PURPOSE: Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed. METHODS: The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results. RESULTS: Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms. CONCLUSION: Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis.
Cost-Benefit Analysis ; Cytomegalovirus* ; DNA ; Fetal Growth Retardation ; Follow-Up Studies ; Gestational Age* ; Gyeonggi-do ; Herpes Simplex* ; Humans ; Immunoglobulin M ; Incidence ; Infant, Newborn* ; Korea* ; Mass Screening* ; Plasma ; Real-Time Polymerase Chain Reaction ; Rubella* ; Simplexvirus ; Syphilis ; Toxoplasmosis ; Ultrasonography

PURPOSE: The aim of this study was to evaluate the efficacy of pamidronate therapy in children and adolescents with secondary osteoporosis. METHODS: Nine patients (7 males, 2 females, 13.2 +/- 2.5 years, 10.1-17.4 years) with secondary osteoporosis who had a history of severe bone pain and/or fracture were enrolled. Intravenous pamidronate 1.5 mg/kg (0.5 mg/kg for 3 consecutive days) was given every 6 to 8 weeks for 0.86 +/- 0.15 years (6 or 8 cycles). Bone mineral density (BMD) in lumbar spine and femoral neck and their Z-scores were measured before treatment, after the fourth and last cycle (sixth or eighth cycle). RESULTS: Underlying diseases were as follows; neurofibromatosis type 1 (n = 2), epilepsy with/without cerebral palsy (N=2), autoimmune disease treated with steroid (n = 2), hematologic malignancy (n = 3). Bone pain was relieved in most of the patients after the first cycle of treatment, and no more fracture occurred thereafter. There was a significant increase in BMD Z-score of the lumbar spine and femoral neck after the last cycle of therapy, compared to baseline values (from -3.91 +/- 1.79 to 1.86 +/- 1.18, in L1-4 and -3.71 +/- 1.83 to -2.53 +/- 1.77 for femoral neck; P = 0.008 and 0.011, respectively). However, there was no significant change in BMD Z-scores between the fourth cycle and the last cycle. Fever developed in 7 out of 9 patients (77.8%), which was relieved by antipyretics. Total serum levels of calcium and phosphorus were significantly decreased (calcium, P = 0.008; phosphorus, P = 0.015) after pamidronate therapy, and three of them experienced symptomatic hypocalcemia during the first cycle. The growth velocity was normal during follow-up periods (mean, 4.47 +/- 1.69 years; range, 1.05 to 6.77 years). CONCLUSION: In conclusion, pamidronate can be administered to the patients with secondary osteoporosis, relieving the symptoms and signs effectively and safely. However, its side effects should be monitored during treatment.
Adolescent ; Antipyretics ; Autoimmune Diseases ; Bone Density ; Calcium ; Cerebral Palsy ; Child ; Diphosphonates ; Epilepsy ; Female ; Femur Neck ; Fever ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; Hypocalcemia ; Male ; Neurofibromatosis 1 ; Osteoporosis ; Phosphorus ; Spine

PURPOSE: Short sleep duration is associated with obesity. Urinary 6-sulfatoxymelatonin (6-OHMS), the principal metabolite of melatonin, is closely related with sleep. We evaluated the difference in urinary 6-OHMS levels between obese girls and normal weight girls, and the relationship of urinary 6-OHMS with other hormones regulating body weight and metabolism. METHODS: A total of 79 girls (6.3 to 12.4 years) were included in this study, of whom 34 were obese; 15, overweight; and 30, normal-weight. We examined their pubertal status and bone age. Fasting serum levels of total ghrelin, leptin, insulin, and first morning urinary 6-OHMS were measured. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated from the fasting insulin and glucose levels. RESULTS: There was no significant difference in the creatinine adjusted 6-OHMS levels between the obese girls and the control group. Urinary 6-OHMS did not show any correlations with body mass index (BMI), BMI percentile, total ghrelin, leptin, and HOMA-IR. Negative correlations were found between urinary 6-OHMS levels and chronological and bone ages. CONCLUSION: Our results suggest that melatonin production is not reduced consistently in obese girls.
Body Mass Index ; Body Weight ; Child ; Creatinine ; Fasting ; Ghrelin ; Glucose ; Humans ; Insulin ; Leptin ; Melatonin ; Obesity

Background: There are many models for predicting diabetes mellitus (DM), but their clinical implication remains vague. Therefore, we aimed to create various DM prediction models using easily accessible health screening test parameters. Methods: Two sets of variables were used to develop eight DM prediction models. One set comprised 62 easily accessible examination results of commonly used variables from a tertiary university hospital. The second set comprised 27 of the 62 variables included in the national routine health checkups. Gradient boosting and random forest algorithms were used to develop the models. Internal validation was performed using the stratified 10-fold cross-validation method. Results: The area under the receiver operating characteristic curve (ROC-AUC) for the 62-variable DM model making 12-month predictions for subjects without diabetes was the largest (0.928) among those of the eight DM prediction models. The ROC-AUC dropped by more than 0.04 when training with the simplified 27-variable set but still showed fairly good performance with ROC-AUCs between 0.842 and 0.880. The accuracy was up to 11.5% higher (from 0.807 to 0.714) when fasting glucose was included. Conclusion We created easily applicable diabetes prediction models that deliver good performance using parameters commonly assessed during tertiary university hospital and national routine health checkups. We plan to perform prospective external validation, hoping that the developed DM prediction models will be widely used in clinical practice.

Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

PURPOSE: This study aimed to evaluate the prognosis of necrotizing enterocolitis (NEC) according to the extent of involvement, among very low birth weight infants. Furthermore, the predictive factors for extent of involvement were evaluated. METHODS: Medical records of all newborns with surgically treated NEC admitted to the neonatal intensive care unit of Seoul National University Children's Hospital between 2005 and 2013 were reviewed. Infants were grouped according to the extent of involvement of NEC: isolated segment involvement (ISI, n=31) and multi-segment involvement (MSI, n=17). We evaluated the clinical characteristics, outcomes, and pre-operative factors according to symptoms, laboratory and radiologic findings. RESULTS: The incidence of small for gestational age was significantly higher in the MSI than ISI group (12.9% vs. 41.2%, P=0.036). The length of resected bowel was significantly longer (1.7 cm vs. 8 cm, P=0.010), and the incidence of short bowel syndrome (SBS) (0% vs. 23.1%, P=0.023) and mortality (3.2% vs. 23.5%, P=0.047) were significantly higher in the MSI than ISI group. However, there was no significant difference between the two groups in terms of high-output stoma, time of full enteral feeding, extrauterine growth retardation, changes of z-score of body weight between admission and discharge and reoperation. Portal vein gas detected by ultrasonography was the only statistically significant predictive factor of extent of involvement (odds ratio=13.237, P=0.029). CONCLUSION: SBS and mortality were higher in MSI NEC compared to ISI NEC. However, there was no difference in the time of full enteral feeding and growth between the two groups. Portal vein gas detected by ultrasonography maybe a predictive factor of extent of NEC.
Body Weight ; Enteral Nutrition ; Enterocolitis, Necrotizing* ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Medical Records ; Mortality ; Portal Vein ; Prognosis* ; Reoperation ; Seoul ; Short Bowel Syndrome ; Ultrasonography

PURPOSE: We aimed to evaluate the effects of two different macrolide prophylaxis protocols (prenatal and postnatal) for Ureaplasma on the development of bronchopulmonary dysplasia (BPD). METHODS: We retrospectively reviewed the medical charts of 121 preterm infants whose birth weights were <1,250 g or gestational ages were <30 postmenstrual weeks. The demographic and clinical characteristics, including the presence of BPD, were compared between a prophylactic group, who received macrolide as prophylaxis prenatally and postnatally according to risk level, and a confirmed treatment group, who received macrolide prenatally and postnatally after detection of Ureaplasma infection. RESULTS: Seventy-four (61.2%) of 121 preterm infants were included in the prenatal prophylaxis group. No significant differences in demographic characteristics were observed between the prenatal prophylaxis and prenatal confirmed treatment group. The detection rate of Ureaplasma and the frequency of postnatal therapeutic treatment with macrolide were lower in the prenatal prophylaxis group than in the prenatal confirmed treatment group (16.2% vs. 40.4%, P=0.003; 8.1% vs. 48.9%, P< 0.001, respectively). Although no significant differences in the incidence of moderate to severe BPD, the rate of severe BPD was lower in the prenatal prophylaxis group than in prenatal confirmed treatment group (18.9% vs. 40.4%, P=0.010). No significant differences in the incidences of BPD of any level of severity were observed between the postnatal prophylaxis and confirmed treatment groups. CONCLUSION: Administration of prenatal prophylaxis with macrolide decreased the detection rate of Ureaplasma after birth and was associated with the decrease in the incidence of severe BPD in preterm infants.
Birth Weight ; Bronchopulmonary Dysplasia* ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Macrolides ; Parturition ; Retrospective Studies ; Ureaplasma Infections ; Ureaplasma*

PURPOSE: Capillary hemangiomas occur more frequently in preterm infants. We aimed to describe the clinical course of capillary hemangiomas in preterm infants. METHODS: The records of preterm infants with a gestational age (GA) of <35 weeks who were admitted to two tertiary neonatal intensive care units from January 2004 to December 2013 and had capillary hemangiomas were reviewed retrospectively. Subgroup analysis of between infants of GA <30 weeks and GA 30-34+6 weeks were done and ad hoc analysis comparing study population and matched preterm infants without hemangioma for investigation of differences in clinical characteristics. RESULTS: Of the 2,772 preterm infants, 112 (4%) infants developed capillary hemangiomas. The majority (91.9 %) of them had a solitary hemangiomas with the trunk was the most commonly involved site (43%). Three quarters of the patients were treated with topical corticosteroid, propranolol or laser treatment. When we divided this population as who were born before or after GA 30 weeks, there was no difference at postmenstrual age (PMA) of onset of capillary hemangiomas (median [IQR], 36(+4) [30(+5)-40(+5)] vs. 36+2 [33(+6)-41(+1)] weeks, P = 0.275). The age at involution of capillary hemangiomas was also not differ between two groups (median [IQR], 7.75 [3.75-12.25] vs. 7.5 [4-13.75] months, P=0.425). There were no statistical differences between preterm infants with capillary hemangiomas and their age, weight and sex matched control preterm infants without hemangiomas in the neonatal and maternal factors. CONCLUSION: The development of capillary hemangiomas occurred at approximately 36 to 37 weeks of PMA regardless of prematurity in preterm infants. Capillary hemangiomas of preterm infants resolved spontaneously and disappear completely by around 7 months of corrected age.
Capillaries* ; Gestational Age ; Hemangioma ; Hemangioma, Capillary* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units, Neonatal ; Propranolol ; Retrospective Studies

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.
Adult ; Cross-Sectional Studies ; Diphtheria ; Diphtheria-Tetanus-acellular Pertussis Vaccines/*administration & dosage ; Female ; Health Knowledge, Attitudes, Practice/*ethnology ; Humans ; Immunization/*statistics & numerical data ; Infant ; Logistic Models ; Multivariate Analysis ; Patient Acceptance of Health Care/*ethnology/statistics & numerical data ; Pregnancy ; Republic of Korea/epidemiology ; Risk ; Surveys and Questionnaires ; Tetanus ; Vaccination ; Whooping Cough/diagnosis/ethnology