PURPOSE: Arterial blood gas and pH measurements are the standard by which adequacy of oxygenation and ventilation are assessed. The major problem with arterial punctures is that they can rarely be done without disturbing the neonates. Crying during arterial puncture usually results in change in respiratory patten and thus may result in significant changes in blood gas values. METHODS: Fifteen neonates admitted to NICU during Jan. to Aug. 1997 with pre-existing arterial lines undergoing arterial puncture for blood culture were studied. Only the neonates who cried vigorously during procedure were selected. Neonates were monitored for O2 saturation by pulse oximeter, for heart rate, respiratory rate and non-invasive blood pressure before and during crying. Arterial blood obtained through arterial lines before crying and arterial blood obtained on crying induced by arterial punctures were analyzed. Vital signs, O2 saturation by pulse oximeter before and during arterial punctures were also evaluated. Body weight of the baby patients examined was 1,750-3,090g, gestational age was 34-42 weeks and blood-sampling was performed during the 1st week of life. RESULTS: In the analysis of arterial blood, all data obtained before and during crying were in normal range. Crying decreased PaCO2 38.6+/-5.6mmHg into 30.6+/-6.7mmHg(P<0.05), HCO3 2.8+/-2.1mmol/L into 19.5+/-3.0mmol/L(P<0.01), and O2 saturation 95.1+/-5.6% into 91.0+/-5.6%(P<0.05), respectively. O2 saturation by pulse oximeter also diminished from 98.3+/-3.1% to 88.8+/-7.8%(P< 0.05) during crying. CONCLUSION: The results of this study imply that blood gases obtained by intermittent arterial punctures may provide data that do not accurately reflect the neonates' respiratory status.
Blood Pressure ; Body Weight ; Crying* ; Gases ; Gestational Age ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Oxygen ; Punctures ; Reference Values ; Respiratory Rate ; Vascular Access Devices ; Ventilation ; Vital Signs

BACKGROUND AND OBJECTIVES: Adult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function. SUBJECTS AND METHODS: Forty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated hemoglobin (HbA1c), DM-induced complications, and left ventricular (LV) function as assessed using conventional and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated. RESULTS: The conventional echocardiographic parameters, with the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between the two groups. Using the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) and E'/A' had an inverse correlation with HbA1c (p=0.042 and p=0.016, respectively). CONCLUSION: Patients with DM in childhood and early adolescence rarely have insight on the significance of DM, and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications.
Adolescent ; Adult ; Child ; Deceleration ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diet ; Echocardiography ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Ventricular Function ; Ventricular Function, Left

Kawasaki disease (KD) is an acute, systemic vasculitis of childhood. The early mortality of KD results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction, and the subacute phase of KD has the highest risk of mortality. Although there have been reports of ischemic heart disease as late cardiologic sequelae of KD in young adults, acute myocardial infarction caused by coronary complications in the subacute phase of KD is rare. We experienced one pediatric patient who developed coronary artery aneurysm and acute myocardiac infarction (AMI) during the subacute phase of incomplete and intravenous immunoglobulin (IVIG)-nonresponsive KD. The patient was given a good prognosis due to close monitoring and early recognition of AMI. Physicians should carefully monitor KD patients who do not respond to initial IVIG therapy and who show progressive coronary artery dilatation. If such a patient complaints of chest pain and the ECG shows hyperacute T waves, the physician should suspect development of AMI.
Aneurysm ; Chest Pain ; Coronary Vessels ; Dilatation ; Electrocardiography ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infarction ; Male* ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction* ; Myocardial Ischemia ; Prognosis ; Systemic Vasculitis ; Thrombosis ; Young Adult

We report a caae of hepatic and intestinal infestation with paragonimus wewstermani complicating abscess formation. The pathway by which the paragonimus westermani reaehea liver and intestine is not well understood. However, there was possiblity that it may become lodged in other organs that the lung because of polonged larval migrations through the diaphragm or into various sites in the abdomen. The patient, 52-year-old female gave a history of having reyeatedly consumed raw crabs. An x-ray film of the chest showed clear lunga Skin test for paragonimus-westermani was positive. Abdominal ultrasonogram showed enlargement of the liver with multiple hypoechoic lesiona ERCP revealed multiple ie lesions in the right lobe of the liver. Abdaminal CT showed multifocal abscess cavities with slight rim enhancements. Above meetioned diagnostic procedures suggested liver abscess or hepatoma. Then, an exploratory laparotomy was done for a definite diagnosis, Frozen biopsy, from liver and surgically exe mass from ileocecal region revealed extrpulmonary paragnomiasis involving liver and cecum. Thus, the patient was treated with prasiquantel. Three months later, abdominal ultrasonogram demonstrated slight enlargement of the liver but no evidence of abnormal mass like lesions.
Abdomen ; Abscess ; Biopsy ; Carcinoma, Hepatocellular ; Cecum* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diaphragm ; Female ; Humans ; Intestines ; Laparotomy ; Liver Abscess ; Liver* ; Lung ; Middle Aged ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Praziquantel ; Skin Tests ; Thorax ; Ultrasonography ; X-Ray Film

PURPOSE: The most common cause of bronchiolitis and pneumonia in infants is respiratory syncytial virus (RSV). We evaluated the clinical characteristics according to RSV subgroup in infantile bronchiolitis and pneumonia. METHODS: This study enrolled infants with bronchiolitis or pneumonia infected by single virus. Virus infection was confirmed by respiratory virus reverse transcriptase polymerase chain reaction in two consecutive seasons (2010-2011, 2011-2012). They were divided into 3 groups: group 1 with RSV A, group 2 with RSV B, and group 3 with other virus. We retrospectively reviewed the medical charts to collect data on the hospitalized patients. RESULTS: Seventy four and 181 infants were included in the two seasons, respectively. The most common virus was RSV B in 2010-2011 and RSV A in 2011.2012. Among 255 infants, 55% (141/255) were group 1, 20% (49/255) group 2, 25% (65/255) group 3. Infants younger than 3 months were 55%. There were no significant age differences between groups. In comparison to group 3, group 1 and 2 showed frequent abnormal chest auscultation, high symptom severity score and need for systemic corticosteroid (P<0.05). In comparison to group 1 and 3, group 2 had longer hospitalization and time to need for normalization of lung sound (P<0.05). The recurrence rates within 6 months showed no significant differences between groups. CONCLUSION: The RSV subgroup changed from one year to another. Patients' clinical manifestations and symptom severity may vary according to infected virus subgroup.
Auscultation ; Bronchiolitis ; Hospitalization ; Humans ; Infant ; Pneumonia ; Recurrence ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Seasons ; Thorax ; Viruses

A recently recognized connective tissue disorder, Loeys-Dietz syndrome (LDS) is a genetic aortic aneurysm syndrome caused by mutations in the transforming growth factor-receptor type I or II gene (TGFBR1 or TGFBR2). They have distinctive phenotypic abnormalities including widely spaced eyes (hypertelorism), bifid uvula or cleft palate, and arterial tortuosity with aortic aneurysm or dissection throughout the arterial tree. LDS is characterized by aggressive and rapid progression of aortic aneurysm. Therefore, the patients with distinct phenotype, marked aortic dilatation and aneurysm at early age should be suspected to be affected by LDS and rapid TGFBR gene analysis should be done. We report one child diagnosed as LDS due to typical phenotypes and two novel missense mutations of the TGFBR2 gene (c.1526G>T and c.1528A>T).
Aneurysm ; Aortic Aneurysm ; Arteries ; Child ; Cleft Palate ; Connective Tissue ; Dilatation ; Eye ; Humans ; Joint Instability ; Loeys-Dietz Syndrome ; Mutation, Missense ; Phenotype ; Protein-Serine-Threonine Kinases ; Receptors, Transforming Growth Factor beta ; Skin Diseases, Genetic ; Thorax ; Uvula ; Vascular Malformations

We report the case of a 7-year-old boy who showed treatment-nonresponsive hypotension (59/29 mmHg) and decreased left ventricular systolic function (fractional shortening 22%) in the acute stage of Kawasaki disease (KD). The present case serves to highlight that methylprednisolone pulse therapy should be considered in patients with intravenous immunoglobulin nonresponsive symptomatic myocarditis during the acute stage of KD.
Adrenal Cortex Hormones ; Child ; Humans ; Hypotension ; Immunoglobulins* ; Male ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Myocarditis*

An apparent life-threatening event (ALTE) is defined as the combination of clinical presentations such as apnea, marked change in skin and muscle tone, gagging, or choking. It is a frightening event, and it predominantly occurs during infancy at a mean age of 1–3 months. The causes of ALTE are categorized into problems that are: gastrointestinal (50%), neurological (30%), respiratory (20%), cardiovascular (5%), metabolic and endocrine (2%–5%), or others such as child abuse. Up to 50% of ALTEs are idiopathic, where the cause cannot be diagnosed. Infants with an ALTE are often asymptomatic at hospital and there is no standard workup protocol for ALTE. Therefore, a detailed initial history and physical examination are important to determine the extent of the medical evaluation and treatment. Regardless of the cause of an ALTE, all infants with an ALTE should require hospitalization and continuous cardiorespiratory monitoring and evaluation for at least 24 hours. The natural course of ALTEs has seemed benign, and the outcome is generally associated with the affected infants' underlying disease. In conclusion, systemic diagnostic evaluation and adequate treatment increases the survival and quality of life for most affected infants.
Airway Obstruction ; Apnea ; Child ; Child Abuse ; Gagging ; Hospitalization ; Humans ; Infant ; Infantile Apparent Life-Threatening Event ; Physical Examination ; Quality of Life ; Skin

PURPOSE: The objectives of this study were to assess ventricular function by tissue Doppler imaging in children who were receiving chemotherapy or who had received chemotherapy, and to apply repeated tissue Doppler imaging to make an early assessment in cardiac toxicity studies. METHODS: This study was conducted on 23 oncology patients on-treatment or off-treatment from April 2005 to July 2005 at Dongsan Medical Center, Keimyung University. All patients(group 1) were divided into two groups, fractional shortening(FS) over 29 percent(group 2) and FS under 28 percent (group 3) in the first category. These same patients were also divided into the following groups:group treated with anthracyclin(group 4) and group treated without anthracyclin(group 5). Deceleration time(DT), isovolumic relaxation time(IVRT), FS, peak early diastolic(E), and peak late diastolic (A) velocity of transmitral flow were measured by M-mode and pulsed wave Doppler. Systolic(Sm), peak early diastolic(Em), and peak late diastolic(Am) velocity in apical 4-chamber and 2-chamber views were measured by tissue Doppler imaging. The author calculated a modified Tei index, E/A, E/Em ratio by using measured values. RESULTS: Twenty three patients were enrolled:12 boys and 11 girls. The average age of patients was 8 years and 4 months. Thirteen out of 23 patients were in the group treated with anthracyclin (group 4) and 6 had FS under 28 percent(group 3). E/Em ratio showed a significant difference between group 1 and control group(6.46+/-1.85 vs 7.06+/-1.64, P<0.05). Other parameters had no difference statistically. CONCLUSION: This study showed that the change of cardiac function developed earlier in diastolic function than in systolic function, as E/Em ratio reflecting the mean LV diastolic pressure showed a significant difference between the control group and chemotherapy groups. Echocardiography using tissue Doppler imaging is a non-invasive, comfortable and reliable method for post-chemotherapy follow up.
Blood Pressure ; Child* ; Deceleration ; Drug Therapy ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Relaxation ; Ventricular Function

We investigated the clinical presentations, diagnostic and therapeutic modalities, and prognosis from follow-up of infants with apparent life-threatening events (ALTE). In addition, the relationship between the clinical characteristics of patients and significant intervention scores was analyzed. We enrolled patients younger than 12 months who were diagnosed with ALTE from January 2005 to December 2012. There were 29 ALTE infants with a peak incidence of age younger than 1 month (48.3%). The most common symptoms for ALTE diagnosis were apnea (69.0%) and color change (58.6%). Eleven patients appeared normal upon arrival at hospital but 2 patients required cardiopulmonary resuscitation during the initial ALTE. The most common ALTE cause was respiratory disease, including respiratory infection and upper airway anomalies (44.8%). There were 20 cases of repeat ALTE and 2 cases of death during hospitalization. Four patients (15.4%) experienced recurrence of ALTE after discharge and 4 patients (15.4%) showed developmental abnormalities during the follow-up period. The patients with ALTE during sleep had lower significant intervention scores (P=0.015) compared to patients with ALTE during wakefulness and patients with previous respiratory symptoms had higher significant intervention scores (P=0.013) than those without previous respiratory symptoms. Although not statistically significant, there was a weak positive correlation between the patient's total ALTE criteria and total significant intervention score (Fig. 2, r=0.330, P=0.080). We recommend that all ALTE infants undergo inpatient observation and evaluations with at least 24 hr of cardiorespiratory monitoring, and should follow up at least within a month after discharge.
Age Distribution ; Clinical Decision-Making ; Critical Care/*statistics & numerical data ; Critical Illness/*mortality/*therapy ; Female ; *Hospital Mortality ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Survival Rate ; Treatment Outcome