PURPOSE: Neonatal seizures are one of the most common neurologic manifestations in neonates and could be the important clinical sign of underlying brain disorders. The aim of this study is to review the clinical characteristics and to find the prognostic factors related to the outcomes of neonatal seizures. METHODS: We reviewed medical records retrospectively in 23 patients with neonatal seizures who admitted to Dankook University Hospital from July 2007 to June 2009. RESULTS: During the study period, neonatal seizures were diagnosed in 23/1,474 (1.56%) neonates. Nineteen of them (82.6%) were term and 4 were preterm. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (n=8, 35%). Other various causes included metabolic disorders (n=4, 17%, carnitine palmitoyl transferase 1 deficiency, severe hypernatremic dehydration, prolonged severe hypoglycemia, and pyridoxine dependent seizure), intracranial hemorrhages (n=2, 9%), congenital brain anomaly (callosal dysgenesis, hemimegalencephaly) (n=2, 9%), and infection (congenital syphilis, early neonatal sepsis, n=2, 9%). Among nineteen neonates (82.6%) who were treated with anticonvulsants, we could not stop the anticonvulsants in six of them (32%). They had severe HIE, prolonged severe hypoglycemia with residual encephalomalatic changes, sinovenous thrombotic hemorrhages due to antithrombin III deficiency, congenital brain anomaly, and septic shock, respectively. CONCLUSION: Approximately one third of neonatal seizures were caused by HIE, and moderate to severe HIE had more serious outcomes. Neonatal seizure could be a significant clinical sign indicating specific underlying etiologies such as stroke, metabolic disturbances or congenital brain anomalies. Therefore, intensive workup and prompt management for neonatal seizures should be considered for better outcomes.
Anticonvulsants ; Antithrombin III Deficiency ; Brain ; Brain Diseases ; Carnitine ; Dehydration ; Hemorrhage ; Humans ; Hypoglycemia ; Hypoxia-Ischemia, Brain ; Infant, Newborn ; Intracranial Hemorrhages ; Medical Records ; Neurologic Manifestations ; Prognosis ; Pyridoxine ; Retrospective Studies ; Seizures* ; Sepsis ; Shock, Septic ; Stroke ; Syphilis ; Transferases

PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.
Anorexia ; Demography ; Escherichia coli ; Fever ; Glucose ; Haemophilus influenzae ; Hand ; Headache ; Hearing ; Hospitals, General ; Humans ; Influenza, Human ; Leukocyte Count ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Neisseria meningitidis ; Paresis ; Pneumonia ; Prognosis ; Retrospective Studies ; Seizures ; Streptococcus ; Streptococcus pneumoniae ; Subdural Effusion ; Vaccination ; Vomiting

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child's age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the vicious cycle of chronic diarrhea and is one of the main one thing among treatments. We should know the exact concept of chronic diarrhea and provide appropriate treatments according to etiologies of chronic diarrhea.
Child ; Diarrhea ; Humans

PURPOSE: We investigated the effect of location changes in the inferior border of the belly board (BB) aperture by adding a bladder compression device (BCD). MATERIALS AND METHODS: We respectively reviewed data from 10 rectal cancer patients with a median age 64 years (range, 45~75) and who underwent computed tomography (CT) simulation with the use of BB to receive pelvic radiotherapy between May and September 2010. A CT simulation was again performed with the addition of BCD since small bowel (SB) within the irradiated volume limited boost irradiation of 5.4 Gy using the cone down technique after 45 Gy. The addition of BCD made the inferior border of BB move from symphysis pubis to the lumbosacral junction (LSJ). RESULTS: Following the addition of BCD, the irradiated volumes of SB and the abdominopelvic cavity (APC) significantly decreased (174.3+/-89.5 mL vs. 373.3+/-145.0 mL, p=0.001, 1282.6+/-218.7 mL vs. 1571.9+/-158 mL, p<0.001, respectively). Bladder volume within the treated volume increased with BCD (222.9+/-117.9 mL vs. 153.7+/-95.5 mL, p<0.001). The ratio of irradiated bladder volume to APC volume with BCD (33.5+/-14.7%) increased considerably compared to patients without a BCD (27.5+/-13.1%) (p<0.001), and the ratio of irradiated SB to APC volume decreased significantly with BCD (13.9+/-7.6% vs. 24.2+/-10.2%, p<0.001). The ratios of the irradiated SB volumeand irradiated bladder volume to APC volume negatively correlated (p=0.001). CONCLUSION: This study demonstrated that the addition of BCD, which made the inferior border of BB move up to the LSJ, increased the ratio of the bladder to APC volume and as a result, decreased the irradiated volume of SB.
Humans ; Rectal Neoplasms ; Urinary Bladder

PURPOSE: A number of countries have experienced an increase in pertussis during the past decade. In particular, there has been an increase in the incidence rate among adolescents and adults. To learn more about the current epidemiology of pertussis, we studied the prevalence and clinical characteristics of pertussis in children in Cheonan, South Korea. METHODS: We collected nasopharyngeal aspirates of 118 patients who were treated for respiratory symptoms at Dankook Univeristy Hospital between March 2008 and September 2009. We performed multiplex PCR for detection of Bordetella pertussis in those aspirates. RESULTS: Of the 118 patients, 10 (8%) were positive by PCR for B. pertussis. Six episodes occurred during the period July to September 2009. Nine of the 10 patients were less than 3 months old. Seven of them had not received DTaP vaccine. The mean duration of coughing before diagnosis was 10.9+/-5.2 days. Ten patients (100%) had paroxysmal cough and 8 (80%) had post-tussive vomiting. Only one patient had fever. One who had complications that include pneumonia, atelectasis and pneumomediastinum developed an absolute increase in leukocyte count (84,400/mm3). There was a statistically significant relation between vaccine being received and development of complications (P=0.033). CONCLUSION: We suspect that there was an epidemic of pertussis between July and September 2009. Further investigation by a pediatric or nationwide surveillance system is needed to monitor the changing epidemiology for pertussis.
Adolescent ; Adult ; Bordetella pertussis ; Child ; Cough ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Fever ; Humans ; Incidence ; Korea ; Leukocyte Count ; Mediastinal Emphysema ; Multiplex Polymerase Chain Reaction ; Organothiophosphorus Compounds ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Pulmonary Atelectasis ; Republic of Korea ; Vomiting ; Whooping Cough

PURPOSE: To investigate whether growth hormone (GH) has a protective effect on neurons in hippocampal slice cultures of neonatal rats exposed to oxygen-glucose deprivation (OGD). METHODS: Cultured hippocampal slices of 7-day-old rats were exposed to OGD for 60 min. Then, the slices were immediately treated with three doses of GH (5, 50, or 500 micrometer) in media. The relative fluorescent densities of propidium iodide (PI) uptake in the slices and relative lactate dehydrogenase (LDH) activities in the media were determined and compared between each GH-treated group of slices and untreated slices (control) at 12 and 24 h after OGD. Immunofluorescent staining for caspase-3 and TUNEL staining were performed to observe the effect of GH on apoptotic neuronal death. RESULTS: The relative fluorescent densities of PI uptake in CA1 and dentate gyrus (DG) of the hippocampal slices in each GH-treated group were not significantly different from those in the untreated slices at 12 and 24 h after OGD (P>0.05). Treatment with GH could reduce the relative LDH activities in the media of the GH-treated groups only at 12 h after OGD (P<0.05). Expression of caspase-3 and TUNEL positivity in CA1 and DG of the slices treated with 50-iM GH were not different from those of the untreated slices at 12 and 24 h after OGD. CONCLUSION: Treatment of hippocampal slice cultures with GH after OGD does not show a definitive protective effect on neuronal death but can reduce the LDH efflux of the slices in media at 12 h after OGD.
Animals ; Apoptosis ; Caspase 3 ; Dentate Gyrus ; Growth Hormone ; In Situ Nick-End Labeling ; L-Lactate Dehydrogenase ; Neurons ; Propidium ; Rats

PURPOSE: To investigate whether growth hormone (GH) has a protective effect on neurons in hippocampal slice cultures of neonatal rats exposed to oxygen-glucose deprivation (OGD). METHODS: Cultured hippocampal slices of 7-day-old rats were exposed to OGD for 60 min. Then, the slices were immediately treated with three doses of GH (5, 50, or 500 micrometer) in media. The relative fluorescent densities of propidium iodide (PI) uptake in the slices and relative lactate dehydrogenase (LDH) activities in the media were determined and compared between each GH-treated group of slices and untreated slices (control) at 12 and 24 h after OGD. Immunofluorescent staining for caspase-3 and TUNEL staining were performed to observe the effect of GH on apoptotic neuronal death. RESULTS: The relative fluorescent densities of PI uptake in CA1 and dentate gyrus (DG) of the hippocampal slices in each GH-treated group were not significantly different from those in the untreated slices at 12 and 24 h after OGD (P>0.05). Treatment with GH could reduce the relative LDH activities in the media of the GH-treated groups only at 12 h after OGD (P<0.05). Expression of caspase-3 and TUNEL positivity in CA1 and DG of the slices treated with 50-iM GH were not different from those of the untreated slices at 12 and 24 h after OGD. CONCLUSION: Treatment of hippocampal slice cultures with GH after OGD does not show a definitive protective effect on neuronal death but can reduce the LDH efflux of the slices in media at 12 h after OGD.
Animals ; Apoptosis ; Caspase 3 ; Dentate Gyrus ; Growth Hormone ; In Situ Nick-End Labeling ; L-Lactate Dehydrogenase ; Neurons ; Propidium ; Rats

PURPOSE: Thyroid hormone is essential for development of the brain in early life. Thyroid dysfunction is more common in the first 2-4 postnatal weeks of life in premature infants than in term infants. This study aimed to identify the prevalence and clinical course of thyroid dysfunction in prematurity. METHODS: Premature infants admitted to and given neonatal screenings at Dankook University Hospital between April 1999 and March 2008 were included in this study. We retrospectively reviewed medical records and categorized subjects into six groups: normal, hypothyroidism, hyperthyrotropinemia, hypothyroxinemia, delayed onset of hypothyroidism, and delayed onset of hyperthyrotropinemia. METHODS: Among 599 subjects, 136 (23%) had initially abnormal thyroid function test (TFT); transient hypothyroxinemia was the most frequent condition (118, 20%). In addition, 8 (17%) of 46 subjects with initially normal TFT levels showed delayed onset of hyperthyrotropinemia with or without low free thyroxine (fT4). Thyroxine was prescribed for 10 patients (1.7%) due to low fT4 levels but was discontinued in 9 patients during follow-up. Thyroid scan confirmed ectopic thyroid in one patient. CONCLUSION: Thyroid dysfunction was frequently seen in premature infants, but most of the conditions were transient. In addition, some infants showed delayed TSH elevation on routine follow-up. Therefore, a recheck of the thyroid function of premature infants at 3-4 weeks is recommended, even if normal thyroid function is initially seen, especially in prematurity of less than 33 weeks of gestational age or birth weight of less than 2,500 grams.
Birth Weight ; Brain ; Follow-Up Studies ; Gestational Age ; Humans ; Hypothyroidism ; Infant ; Infant, Newborn ; Infant, Premature ; Medical Records ; Neonatal Screening ; Prevalence ; Retrospective Studies ; Thyroid Dysgenesis ; Thyroid Function Tests ; Thyroid Gland ; Thyroxine

PURPOSE: Thyroid hormone is essential for development of the brain in early life. Thyroid dysfunction is more common in the first 2-4 postnatal weeks of life in premature infants than in term infants. This study aimed to identify the prevalence and clinical course of thyroid dysfunction in prematurity. METHODS: Premature infants admitted to and given neonatal screenings at Dankook University Hospital between April 1999 and March 2008 were included in this study. We retrospectively reviewed medical records and categorized subjects into six groups: normal, hypothyroidism, hyperthyrotropinemia, hypothyroxinemia, delayed onset of hypothyroidism, and delayed onset of hyperthyrotropinemia. METHODS: Among 599 subjects, 136 (23%) had initially abnormal thyroid function test (TFT); transient hypothyroxinemia was the most frequent condition (118, 20%). In addition, 8 (17%) of 46 subjects with initially normal TFT levels showed delayed onset of hyperthyrotropinemia with or without low free thyroxine (fT4). Thyroxine was prescribed for 10 patients (1.7%) due to low fT4 levels but was discontinued in 9 patients during follow-up. Thyroid scan confirmed ectopic thyroid in one patient. CONCLUSION: Thyroid dysfunction was frequently seen in premature infants, but most of the conditions were transient. In addition, some infants showed delayed TSH elevation on routine follow-up. Therefore, a recheck of the thyroid function of premature infants at 3-4 weeks is recommended, even if normal thyroid function is initially seen, especially in prematurity of less than 33 weeks of gestational age or birth weight of less than 2,500 grams.
Birth Weight ; Brain ; Follow-Up Studies ; Gestational Age ; Humans ; Hypothyroidism ; Infant ; Infant, Newborn ; Infant, Premature ; Medical Records ; Neonatal Screening ; Prevalence ; Retrospective Studies ; Thyroid Dysgenesis ; Thyroid Function Tests ; Thyroid Gland ; Thyroxine

PURPOSE: We performed this study to compare the TSH and free T4 levels according to gestational age and birth weight, and to reevaluate the cut-off values in the neonatal screening test for congenital hypothyroidism. METHODS: Total 2,133 neonates(1,749 healthy newborns and 384 sick neonates) were screened in Dankook University Hospital from May 2000 to January 2003. Neonates with abnormal TSH values (higher than 20 microliterU/mL) or abnormal free T4 levels(lower than 1 ng/dL) were recalled to recheck the thyroid function test. At that time, physical examinations and history-taking regarding perinatal problem, medication history, and mother's illness were undertaken. RESULTS: Serum TSH and free T4 values revealed no significant difference according to sex, delivery type, and Apgar score. The free T4 levels showed statistically significant differences, with gestational age or birth weight(P<0.01). The recall rate of neonates due to abnormal screening test was 7.48 percent. Compared with original cut-off values, the recall rate of the new cut-off values setted to TSH higher than 20 microliterU/mL or free T4 lower than 0.64 ng/dL decreased from 7.48 percent to 4.8 percent in the healthy group. But, it compromised sensitivity when applied to the sick group. CONCLUSION: In this study, neonatal free T4 levels were significantly different according to birth weight, gestational age, and the presence of compromised condition. Although the recall rate by TSH >20 microliterU/mL or free T4<1 ng/dL was relatively high, it was impossible to set up new cut-off values without compromising sensitivity. We think studies including a larger study population will be required to change the cut-off values.
Apgar Score ; Birth Weight ; Congenital Hypothyroidism* ; Gestational Age ; Humans ; Infant, Newborn ; Mass Screening ; Neonatal Screening* ; Parturition ; Physical Examination ; Thyroid Function Tests