Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI). Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent 99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups. Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P=0.00). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P=0.00). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P=0.00). Conclusions Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.

An infant’s sleep varies considerably from that of adults in terms of structure, amount, and breathing pattern. After birth, sleep becomes evenly distributed throughout the day and night. Nighttime sleep gradually increases with the maturation of circadian rhythm, and sleep is gradually consolidated. Electroencephalography characteristics change with age, from early and dominant active (REM) sleep in newborns to increasing NREM sleep. Similar to other elements of growth, the upper respiratory tract and ribcage gradually increase in size with age, and respiratory control also improves. With these changes, sleep patterns also change. At this time that various sleep disorders may appear. Improved understanding of age-dependent changes in infant sleep can help determine the etiology and facilitate diagnosis of infant sleep diseases.

An infant’s sleep varies considerably from that of adults in terms of structure, amount, and breathing pattern. After birth, sleep becomes evenly distributed throughout the day and night. Nighttime sleep gradually increases with the maturation of circadian rhythm, and sleep is gradually consolidated. Electroencephalography characteristics change with age, from early and dominant active (REM) sleep in newborns to increasing NREM sleep. Similar to other elements of growth, the upper respiratory tract and ribcage gradually increase in size with age, and respiratory control also improves. With these changes, sleep patterns also change. At this time that various sleep disorders may appear. Improved understanding of age-dependent changes in infant sleep can help determine the etiology and facilitate diagnosis of infant sleep diseases.

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.
Child ; Cicatrix ; Diagnosis ; Discrimination (Psychology) ; Fever ; Humans ; Infant ; Kidney ; Methods ; Prognosis ; Pyelitis ; Pyelonephritis ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections

PURPOSE: We investigated whether a renal size discrepancy on a renal sonogram (US) in children with febrile urinary tract infection (UTI) was correlated with the presence of cortical defects on their dimercaptosuccinic acid (DMSA) renal scan. METHODS: We examined 911 children who were admitted consecutively to our hospital with their first episode of febrile UTI from March 2001 to September 2014. All enrolled children underwent a US and DMSA scan during admission. According to the US findings, including the renal size discrepancy, data were compared between children with positive and negative DMSA scan results. A positive DMSA scan result was defined as reduced or absent tracer localization and indistinct margins that did not deform the renal contour. RESULTS: Mean renal lengths of the right and left kidneys were larger in children with positive DMSA scan results than in children with negative DMSA scan results (63.2±11.3 mm vs. 58.4±7.8 mm, P<0.001; 64.9±11.2 mm vs. 59.9±7.9 mm, P<0.001; respectively). A significant difference was observed in both renal lengths between children with positive and negative DMSA scan results (4.6±3.8 mm vs. 3.3±2.6 mm, P<0.001). A multiple logistic regression analysis, revealed that a small kidney, cortical thinning, and a renal length discrepancy on US findings were significant factors for predicting the presence of cortical defects on an acute DMSA scan [P=0.028, 95% confidence interval (CI) 1.054–2.547; P=0.004, 95% CI 1.354–4.810; P<0.001, 95% CI 1.077–1.190, respectively]. CONCLUSION: In conclusion, a renal size discrepancy on US findings in children with their first episode of febrile UTI was a helpful tool for predicting the presence of cortical defects on an acute DMSA scan.
Child ; Humans ; Kidney ; Logistic Models ; Pyelonephritis ; Succimer ; Urinary Tract Infections

PURPOSE: This study aimed to compare the neonatal outcome by quantifying the effect of maternal age on low birth weight (LBW). METHODS: We reviewed the medical records of 12,742 newborn infants born at CHA Bundang Medical Center from January 2009 to December 2013. Infants were compared after being categorized by the following 4 maternal age groups - <25 years (N=343), 25-34 years (N=8,573), 35-39 years (N=3,186), > or =40 years (N=640). Statistical analysis included use of logistic regression models with likelihood ratio tests for interaction effects. RESULTS: Incidence of perinatal complications tended to increase significantly with maternal age - gestational diabetes mellitus (GDM; P<0.001), pregnancy induced hypertension (PIH; P=0.019), placenta previa (P<0.001), and cesarean section (P<0.001). Compared to the age group of 25-34 years (reference group), no significant differences were found in age group of 35-39 year [odds ratio (OR)=0.945, 95% confidence interval (CI) 0.847-1.056, P=0.319] and > or =40 years (OR=0.841, 95% CI 0.671-1.056, P=0.136) for LBW. After adjusted by gestational age, incidence of in vitro fertilization (IVF), and perinatal complications, maternal age was not found to be an independent risk factor for LBW (OR=0.847, 95% CI 0.730-0.982, P=0.028 for 35-39 years, and OR=0.652, 95% CI 0.481-0.884, P=0.006 for > or =40 years). CONCLUSION: Although incidence of perinatal complications tends to increase with age, neonatal outcome of age group of > or =35 years measured by incidence of LBW infants was not unfavorable compared to the reference group. The result suggests that the thorough prenatal care may be more important than the maternal age itself.
Cesarean Section ; Diabetes, Gestational ; Female ; Fertilization in Vitro ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Logistic Models ; Maternal Age* ; Medical Records ; Parturition* ; Placenta Previa ; Pregnancy ; Prenatal Care ; Risk Factors

Menkes disease is caused by mutations in the ATP7A gene that lead to intracellular copper transport defects and characterized by brownish twisted (kinky) hair accompanied by growth retardation and intellectual disability. Reduced nitric oxide (NO) production contributes to infantile hypertrophic pyloric stenosis (IHPS) because NO plays an important role in smooth muscle relaxation. Here we describe a case of Menkes disease and IHPS in a 72-day-old male patient with severe persistent vomiting and convulsions with a novel ATP7A mutation.
Copper ; Hair ; Humans ; Intellectual Disability ; Male ; Menkes Kinky Hair Syndrome* ; Muscle, Smooth ; Nitric Oxide ; Nitric Oxide Synthase ; Pyloric Stenosis ; Pyloric Stenosis, Hypertrophic* ; Relaxation ; Seizures ; Vomiting

PURPOSE: Sleep onset association disorder (SOAD) is a form of behavioral insomnia observed in children that is caused by inappropriate sleep training. SOAD typically disturbs the sleep of not only infants and children but also their parents. We investigated levels of depression and marital intimacy among parents of infants with typical SOAD, to understand the influence of SOAD on family dynamics, as well as examine ways for improving depression and marital intimacy through behavioral training. METHODS: Depression and marital intimacy were assessed using the Beck Depression Inventory (BDI) and Waring Intimacy Questionnaire (WIQ). These measures were administered to 65 parents of infants (n=50) diagnosed with SOAD. We conducted sleep education and behavioral training for the parents and compared levels of depression and marital intimacy after 2-6 weeks of training. RESULTS: The 65 parents consisted of 50 mothers and 15 fathers. Depressive symptoms were higher among mothers than fathers (P =0.007). Marital intimacy was negatively correlated with depressive symptoms. Twenty-six parents were assessed again after sleep training. We found that mothers' depressive symptoms and marital intimacy improved post training. CONCLUSION: SOAD can be detrimental to both infants and parents, especially for parents who sleep with their infants. For instance, disruption of sleep patterns in such parents can reduce marital intimacy. However, behavioral modification is an effective treatment for infants with frequent nighttime waking, as well as for diminishing the depressive symptoms of sleep-deprived parents.
Child ; Depression ; Fathers ; Humans ; Infant ; Mothers ; Parents ; Surveys and Questionnaires ; Sleep Initiation and Maintenance Disorders

PURPOSE: South Korean adolescents have been identified as a chronic partial sleep-deprived population in several previous studies. This study was to identify the current nocturnal sleep duration by age in South Korean adolescents and to analyze the association of emotional status factors such as subjective happiness, depression and suicidal attempts, and health-risk behaviors with the nocturnal sleep duration. METHODS: The findings in this study are based on the data obtained from the 7th Korea Youth Risk Behavior Web-Based Survey (KYRBWS-VII), a cross-sectional, annual survey of the health-risk behaviors in a representative sample of South Korean middle- and high-school students aged 13-18 years, which was conducted in 2011. Out of 75,643 students from 800 schools across the nation, 75,205 students were selected by using the complex sampling design of the survey. We analyzed the relationships between the duration of nocturnal sleep and emotional status (subjective happiness, stress level, depression, and suicidal thoughts), health-risk behaviors (smoking, drinking), and sleep satisfaction. RESULTS: There was a significant relationship between the duration of sleep and the emotional status. In general, happy students had the longest nocturnal sleep duration, regardless of their grades. Self-rated stress levels and depression in adolescents were inversely proportional to nocturnal sleep duration. Health-risk behaviors such as smoking and alcohol consumptions were more common in sleep-deprived students (P<0.001). CONCLUSION: Appropriate nocturnal sleep duration is critical for emotional health as well as prevention of suicide in the adolescent population.
Adolescent* ; Depression ; Happiness ; Humans ; Korea ; Risk-Taking ; Sleep Deprivation ; Smoke ; Smoking ; Suicidal Ideation ; Suicide

Enterovirus infection is often aggravated and manifests as various neurological complications such as aseptic meningitis, brainstem encephalitis, poliomyelitis-like acute flaccid paralysis, transverse myelitis, and severe systemic diseases. There are a few reports indicating that enterovirus is associated with acute disseminated encephalomyelitis (ADEM), acute flaccid paralysis, or Guillain-Barre syndrome separately. However, none of these report ADEM and acute flaccid paralysis occurring simultaneously. Here, we present a case of combined ADEM and acute flaccid paralysis associated with enteroviral infection in a child and reviewed the relevant literature. A 5-year-old boy was admitted to the hospital for headache and vomiting with evident meningeal irritation signs. Despite of antibiotic therapy, his mental state rapidly declined to coma with abnormal upper motor neuron (UMN) signs. During 5 consecutive days of steroid pulse therapy, his abnormal UMN signs abruptly changed to flaccid paralysis. Suspected acute flaccid paralysis due to enterovirus prompted the addition of intravenous immunoglobulin (IVIG). On hospital day 33, he was discharged with full recovery of muscle tone and strength with an alert mental state.
Attention Deficit Disorder with Hyperactivity ; Brain Stem ; Child ; Child, Preschool ; Coma ; Encephalitis ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated* ; Enterovirus ; Enterovirus Infections ; Guillain-Barre Syndrome ; Headache ; Humans ; Immunoglobulins ; Male ; Meningitis, Aseptic ; Motor Neurons ; Muscle Hypotonia ; Muscles ; Myelitis, Transverse ; Paralysis* ; Vomiting