to, seizures associated with minor infections.

• Clinical and Experimental Pediatrics
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• v.64 no.10
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• pp.504-510
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• 2021

Population screening of newborns is an extremely important and informative diagnostic approach that allows early identification of babies who are predisposed to the development of a number of serious diseases. Some of these diseases are known and have effective treatment methods. Neonatal screening enables the early diagnosis and subsequent timely initiation of therapy. This helps to prevent serious complications and reduce the percentage of disability and deaths among newborns and young children. Primary immunodeficiency diseases and primary immunodeficiency syndrome (PIDS) are a heterogeneous group of diseases and conditions based on impaired immune system function associated with developmental defects and characterized by various combinations of recurrent infections, development of autoimmune and lymphoproliferative syndromes (genetic defects in apoptosis, gene mutation Fas receptor or ligand), granulomatous process, and malignant neoplasms. Most of these diseases manifest in infancy and lead to serious illness, disability, and high mortality rates. Until recently, it was impossible to identify children with PIDS before the onset of the first clinical symptoms, which are usually accompanied by complications in the form of severe coinfections of a viral-bacterial-fungal etiology. Modern advances in medical laboratory technology have allowed the identification of children with severe PIDS, manifested by T- and/or B-cell lymphopenia and other disorders of the immune system. This review discusses the main existing strategies and directions used in PIDS screening programs for newborns, including approaches to screening based on excision of T-cell receptors and kappa-recombination excision circles, as well as the potential role and place of next-generation sequencing technology to increase the diagnostic accuracy of these diseases.