Purpose: Mycoplasma pneumoniae pneumonia (MP) is a major cause of community-acquired pneumonia (CAP) in children and is associated with extrapulmonary manifestations (EPM). The incidence and risk factors for EPM in children are unknown. Methods: This was a retrospective study involving 65,243 pediatric patients with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Medical records were reviewed to collect information regarding the clinical characteristics, radiological results, and laboratory findings. Logistic regression with multivariate analysis was performed to evaluate the risk factors associated with EPM in MP. Results: The incidence of EPM was 23.9%, including elevation of liver enzymes (18.1%), mucocutaneous manifestations (4.4%), proteinuria (4.1%), cardiovascular and neurological manifestations (0.4%), hematologic manifestations (0.2%), and arthritis (0.2%). Statistical analysis showed that mucocutaneous manifestations significantly increased with elevated alanine aminotransferase (adjusted odds ratio [aOR], 3.623; 95% confidence interval [CI], 1.933-6.790) and atopic sensitization (aOR, 2.973; 95% CI, 1.615–5.475) and decreased with respiratory virus coinfection (aOR, 0.273; 95% CI, 0.084–0.887). Elevated liver enzymes were significantly associated with elevated lactate dehydrogenase (aOR, 3.055; 95% CI, 2.257–4.137), presence of pleural effusion (aOR, 2.635; 95% CI, 1.767–3.930), and proteinuria with respiratory virus coinfection (aOR, 2.245; 95% CI, 1.113–4.527). Conclusion Approximately 24% of pediatric patients with MP had various EPM. As the risk factors associated with each EPM were different, it is necessary to evaluate the various clinical aspects and findings of MP to predict and prepare for the occurrence of EPM.

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.
Air Filters ; Air Pollution ; Animals ; Asthma ; Child ; Dander ; Dogs ; Education ; Environmental Exposure ; Humans ; Logistic Models ; Odds Ratio ; Ownership ; Risk Factors ; Smoke ; Social Change ; Tobacco

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.
Asthma ; Caregivers ; Child ; Delivery of Health Care ; Humans ; Hypersensitivity ; Korea ; Medication Adherence ; Transdermal Patch

PURPOSE: Croup is known to have epidemics in seasonal and biennial trends, and to be strongly associated with epidemics of parainfluenza virus. However, seasonal and annual epidemics of croup have not been clearly reported in Korea. This study aimed to examine the seasonal/annual patterns and etiologies of childhood croup in Korea during a consecutive 6-year period. METHODS: Pediatric croup data were collected from 23 centers in Korea from 1 January 2010 to 31 December 2015. Electronic medical records, including multiplex reverse transcription polymerase chain reaction (RT-PCR) results, demographics and clinical information were cross-sectionally reviewed and analyzed. RESULTS: Overall, 2,598 childhood croup patients requiring hospitalization were identified during the study period. Among them, a total of 927 who underwent RT-PCR were included in the analysis. Males (61.5%) predominated, and most (63.0%) of them were younger than 2 years of age (median, 19 months; interquartile range, 11–31 months). Peak hospitalization occurred in 2010 and 2012 in even-numbered years, and parainfluenza virus (PIV, 39.7%) was the most common cause of childhood croup requiring hospitalization, followed by respiratory syncytial virus (14.9%), human rhinovirus (12.5%), Mycoplasma pneumonaie (10.6%), and human coronavirus (7.3%). CONCLUSION: It is concluded that croup hospitalization has a biennial pattern in even-numbered years. PIV may be the most common cause of childhood croup; however, croup epidemics could be attributed to other viruses.
Child ; Coronavirus ; Croup ; Demography ; Electronic Health Records ; Hospitalization ; Humans ; Korea ; Male ; Mycoplasma ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Reverse Transcription ; Rhinovirus ; Seasons

PURPOSE: Recently, the prevalence and disease burden of asthma have increased. Thus, the need for early diagnosis and appropriate management of asthma is emerging. However, it is difficult to identify the diagnosis, symptoms and the prevalence of asthma due to lack of reliable investigating items. The purpose of this study was to develop a standardized survey format in order to assess the prevalence of asthma in Koreans. METHODS: We investigated surveys and related information that are utilized to assess asthma diagnosis and prevalence by systematic review. After that, Delphi survey was conducted on 44 Korean allergists in order to develop a standardized survey in Korea. The process consisted of 3 serial rounds across 3 age groups. Each subsequent round narrowed investigating items for the decision of standard set about asthma prevalence, current asthma, and asthma aggravation. RESULTS: Lifetime asthma was defined as “ever doctor-diagnosed asthma” in all age groups. Current asthma was defined as “treatment for asthma during the past 12 months” in all age groups, and “doctor-diagnosed asthma during the past 12 months” was added on the ≥5-year-old and adult groups. “Wheezing ever” was defined as “wheezing at any time in the past,” and current wheeze was defined as “wheezing in the last 12 months.” Asthma aggravation was defined as “visits at the emergency department or admission due to asthma attack within the last 12 months” in all age groups. CONCLUSION: We established applicable nationwide definitions of “lifetime asthma,” “current asthma,” and “asthma aggravation” in Koreans by the Delphi survey.
Adult ; Asthma ; Diagnosis ; Early Diagnosis ; Emergency Service, Hospital ; Humans ; Korea ; Prevalence

PURPOSE: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. METHODS: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. RESULTS: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. CONCLUSION: Nasal eosinophilia was significantly associated with sensitization to aeroallergens.
Adolescent* ; Alternaria ; Ambrosia ; Animals ; Artemisia ; Cats ; Child* ; Cynodon ; Dactylis ; Dermatophagoides farinae ; Dogs ; Eosinophilia* ; Eosinophils ; Hospitals, Teaching ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Leukocytes ; Lolium ; Male ; Phleum ; Pyroglyphidae ; Retrospective Studies ; Rhinitis* ; Seoul

PURPOSE: Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP. METHODS: Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP real-time PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed. RESULTS: PCR was positive in 57 cases. Longer fever duration before admission (P < 0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P < 0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P < 0.001). CONCLUSION: Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy.
Antibodies ; Child* ; Diagnosis ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Fever ; Humans ; Immunoglobulin M* ; Mycoplasma pneumoniae ; Mycoplasma* ; Pediatrics ; Pharynx ; Pneumonia ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Respiratory Tract Infections ; ROC Curve ; Sensitivity and Specificity

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.
Airway Obstruction ; Bronchoscopy ; Child* ; Diagnosis ; Foreign Bodies* ; Humans ; Radiography ; Radiography, Thoracic* ; Retrospective Studies ; Sensitivity and Specificity ; Thorax* ; Tomography, X-Ray Computed

Identifying allergic sensitization is important for the proper diagnosis and management of allergic diseases. Skin prick testing and measuring serum specific IgE antibodies are standard tests to confirm allergic sensitization. Skin prick testing has many advantages, but it is difficult to perform on young children. Serum specific IgE can be easily performed on young children, but it can be performed only up to 12 antigens in patients younger than 6 years due to insurance coverage. Therefore, it is important to select appropriate antigens for the patients. Appropriate allergens may vary depending on the patient's age, accompanying disease, and residential area, so that detailed history taking is essential for proper allergen selection. In this review, we will discuss considerations for selecting appropriate allergens for clinicians when performing an allergy test on difficult-to-test children under 6 years of age.
Allergens ; Antibodies ; Asthma ; Child* ; Dermatitis, Atopic ; Diagnosis ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Insurance Coverage ; Rhinitis, Allergic ; Skin

OBJECTIVE: Bone flap resorption (BFR) is a complication of cranioplasty (CP) that increases the risk of brain damage and can cause cosmetic defects. In this study, the risk factors for BFR were examined to improve the prognosis of patients after CP for traumatic brain injury (TBI). METHODS: This study was conducted in 80 patients with TBI who underwent decompressive craniectomy and CP with an autologous bone graft between August 2006 and August 2017. BFR was defined as a >0.1 ratio of the difference between the initial bone flap area and the last bone flap area to the craniectomy size and a < 0.5 ratio of the last bone flap thickness to the bone thickness of the contralateral region on computed tomography scans and plain skull radiographs. The patients were divided into the BFR and non-BFR groups, and medical data were compared between the two groups. RESULTS: Among the 80 patients, 22 (27.5%) were diagnosed as having BFR after CP. The earliest cases of BFR occurred at 57 days after CP, and the latest BFR cases occurred at 3,677 days after CP. Using multivariate logistic regression analyses, the initial dead space size (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001–1.004; p=0.006) and multiplicity of the bone flap (OR, 3.058; 95% CI, 1.021–9.164; p=0.046) were found to be risk factors for BFR. CONCLUSION: The risk factors for BFR in this study were the initial dead space size and multiplicity of the bone flap.
Bone Resorption ; Brain ; Brain Injuries* ; Craniotomy ; Decompressive Craniectomy ; Humans ; Logistic Models ; Prognosis ; Risk Factors* ; Skull ; Transplantation ; Transplants