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Increment in vitamin D level and bone mineral accrual in children with vitamin D deficiency.

Yashwant Kumar RAO ; Tanu MIDHA ; Satyajeet SINGH ; Anurag BAJPAI ; Amita TILAK

Korean Journal of Pediatrics.2016;59(7):292-297. doi:10.3345/kjp.2016.59.7.292

PURPOSE: To compare different regimens of vitamin D with respect to its serum increment levels and bone mineral accrual in vitamin D-deficient children. METHODS: Children identified as being vitamin D deficient (serum levels<20 ng/mL) were divided into 3 treatment groups by stratified block randomization (group 1, 4,000 IU/day of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; group 2, 30,000 IU/wk of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; and group 3, 300,000 IU of vitamin D3 once intramuscularly plus 50 mg/kg/day calcium). After regimen completion, each child received a maintenance dose of 400 IU/day vitamin D3 plus 50 mg/kg/day calcium. Their serum vitamin D level was measured after 3 and 12 months. Total body less head bone mineral concentration (BMC) and total body less head bone mineral density (BMD) were measured after 12 months. RESULTS: The mean increment in serum vitamin D levels from baseline to 3 months was significantly higher in group 3 than in groups 1 and 2, but the levels from 3 to 12 months were almost similar among all 3 groups. There were no significant differences among the 3 groups with respect to percentage increase of BMD and BMC. CONCLUSION: The injectable form of vitamin D was more efficacious than the oral forms in increasing the serum level to the normal range. All 3 regimens were equally effective in increasing the BMC and BMD. The 400 IU/day maintenance dose was sufficient to keep the serum level within the normal range.
Bone Density ; Calcium ; Child* ; Cholecalciferol ; Head ; Humans ; Miners* ; Random Allocation ; Reference Values ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

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White matter injury following rotavirus infection in neonates: new aspects to a forgotten entity, 'fifth day fits'?.

Jung Sook YEOM ; Chan Hoo PARK

Korean Journal of Pediatrics.2016;59(7):285-291. doi:10.3345/kjp.2016.59.7.285

That rotavirus infection can cause neurological symptoms in young children has been well established. However, it is surprising why rotavirus infection has been overlooked as a cause of neonatal seizures for many years, despite significant research interest in neonatal rotavirus infection. Neonates are the age group most vulnerable to seizures, which are typically attributed to a wide range of causes. By contrast, because rotavirus infection is usually asymptomatic, it has been difficult to identify an association between this virus and neonatal seizures. The conventional wisdom has been that, although neonates are commonly infected with rotavirus, neurological complications are rare in this age. However, recent studies using diffusion-weighted imaging (DWI) have suggested a connection between rotavirus infection and neonatal seizures and that rotavirus infection can induce diffuse white matter injury without direct invasion of the central nervous system. The clinical features of white matter injury in rotavirus-infected neonates include the onset of seizures at days 4–6 of life in apparently healthy term infants. The recent findings seem to contradict the conventional wisdom. However, white matter injury might not be a completely new aspect of rotavirus infection in neonates, considering the forgotten clinical entity of neonatal seizures, 'fifth day fits'. With increased use of DWI in neonatal seizures, we are just starting to understand connection between viral infection and white matter injury in neonates. In this review, we discuss the historical aspects of rotavirus infection and neonatal seizures. We also present the clinical features of white matter injury in neonatal rotavirus infection.
Central Nervous System ; Child ; Humans ; Infant ; Infant, Newborn* ; Rotavirus Infections* ; Rotavirus* ; Seizures ; White Matter*

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Intervention with Balloon Valvuloplasty followed by Patent Ductus Arteriosus Stent in a Patient with Pulmonary Atresia with Intact Ventricular Septum.

Han Hyuk LIM ; Young Deuk KIM ; Jae Hwan LEE ; Mea Young CHANG ; Hong Ryang KIL

Korean Journal of Pediatrics.2005;48(11):1256-1259.

Pulmonary atresia with intact ventricular septum (PAIVS) is rare, less than 1% of congenital heart disease. It needs a therapeutic approach according to its individual morphologic feature. Surgical treatment of valvotomy and modified Blalock-Taussig shunt or non-surgical interventional catheter balloon valvuloplasty can be used for mild to moderate hypoplasia of right ventricle. Fontan operation can be considered for less optimum morphological substrate of two ventricular repair. A 3- day-old male neonate was admitted with cyanosis and cardiac murmur. On echocardiogram, he had membranous pulmonary atresia with intact ventricular septum, normal sized tripartite right ventricle, large atrial septal defect with right-to-left shunt, small sized patent ductus arteriosus, and moderate tricuspid regurgitation. He was treated with intravenous continuous infusion of prostaglandin E1 (PGE1) at once. On the third day of hospitalization, Balloon valvuloplasty was performed. After insertion of patent ductus arteriosus stent on the tenth day, PGE1 infusion was discontinued. On the fifteenth day, he was discharged. Now, he is 9 months old and has nearly normal cardiac structure and function with 97% of percutaneous oxygen saturation.
Male ; Infant, Newborn ; Humans

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A Single Nucleotide Deletion resulting in Frameshift in Two Korean Neonates with Thyroxine-Binding Globulin Deficiency.

Sang Joon PARK ; Jin Soon SUH ; Min Ho JUNG ; Hee Jin LEE ; Byung Kyu SUH ; Won Bae LEE ; Byung Churl LEE

Korean Journal of Pediatrics.2005;48(11):1252-1255.

Abnormalities in the levels of thyroxine-binding globulin (TBG) are not associated with clinical disease and they do not require treatment. Congenital TBG deficiency is inherited in an X-linked manner. To date, some complete and partial TBG variants and one polymorphism have been identified by analysis of the TBG gene. Two male neonates were referred to us because of their low T4 levels that were noted on the neonatal screening test. They showed normal levels of free T4 and TSH. Their serum TBG was not detectable and those values of their parents were within the normal ranges. The genomic DNA was extracted from their white blood cells and the four coding exons of the TBG gene were amplified by using polymerase chain reaction. Sequencing of the four coding regions and all the intron/exon junctions revealed a single nucleotide deletion of the first base of the codon 352 of the mature protein in both of the neonates. This mutation resulted in a frameshift and a premature stop codon (TGA) 374. Their mothers were shown to be heterozygotes. We detected a single nucleotide deletion resulting in a frameshift in two male Korean neonates who had complete TBG deficiency.
Male ; Infant, Newborn ; Humans

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Different Clinical Courses of Henoch-Schonlein Purpura in Children, Adolescents and Adults.

Joo Hee HONG ; Hyung Joon NA ; Mee Kyung NAMGOONG ; Seung Ok CHOI ; Byng Geun HAN ; Soon Hee JUNG ; Hwang Min KIM

Korean Journal of Pediatrics.2005;48(11):1244-1251.

PURPOSE: Henoch-Schonlein purpura (HSP) is the most common and benign systemic vasculitis in children. Few reports have focused on worse outcomes of HSP in adults. The age of onset is suggested as a main risk factor. We assessed the characteristics of adolescent-onset HSP. METHODS: We retrospectively analyzed 205 cases presented from Aug. 1993 to Oct. 2003. Patients were classified as children (< 10 years of age), adolescents (10-20 years of age), and adults (> 20 years of age). RESULTS: The mean age was 5.7+/-1.8 years in 149 children, 13.5+/-2.4 years in 38 adolescents, and 44.9+/-14.5 years in 18 adults. The male to female ratio was 1.2: 1 in children and adolescents, and 2: 1 in adults. Previous upper respiratory infections were found in 53.4 percent of children, 32.4 percent of adolescents, and 33.3 percent of adults. Positivity of stool occult blood was more frequent in adults (50.5 percent) than in children (23.0 percent) (P< 0.05). Renal involvement was found in 46 cases (30.9 percent) of children, 23 cases (60.5 percent) of adolescents, and 15 cases (83.3 percent) of adults. Recurrences occurred in 23 cases (15.4 percent) of children, nine cases (23.7 percent) of adolescents, and three cases (16.7 percent) of adults. Among the cases with renal involvement, 97.8 percent of children and 87.0 percent of adolescents improved to normal or asymptomatic urinary abnormalities. 60.0 percent of adults persisted with severe nephropathy and 13.3 percent progressed to renal insufficiency. CONCLUSION: Although the outcome of adolescent HSP was as good as children, the clinical manifestations were similar to those of adults. Adolescents had the highest rate of recurrences. Thus long term observations may be needed in adolescent onset HSP.
Child ; Adolescent ; Adult ; Male ; Female ; Humans ; Risk Factors

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Serum Ferritin as a Risk Factor in Type 2 Diabetes Mellitus.

Jung Hyun KIM ; Ho Seong KIM ; Duk Hee KIM

Korean Journal of Pediatrics.2005;48(11):1239-1243.

PURPOSE: Iron accumulation interferes with hepatic insulin extraction and affects insulin synthesis and secretion. The purpose of this study is to investigate the correlation between serum ferritin and type 2 diabetes mellitus. METHODS: We compared the serum ferritin level among 18 patients in an impaired glucose tolerance (IGT) group, 36 in a type 1 diabetes group, eight in a type 2 diabetes group and 29 in a healthy control group. The correlation between serum ferritin levels and sex, body mass indices (BMI), blood pressure (BP), serum fasting sugar level and serum fasting insulin level were also analyzed. RESULTS: The mean log ferritin were 1.33+/-0.32 (healthy control group), 1.63+/-0.19 (IGT group) and 1.90+/-0.30 (type 2 diabetes group). In the IGT group, log ferritin was higher than in the healthy control group (P=0.001). The log ferritin of the type 2 diabetes group was higher than that of the healthy control group (P=0.001). Comparing log ferritin to other factors, log ferritin had a significant positive correlation with body mass indices (P< 0.001), systolic blood pressure (P=0.001), and fasting glucose (P= 0.001), fasting insulin (P=0.002). CONCLUSION: Compared to the normal healthy group, serum ferritin concentrations were significantly higher in the IGT group and the type 2 diabetes group. The elevation of serum ferritin concentration may be a risk factor of type 2 diabetes mellitus.
Risk Factors

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Lorenzo's Oil Treatment in X-linked Adrenoleukodystrophy.

Hyo Jung KIM ; Eun Young KIM ; Young Jong WOO ; Hoon KOOK

Korean Journal of Pediatrics.2005;48(11):1232-1238.

PURPOSE: Though more than 15 years have passed after introduction of Lorenzo's oil therapy in X- linked adrenoleukodystrophy (ALD), its efficacy is still fully not known. In patients who already have neurologic symptoms, most reports indicate that the neurologic disability continues to increase. We evaluated its efficacy in X-linked ALD patients. METHODS: Four patients who were treated with Lorenzo's oil for at least 12 months were enrolled from 1996 to 2003. During treatment, changes of neurologic symptoms, brain magnetic resonance imaging (MRI) findings, and serum saturated very long-chain fatty acid (C26: 0) were assessed. RESULTS: Two patients with childhood cerebral ALD had progression of neurologic symptoms and MRI lesions during treatment. One asymptomatic patient developed childhood cerebral ALD after six year treatment of Lorenzo's oil. One "Addison only" patient remained neurologically intact after three years. During Lorenzo's oil therapy, serum C26: 0 levels which had increased at diagnosis decreased in all four patients. CONCLUSION: Treatment with Lorenzo's oil did not prevent disease progression in childhood cerebral ALD patients who were already symptomatic. Long term follow up will be needed in asymptomatic ALD including "Addison only" to reveal the efficacy of Lorenzo's oil.
Child ; Male ; Female ; Humans

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Comparison of Epileptic Seizures between Preterm and Term-born Epileptic Children with Periventricular Leukomalacia.

Hee Jeong JEONG ; Eun Sil LEE ; Han Ku MOON

Korean Journal of Pediatrics.2005;48(11):1225-1231.

PURPOSE: This study compares the first epileptic seizures between preterm and term-born children with periventricular leukomalacia and epilepsy. METHODS: From 108 cases having lesions of high signal intensity around the ventricles in T2 weighted imaging of a brain magnetic resonance study, we selected 37 cases that showed epileptic seizures two times or more and divided them into the group of preterm-born (27 cases) and term- born children (10 cases). A retrospective study was made by comparing the two groups with regard to age, type of the first epileptic seizures, EEG findings and responsiveness to anticonvulsants. RESULTS: The age of the first epileptic seizure was 22.2+/-18.3 months in the preterm-born group and 26.9+/-21.1 months in the term-born group (P=0.505). As for the first epileptic seizure, 11 out of the 27 cases in the preterm-born group had infantile spasms. Out of the 10 cases in the term-born group, 7 had complex partial seizures. In the preterm group, hypsarrhythmias were found in 11 cases, focal epileptiform discharges in 6 cases. In term-born group, focal epileptiform discharges were found in 5 cases but no epileptiform discharge was found in 3 cases. Intractable epilepsies were diagnosed in 6 cases and all of them belonged to the preterm-born group. CONCLUSION: More severe epilepsies such as infantile spasm and intractable epilepsies seem to be more common in preterm-born epileptic children with PVL as well as more severely abnormal EEG finding compared to term-born epileptic children.
Infant ; Child ; Male ; Female ; Humans

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The Relation between Obesity and Glomerular Filtration Rate in Children and Adolescents.

Youngsu JUNG ; Dongwoon KIM ; Inseok LIM

Korean Journal of Pediatrics.2005;48(11):1219-1224.

PURPOSE: The prevalence of obesity in children and adolescents has been rising rapidly in Korea because of changes of diet and lifestyle. As with adults, obesity in children and adolescents can cause diabetes mellitus, hyperlipidemia, cardiovascular diseases and renal diseases. The aim of the present study is to examine the relation of obesity, glomerular filtration rate (GFR) and serum cystatin C concentration in children and adolescents. METHODS: Data of 115 children and adolescents aged between 6 years and 20 years without clinical evidence of renal diseases were included in the study. From May 2004 to December 2004, blood samples were collected from children and adolescents who were seen at the Department of Pediatrics at Chungang University Yongsan Hospital. Obesity degrees and body mass indices (BMI) were measured, and GFRs were estimated from Schwartz's formula. Serum cystatin C was measured by particle enhanced nephelometric immunoassay using Behring Nephelometer II. RESULTS: GFRs were significantly different between the obese group (BMI > 95 percentile, 145.79+/-23.10 mL/min) and the non-obese group (BMI < 95 percentile, 134.61+/-26.19 mL/min) divided by BMI (P=0.031). GFRs were not significantly different between the obese group (obesity degree > 120 percent, 144.29+/-23.08 mL/min) and the non-obese group (obesity degree < 120 percent, 134.54+/-26.57 mL/ min) divided by obesity degree (P=0.051), but were significantly different between severe obese group (obesity degree > 150 percent, 155.55+/-20.40 mL/min) and the non-obese group (P=0.004). GFRs were correlated positively with BMI (r2=0.037, P=0.039), but were not correlated significantly with obesity degree (r2=0.030, P=0.066). Serum cystatin C concentrations were not significantly different between the obese group and the non-obese group, divided by BMI as well as by obesity degree (P> 0.05). CONCLUSION: Obesity may lead to an alteration of renal hemodynamics such as hyperfiltration, appropriate control and management for obesity is necessary.
Child ; Adolescent ; Adult ; Male ; Female ; Humans

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Clinical Features of Symptomatic Neonates with Ebstein's Anomaly.

Hee Jin CHO ; In Sil LEE ; Jae Kon KO

Korean Journal of Pediatrics.2005;48(11):1212-1218.

PURPOSE: Forward pulmonary blood flow may be absent in some neonates with Ebstein's anomaly by anatomical or functional pulmonary atresia in association with the elevated pulmonary vascular resistance, patent ductus arteriosus and tricuspid regurgitation. We reviewed the presentation and outcomes of symptomatic neonates with Ebstein's anomaly focusing on the pulmonary atresia. METHODS: Clinical presentation and outcome of 15 symptomatic neonates with Ebstein's anomaly seen at Asan medical center from 1998 to 2004 were reviewed. RESULTS: Ten (67%) of 15 patients showed no forward pulmonary blood flow and 6 of them had functional pulmonary atresia. O2 saturation and pH were lower and cardiothoracic (CT) ratio in chest radiography was more increased in the patients with pulmonary atresia than in the patients without pulmonary atresia (P< 0.05). pH and CT ratio were not different between the anatomical and functional pulmonary atresia group, but O2 saturation was lower in functional atresia group (P< 0.05). 13 patients (87%) were managed with PGE1. 4 of 6 patients with functional pulmonary atresia were treated with inhaled nitric oxide. Surgery was performed in 1 of 5 patients without pulmonary atresia and in 8 of 10 patients with pulmonary atresia during follow-up period (mean 37 months). 3 patients (20%) died and none of patients without pulmonary atresia died. CONCLUSION: We found that most symptomatic neonates with Ebstein's anomaly had functional or anatomical pulmonary atresia. The neonates with Ebstein's anomaly who had no forward pulmonary blood flow were more symptomatic and needed surgery earlier. Further studies will be needed to distinguish effectively functional and anatomical pulmonary atresia and to manage appropriately neonates with functional atresia.
Infant, Newborn ; Humans

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