• Pediatric Infection and Vaccine
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• v.19 no.3
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• pp.89-110
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• 2012

Meningococcal Disease, manifesting as meningitis and septicemia, is a life-threatening bacterial infection that results in significant morbidity and mortality, particularly in childhood. Its epidemic potential and limited opportunities for clinical intervention due to its rapid course present unique public health and clinical challenges. Incidence is highest in infants and young children, with a secondary peak of risk in adolescents. Approximately 10% of cases are fatal and survivors can be left with serious and permanent sequelae including amputations, hearing loss and cognitive impairment. Transmission is only from human-to-human, by infected respiratory tract secretions or saliva and therefore crowding poses a tremendously elevated risk for disease development. Military recruits and university students are at high risk due to the high carriage rate in adolescents, their behavior patterns and close contact. Menveo$^{(R)}$ (Novartis Vaccines and Diagnostics), a novel quadrivalent meningococcal conjugate vaccine directed against meningococcal serogroups A, C, W-135 and Y, has been shown to be immunogenic and well tolerated in all age groups and was recently licensed for use in Korea. Recent cases and deaths among military recruits drew public attention to their elevated risk and the Korean government has recommended vaccination of all new military recruits. Many Korean students seek to attend school, university, or language institutes in countries where routine meningococcal vaccination is required - clinicians should be aware of such requirements to ensure that students are vaccinated prior to arrival in the destination country.

• Clinical and Experimental Pediatrics
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• v.57 no.4
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• pp.164-170
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• 2014

Influenza causes acute respiratory infections and various complications. Children in the high-risk group have higher complication and hospitalization rates than high-risk elderly individuals. Influenza prevention in children is important, as they can be a source infection spread in their communities. Influenza vaccination is strongly recommended for high-risk children with chronic underlying circulatory and respiratory disease, immature infants, and children receiving long-term immunosuppressant treatment or aspirin. However, vaccination rates in these children are low because of concerns regarding the exacerbation of underlying diseases and vaccine efficacy. To address these concerns, many clinical studies on children with underlying respiratory diseases have been conducted since the 1970s. Most of these reported no differences in immunogenicity or adverse reactions between healthy children and those with underlying respiratory diseases and no adverse effects of the influenza vaccine on the disease course. Further to these studies, the inactivated split-virus influenza vaccine is recommended for children with underlying respiratory disease, in many countries. However, the live-attenuated influenza vaccine (LAIV) is not recommended for children younger than 5 years with asthma or recurrent wheezing. Influenza vaccination is contraindicated in patients with severe allergies to egg, chicken, or feathers, because egg-cultivated influenza vaccines may contain ovalbumin. There has been no recent report of serious adverse events after influenza vaccination in children with egg allergy. However, many experts recommend the trivalent influenza vaccine for patients with severe egg allergy, with close observation for 30 minutes after vaccination. LAIV is still not recommended for patients with asthma or egg allergy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.2
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• pp.80-84
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• 2014

Clostridium difficile infection has been increasing since 2000 in children and in adults. Frequent antibiotics use, comorbidity, and the development of hypervirulent strains have increased the risk of infection. Despite the high carriage rates of C. difficile, infants rarely develop clinical infection. Discontinuing antibiotics and supportive management usually leads to resolution of disease. Antibiotics use should be stratified depending on the patient's age and severity of the disease.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.90-100
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• 2004

Objective : Urinary tract infection(UTI) is a frequent serious bacterial infection in young infants. The clinical presentation may be non-specific and variable, depends on factors such as the age and the level of infection. Children with renal involvement may be at risk of permanent renal damage. Experimental studies have shown that renal lesions caused by acute febrile UTI may be prevented or diminished by early diagnosis and treatment. Therefore, it is important to find a method that can permit early diagnosis and identification of patients who are at risk for progressive renal damage. We designed this study to identify related factors in culture positive UTI infants, and also to identify related factors in culture negative UTI infants, who are febrile with pyuria, by using renal imaging and functional studies including renal sonography, DMSA scan and VCUG. Methods : Retrospectively analyzed the medical records of 136 febrile infants with pyuria over 2 years(from January 2001 to February 2003). Urine culture was done in all cases, and regardless of urine culture findings, renal imaging study was done if symptomatic UTI suspected. Results : Total 57 organisms were isolated in 53 patients. E. coli was the most common organism(86%), followed by E. faecalis, M. morganii, Proteus species, P. aeruginosa, S. aureus and E. fergusonii. Most of the isolates had high sensitivity on cephalosporins or amikacin and had low sensitivities on aminopenicillins. Abnormal acute phase DMSA scan or VCUG findings were seen in both urine culture positive and negative group without statistical differences(P>0.05). In febrile infants with pyuria, fever over 48 hours, older age and high CRP related to abnormal acute phase DMSA scan findings regardless urine culture results. Conclusion : 1st or 3rd generation cephalosporins with amikacin could be the first choice of treatment for UTI. Febrile infants with positive urine culture dose mean urinary tract infection but not acute pyelonephritis which directly relates to cortical damage which could be confirmed by acute phase DMSA scan. Even cases with negative urine culture findings, acute pyelonephritis should be concerned in febrile infants with pyuria who are older than 3 months of age, has fever over 48 hours or high CRP level. And in such cases, acute phase DMSA scan and VCUG should be evaluated for early treatment and long term prognosis.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.27-33
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• 2005

Purpose : To determine incidence, characteristics and risk factors associated with intrauterine intraventricular hemorrhage(IU-IVH) among premature infants. Methods : The medical records of infants with intraventricular hemorrhage(IVH) admitted to the neonatal intensive care unit of Asan Medical Center from January 1999 to June 2003 were reviewed retrospectively. Infants whose IVH with cystic change were detected within five days of life were defined as the IU-IVH group. The control group included those without any IVH. Various maternal and neonatal factors were evaluated between the IU-IVH and control groups, and risk factors for IU-IVH were identified using multiple logistic regression analysis. Results : The incidence of IU-IVH was 49/1024(15.9%). Mothers who are younger, primiparous, use less antenatal steroid, and neonates with greater incidence of neonatal respiratory distress syndrome, had higher incidences of IU-IVH compared to neonates with normal neurosonography. Risk factors associated with IU-IVH included neonatal respiratory distress syndrome and placenta infarct by placenta biopsy. Most infants with IU-IVH were ${\geq}1,501g$, ${\geq}34$ weeks gestational age and had low grade IVH. The size of the cysts associated with IU-IVH remained the same or disappeared in 96 %. IU-IVH does not seem to affect short-term neurodevelopmental outcome although a longer period of follow-up is needed. Conculusion : IU-IVH occurred mostly in ${\geq}1,501g$, ${\geq}34$ weeks infants with grade I IVH without developmental delays. However, the high incidence of total IVH merits more attention in terms of awareness of its existence as an unusual IVH among premature infants.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.636-642
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• 2007

Purpose : Fluconazole prophylaxis for very low birth weight (VLBW) infants has been shown to reduce invasive fungal infection and its mortality. This study aims to evaluate the effect of fluconazole prophylaxis in VLBW infants on the incidence and mortality of fungal infection. Methods : VLBW infants with endotracheal intubation and central vascular access admitted to the Neonatal Intensive Care Unit (NICU) at Chonnam University Hospital were enrolled. Twenty eight infants of 7-month baseline period from January to July 2005 ('non-fluconazole group') were compared with 29 infants of a 7-month fluconazole period from January to July 2006 ('fluconazole group'). Results : Gestational age, birth weight, sex, mode of delivery, frequency of twin pregnancy, chorioamnionitis, antenatal steroid and rupture of membranes were similar between the fluconazole and non-fluconazole groups. The rate of extremely low birth weight (ELBW) infants, frequency and duration of prophylactic antibiotics, total parenteral nutrition and umbilical catheters, duration of intralipid, mechanical ventilation and nasal continuous positive airway pressure (CPAP) were also not significant. However, frequency of percutaneous central venous catheterization (PCVC) and intralipid administration, and duration of PCVC were significant between the two groups. The overall incidence and mortality of fungal infection were not different between the two groups. Although the Malassezia infection was increased in the fluconazole group (P<0.05), candida was significantly decreased compared to the non-fluconazole group (P<0.05). Conclusion : Fluconazole prophylaxis in high risk VLBW infants decreased the candida infection significantly. Antifungal prophylaxis is recommended in terms of cost effectiveness, but further study is needed to clarify the reason for the increase of Malassezia infection.

• Journal of Korean Neurosurgical Society
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• v.61 no.3
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• pp.393-401
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• 2018

The prognosis of brain tumors in children has improved for last a few decades. However, the prognosis remains dismal in patients with recurrent brain tumors. The outcome for infants and young children in whom the use of radiotherapy (RT) is very limited because of unacceptable long-term adverse effect of RT remains poor. The prognosis is also not satisfactory when a large residual tumor remains after surgery or when leptomeningeal seeding is present at diagnosis. In this context, a strategy using high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) has been explored to improve the prognosis of recurrent or high-risk brain tumors. This strategy is based on the hypothesis that chemotherapy dose escalation might result in improvement in survival rates. Recently, the efficacy of tandem HDCT/auto-SCT has been evaluated in further improving the outcome. This strategy is based on the hypothesis that further dose escalation might result in further improvement in survival rates. At present, the number of studies employing tandem HDCT/auto-SCT for brain tumors is limited. However, results of these pilot studies suggest that tandem HDCT/auto-SCT may further improve the outcome. In this review, we will summarize our single center experience with tandem HDCT/auto-SCT for recurrent or high-risk brain tumors.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.217-223
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• 2015

The obesity epidemic is a worldwide problem. Factors predisposing to obesity include genetics, race, socioeconomic conditions, birth by cesarean section, and perinatal antibiotic use. High protein (HP) content in infant formulas has been identified as a potential culprit predisposing to rapid weight gain in the first few months of life and leading to later obesity. In a large multicountry study the effects of lower protein (LP) formula (1.77 and 2.2 g protein/100 kcal, before and after the 5th month, respectively) were compared to those of higher protein (2.9 and 4.4 g protein/100 kcal, respectively). Results indicated that at 24 months, the weight-for-length z score of infants in the LP formula group was 0.20 (0.06, 0.34) lower than that of the HP group and was similar to that of the breastfed reference group. The authors concluded that a HP content of infant formula is associated with higher weight in the first 2 years of life but has no effect on length. LP intake in infancy might diminish the later risk of overweight and obesity. At 6 years of age HP children had a significantly higher body mass index (by 0.51; 95% confidence interval [CI], 0.13-0.90; p=0.009) and a 2.43 (95% CI, 1.12-5.27; p=0.024) fold greater risk of becoming obese than those who received the LP. In conclusion, several factors may influence development of metabolic syndrome and obesity. Breastfeeding should always be encouraged. An overall reduction of protein intake in formula non breastfed infants seems to be an additional way to prevent obesity.

• Clinical and Experimental Pediatrics
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• v.57 no.8
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• pp.357-362
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• 2014

Purpose: The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. Methods: We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. Results: Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was $1.36{\pm}1.0$ days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was $2.8{\pm}1.4$. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were $4,159{\pm}3,714pg/mL$ and $957{\pm}902pg/mL$, respectively, which decreased significantly in the convalescent phase. Conclusion: Incomplete KD was observed in 87.5% patients. Serum NT- proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.23.1-23.6
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• 2016

Objectives A stable follow-up participation rate is a very important factor for validity in a cohort study. This study analyzed the factors that affect the participation rate at one hospital-based birth cohort in South Korean. Methods The participants were recruited from the Mothers' and Children's Environmental Health study between 2006 and 2010. The analysis targeted 1751 mothers who participated in a birth cohort. We conducted analyses of general characteristics during pregnancy and those of infants at birth that affect the participation rate of the 6-month follow-up survey. Results The participation rate for the 6-month follow-up survey was 60.4%. The participation rate in the follow-up of the subsequent period decreased within a 5% to 10% range compared to the number of subjects. The participation rate of premature infants was 16.9% lower than that of a full-term infant (52.6% vs. 69.5%). Analysis showed a 16.7% difference between the participation rate of low-birthweight infants in follow-ups (53.7%) and the participation rate of infants with normal weight (70.4%). The participation rate of mothers who were employed during pregnancy was significantly lower for the 6-month follow-up compared to the participation rate of mothers who were unemployed during pregnancy. Conclusions In this study, factors such as premature birth, low-birthweight, and the employment status of the mother during pregnancy affected the participation rate of the follow-up survey for the birth cohort at six months. A specific strategy is needed to encourage survey participation for the high risk groups in the follow-ups.