Showing papers in "Korean Journal of Pediatrics in 2008"

2007 Korean National Growth Charts: review of developmental process and an outlook

Abstract: Purpose : Since 1967, The Korean Pediatric Society and Korean Government have developed Korean Growth Standards every 10 years. Last version was published in 1998. During past 40 years, Korean Growth Standards were mainly descriptive charts without any systematic nor statistical standardization. With the global epidemic of obesity, many authorities such as World Health Organization (WHO) and United States' Centers for Disease Control (CDC) have been changed their principles of growth charts to cope with the situations like ours. This article summarizes and reviews the whole developmental process of new 2007 Korean Growth Charts with discussion. Methods : With the initiative of Division of Chronic Disease Surveillance in Korea Centers for Disease Control and Prevention, we have performed new national survey for the development of new Standards in 2005 and identified marked increase of childhood obesity and plateau of secular increment of final height in late adolescents. We have developed new Growth Standards via adapting several innovative methods, including standardization of all available raw data, which were acquired in 1997 and 2005 national survey and full application of LMS method. Results : We could get new standardized charts; weight-for-age, length/height-for-age, weight-for- height, head circumference-for-age and BMI-for-age. Other non-standardized charts based on 2005 survey data were also published; waist circumference-for-age, mid-arm circumference-for-age, chest circumference-for-age and skinfold-for-age. Clinical guideline was also developed. Conclusion : Developmental process and results of new Korean Growth Charts are comparable with other internationally well-known Growth Standards, WHO 2006 Growth Standards and CDC Growth Charts. 2007 Korean Growth Charts are relevant especially in Korea and Korean ethnic groups.

Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005

Abstract: Purpose : The objective of this study was to provide current estimates of the prevalence and examine trends of overweight and obesity in children and adolescents. Methods : Height and weight measurements from 183,159 (112,974 in 1997, 70,185 in 2005) children and adolescents aged 2 to 18 years were obtained via the 1997 and 2005 National Growth Survey. Obesity among children and adolescents was defined as being at or above the 95th percentile of the gender-specific body mass index (BMI) for age in the 2007 Korean National Growth Charts or a BMI of 25 or higher; overweight was defined as being at or above the 85th percentile to less than the 95th percentile BMI. Results : In 2005, 9.7% (11.3% for boys, 8.0% for girls) of South Korean children and adolescents were obese; 19.0% (19.7% for boys, 18.2% for girls) were overweight or obese. The overall prevalence of obesity increased from 5.8% in 1997 to 9.7% in 2005 (from 6.1% in 1997 to 11.3% in 2005 for boys and from 5.5% in 1997 to 8.0% in 2005 for girls); the increasing trend was most evident in boys, especially those aged 13-18 years. Conclusion : The prevalence of obesity among children and adolescents increased significantly during the eight-year period from 1997 to 2005. This study suggests that we need to make a priority of developing strategies to control obesity in children and adolescents; the potential health effects of increases in obesity are of considerable public health importance.

The prevalences of asthma and allergic diseases in Korean children

Abstract: Asthma and allergic diseases are one of the most common disorders in children. Due to its increased prevalence, as well as the increased morbidity and mortality from these diseases, asthma and allergic diseases have come to be recognized as a major worldwide public health issue. In addition, socioeconomic burden of asthma and allergic diseases also has increased in Korea. The International Study of Asthma and Allergies in Childhood (ISAAC) investigated the worldwide prevalence of asthma and other allergic diseases using simple standardized methods because of the comparison of asthma and allergic diseases between the countries. In Korea, several epidemiologic studies have been conducted to determine the prevalence of asthma in children. Although these studies showed increased prevalence of asthma among Korean children (from 3.4% in 1964 to 10.1% in 1989), these findings were based on data from small numbers of subjects. The first Nationwide Study of Asthma and Allergies in Korean Children, which utilized the Korean version of ISAAC written and video questionnaire, was conducted in 1995 and the second Nationwide Study of Asthma and Allergies in Korean Children was conducted in 2000, directed by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We report here the prevalence of asthma and other allergic diseases in Korean children and adolescents, and show the changes that occurred over this 5 year period. We also describe the risk factors for development of these diseases in Korean children. We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 25,117 children selected from 34 elementary school and 14,946 children selected from 34 middle school across the nation, the response rate was 94.8%. In 2000, 27,831 children selected from 34 elementary school and 15,214 children selected from 34 middle school, and the response rate was 96.4%. From these studies, we can confirm that increase of the prevalences of asthma, allergic rhinitis, and atopic dermatitis in Korea, except the prevalence of food allergy. Especially, the video questionnaire showed increases in the lifetime and 12 month prevalence rates of wheeze at rest, exerciseinduced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time in middle school children. In addition, the increase of prevalences of symptoms, diagnosis and treatment of atopic dermatitis was noted significantly. Risk factor analysis showed that body mass index (BMI), passive smoking and living with a dog or cat were associated with higher risk of

Normative blood pressure references for Korean children and adolescents

Abstract: Purpose : It is now understood that blood pressure (BP) measurement in the routine pediatric examination is very important because of the relevance of childhood BP to pediatric health care and the development of adult essential hypertension. There hasn't been a reference table of BP for Korean children and adolescents up to now. This study was to make normative BP references and to provide criteria of hypertension for Korean children and adolescents. Methods : BP measurements were done on 57,433 Koean children and adolescents (male: 29,443, female: 27,990), aged 7 to 20 years, in 2005. Heights and weights were measured simultaneously. Oscillometric devices, Dinamap Procare 200 (GE Inc., Milwaukee, Wi, USA), were used for the measurements. BPs were measured 2 times and mean levels were gathered for the analysis. Outliers of 2,373 subjects with overweight per height, over ＋3SD, were excluded for the analysis. For the BP centiles adjusted by sex, age and height, fixed modified LMS method which was adopted from the mixed effect model of 2004 Task Force in NHLBI (USA) was used. Results : Normative BP tables for Korean children and adolescents adjusted for height percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th), gender (male, female) and age(7 to 18 years) were completed. Height centiles of Korean children and adolescents are available from Korean Center for Disease Control and Prevention homepage, http://www.cdc.go.kr/webcdc/. Criteria of hypertension (95th, 99th percentile) and normal range of BP (50th, 90th) adjusted for height percentiles, age and gender were made. Conclusion : This is the first study to make normative BP tables and define hypertension for the Korean children and adolescents. Reliability and accuracy of Dinamap Procare 200 oscillometer for BP measurements remains debatable.

Epidemiology of anaphylaxis in Korean children

Abstract: Anaphylaxis is an acute systemic reaction caused by IgE-mediated immunological release of mediators from mast cells and basophils to allergenic triggers, such as food, insect venoms, and medications. An alternative definition was recently proposed as follows: anaphylaxis is a "condition caused by an IgE mediated reaction" that is "often life threatening and almost always unanticipated." The reaction can be severe enough to lead to the rapid onset of symptoms, including dizziness, upper airway occlusion, bronchial constriction, hypotension, urticaria, cardiovascular arrhythmias and possible cardiac arrest. The incidence or prevalence of anaphylaxis in Korean pediatrics has not known. Thus, Epidemiology of Anaphylaxis in Pediatrics based on the data from Korean Health Insurance Review and Assessment Service (KHIRA) from 2001 to 2007 and questionnaire to the member of Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD) who are working at the training hospitals was studied. The incidence of anaphylaxis under age 19 is 0.7-1.0 per 100,000 year-person. The causes of anaphylaxis based on data from KHIRA were unknown (61.7%), food (24.9%), medications (12.4%), and serum (1.0%).

Trends in survival rate for very low birth weight infants and extremely low birth weight infants in Korea 1967-2007

Abstract: To investigate the trends in the survival rate (SR) for very low birth weight infants (VLBW) and extremely low birth weight infants (ELBWI) in Korea, a total of 43 articles pertaining to SR were analyzed, covering the years from 1967 to 2007. The changes in SR were compared using 5 year periods. The SR for VLBWI has increased remarkably, from 31.8% in early 1960 to 65.8% in early 1990 and 78.8% in early 2000. The SR for ELBWI has increased from 8.2% in early 1960 to 37.4% in early 1990 and 62.4% in early 2000. The SR has improved steeply since early 1990. When the SRs for VLBWI in Korea were compared with those in the U.S.A. and Japan, the figures were 40%, 72%, and 79% in 1985; 65.8%, 82%, and 86% in 1990; 71.3%, 86%, and 88% in 1995; 78.8%, 86%, and 89% in 2000, respectively. Although the recent SRs for VLBWI and ELBWI in Korea has improved rapidly, they have not yet reached the levels in these highly developed countries. To obtain accurate statistics that could be represented as an SR for premature infants in Korea, we have to develop a nationwide network database project.

Epidemic acute interstitial pneumonia in children occurred during the early 2006s

Abstract: Purpose : This study was aimed to analyze the clinical characteristics of patients with acute interstitial pneumonia who had presented similar clinical patterns from March to June, 2006 and to describe our experience of treatment and to identify risk factors associated with prognosis. Methods : The clinical characteristics, radiologic and histopathologic findings and response to steroids of 15 patients (non-survival group [n=7] and survival group [control, n=8]) with acute interstitial pneumonia were investigated through the review of medical records. Results : The mean age of the patients was 26 (range: 3-48) months. Cough, cyanosis and fever were frequent symptoms. The most frequent radiologic findings on admission were pneumomediastium and extensive ground glass opacity. Surgical lung biopsy was performed on 8/15 (53.3%) patients and diffuse alveolar damage was found. Mechanical ventilation was applied for 9/15 (60.0%) patients for 40 (range: 1-99) days. Five patients in survival group received steroid treatment and 7 patients in non-survivial group (P=0.20). One patient in survival group received steroid pulse treatment and 4 patients in non-survival group (P=0.12). Seven patients died all of respiratory failure. The survival rate was 53.4%. Conclusion : The patients with acute interstitial pneumonia which occurred on spring 2006 showed high mortality because of rapidly and extensively progressing pulmonary fibrosis and air leakage. Therefore, we should consider surgical lung biopsy and steroid application earlier. We should recognize this acute interstitial pneumonia occurring on spring in domestics and need to investigate the cause and treatment in large scale.

Detection and clinical manifestations of twelve respiratory viruses in hospitalized children with acute lower respiratory tract infections : Focus on human metapneumovirus, human rhinovirus and human coronavirus

Abstract: Purpose : This study was perfomed to analyze in detail the viral etiology of acute lower respiratory tract infections (ALRI) in Cheunan, Korea by multiplex RT-PCR, including human rhinovirus (hRV) and newly identified viruses such as human metapneumovirus (hMPV) and human coronavirus (HCoV-OC43, HCoV-229E/NL63). Method : Nasopharyngeal aspirates (NPA) were collected from 863 hospitalized children with ALRI on the first day of admission at Soonchunhyang University Cheonan Hospital and analyzed by multiplex RT-PCR from December 2005 to November 2006. Results : Viral agents were detected from 474 subjects (54.9%). The identified viral pathogens were hRV 9.2%, hMPV 6.8 %, HCoV-229E/NL63 1.4%, and HCoV-OC43 2.1%. Coinfections with ≥2 viruses were observed in 108 patients (22.8%). The major period of viral ALRI was the first year of life. Clinical diagnoses of viral ALRI were pneumonia (59.5%), bronchiolitis (24.7%), tracheobronchitis (11.4%), and croup (4%). The most common causes of bronchiolitis was respiratory syncytial virus B (RSV B), whereas hMPV, hRV, HCoV-229E/NL63, and HCoV-OC43 were commonly found in patients with pneumonia. The number of hMPV infections peaked between March and May 2006. HCoV-OC43 was prevalent from November to February 2006, whereas HCoV-229E and hRV were detected throughout the year. Conclusion : Although the study was confined to one year, hMPV was not detected during winter and peaked between March and April, which was not consistent with previous studies'. This present study indicates that HCoV is a less common respiratory pathogen in cases of ALRI in Korean children

The methodology for developing the 2007 Korean growth charts and blood pressure nomogram in Korean children and adolescents

Abstract: Purpose : This study was to provide the methods of developing the growth charts and the blood pressure nomogram among Korean children and adolescents. Methods : The growth charts were developed based on the data from the national growth surveys for children and adolescents in 1998 and 2005. The percentile charts were developed through two stages. At the first stage, the selected empirical charts were smoothed through several fitting procedures including parametric and non-parametric methods. At the second stage, a modified LMS (lambda, mu, sigma) statistical procedure was applied to the smoothed percentile charts. The LMS procedure allowed to estimate any percentile and to calculate standard deviation units and z-scores. The charts for weight- for-age, height-for-age, BMI-for-age, weight-for-height and head circumference-for-age were developed by sex. Age and normalized height controlled sex-specific nomograms of systolic and diastolic blood pressure were developed by a fixed effect model of general regression using the data from 2005 national growth survey. Results : The significant systemic differences between the percentiles of growth charts and the empirical data were not found. The final output of the study is available from Korean Center for Disease Control and Prevention homepage, http://www.cdc.go.kr/webcdc/. Blood Pressure nomogram was tabulated by height percentiles and age using the regression coefficients analyzed with regression model. Conclusion : 2007 growth charts and blood pressure nomogram were the first products based on the statistical modeling using the national survey data. The further study on the methodology including data collection, data cleaning and statistical modeling for representative growth charts would be needed.

Changes in birth rates of low birth weight and premature infants in Korea over the past 7 years

Abstract: In recent years, Korea has experienced a steadily declining birth rate, which is a serious social problem in the country. Although living conditions have improved, the birth rates for low birth weight infants and preterm babies has increased because more and more women choose to give birth later in life and the social environment has changed. The rise in low birth weight infants may increase infant mortality rates and morbidity rates. However, the recent improvements in neonatal care has elevated the survival rate of low birth weight infants up to 90 percent and lowered the weight of the very low birth weight infants that can now be saved. In this study, we used dynamic population statistics from the Korea National Statistical Office,■which represents the current trend of social stratification and the population of this period. We analyzed birth records for a seven-year period and studied the changes in the delivery rate of preterm and low birth weight infants and the problems related to those changes. The results show that the rate of low birth weight infants has increased from 3.79% to 4.35% for the past seven years. The rate of preterm babies rose from 3.79% to 4.89%. The number of babies born from mothers aged 35 or more went up from 6.69% to 11.83% of the total number of the babies born. As maternal age has risen, the risks of delivering a preterm or low birth weight infant have also increased.

A survey of body shape perception and weight control of adolescent girls in three areas of Korea

Abstract: Purpose : This study aimed to investigate body shape perception, weight control behaviors and eating habits of adolescent girls in urban, suburban and rural areas of Korea to obtain basis for establishing adequate weight control program for adolescent. Methods : From May 2002 to November 2002, a cross-sectional questionnaire survey and physical examination were conducted to examine body shape perception, weight control behaviors, eating habits and health status of 2,891 adolescent girls and 891 boys in Seoul, Ansan and Paju. Results : The proportion of underweight adolescent girl was decreased in rural area than in urban area. 46.3% of girls considered themselves to be somehow or very obese. Notably 3.2% of underweight girls considered themselves obese. 57.9% were unsatisfied with their own body shape. The proportion of dissatisfaction increased with age and body mass index (BMI), but there were no differences among area. The experiences of weight control increased by age, BMI and dissatisfaction of own body shape. The eating attitudes test-26 (EAT-26) score of girls was significantly higher than that of boys. The girls with high risk of eating disorder were 10.9%. And risk factors of eating disorder were living in urban area, severe stress for weight control excessive expenditure for appearance and think themselves unhealthy. Conclusion : The findings of this study demonstrate that there were serious impairment of body shape perception of adolescent girls and unhealthy, inadequate weight control behaviors were widely done. Therefore adequate weight control program for adolescent girl should be established promptly.

Performance effectiveness of pediatric index of mortality 2 (PIM2) and pediatricrisk of mortality III (PRISM III) in pediatric patients with intensive care in single institution: Retrospective study

Abstract: Purpose : To investigate the discriminative ability of pediatric index of mortality 2 (PIM2) and pediatric risk of mortality III (PRISM III) in predicting mortality in children admitted into the intensive care unit (ICU). Methods : We retrospectively analyzed variables of PIM2 and PRISM III based on medical records with children cared for in a single hospital ICU from January 2003 to December 2007. Exclusions were children who died within 2 h of admission into ICU or hopeless discharge. We used Students t test and ANOVA for general characteristics and for correlation between survivors and non-survivors for variables of PIM2 and PRISM III. In addition, we performed multiple logistic regression analysis for Hosmer-Lemeshow goodness-of-fit, receiver operating characteristic curve (ROC) for discrimination, and calculated standardized mortality ratio (SMR) for estimation of prediction. Results : We collected 193 medical records but analyzed 190 events because three children died within 2 h of ICU admission. The variables of PIM2 correlated with survival, except for the presence of post-procedure and low risk. In PRISM III, there was a significant correlation for cardiovascular/neurologic signs, arterial blood gas analysis but not for biochemical and hematologic data. Discriminatory performance by ROC showed an area under the curve 0.858 (95% confidence interval; 0.779-0.938) for PIM2, 0.798 (95% CI; 0.686-0.891) for PRISM III, respectively. Further, SMR was calculated approximately as 1 for the 2 systems, and multiple logistic regression analysis showed χ2 (13)=14.986, P=0.308 for PIM2, χ2 (13)= 12.899, P=0.456 for PRISM III in Hosmer-Lemeshow goodness-of-fit. However, PIM2 was significant for PRISM III in the likelihood ratio test (χ2 (4)=55.3, P

Overview of the national health screening program for infant and children

Abstract: The mission of National Health Screening Program for Infant and Children is to promote and improve the health, education, and well-being of infants, children, families, and communities. Although the term 'diagnosis' usually relates to pathology, a similar diagnostic approach applies to the child seen primarily for health supervision. In the case of health, diagnosis determines the selection of appropriate health promoting and preventive interventions, whether medical, dental, nutritional, educational, or psychosocial. Components of the diagnostic process in health supervision include the health 'interview'; assessment of physiological, emotional, cognitive, and social development (including critical developmental milestones); physical examination; screening procedures; and evaluation of strengths and issues. Open and informed communication between the health professional and the family remains the most significant component of both health diagnosis and health promotion. Families complete medical history forms at their health supervision visit. Family-friendly questionnaires, checklists, and surveys that are appropriate for the child’'s age are additional tools to improve and update data gathering. This type of information helps initiate and inform discussions between the family and the health professional. This article provides a comprehensive review of current National Health Screening Program for Infant and Children in Korea.

Epidemiologic study of Kawasaki disease in 6 months old and younger infants

Abstract: Purpose : The aim of this study was to investigate the epidemiologic status of Kawasaki disease (KD) in infants ≤6 months of age. Methods : For the epidemiologic study of KD in Korea, data from 22,674 KD patients were collected from 1997 to 2005 on a 3-year basis by a retrospective survey. From this survey, data of 1,739 KD patients ≤6 months of age were analyzed and compared with those of KD patients >6 months of age. Results : A total of 1,739 patients ≤6 months of age, including 1,088 males and 651 females, represented 7.7% of total KD patients. These subjects included 22 patients aged 6 months old with data from 1,739 KD patients ≤6 months old showed significantly higher incidences of CA abnormalities and CA aneurysms in the younger patients.

The prevalence of pediatric endocrine and metabolic diseases in Korea

Abstract: The government neonatal screening program has a 17-years history. Therefore, it can now provide information on the prevalence of endocrine and metabolic diseases which included in neonatal screening. Knowledge of the prevalence of metabolic diseases is very important with these results, the most effective screening methods can be determined and diseases can be identified that should be added to neonatal screening. For these purposes regular follow-up of patients with metabolic diseases and quality assuarance are also needed.

A case of Hallermann-Streiff syndrome with aphakia

Abstract: = Abstract = Hallermann-Streiff syndrome is a rare disease. Approximately 150 cases have been reported including 6 cases in Korea. The authors experienced a case of Hallermann-Streiff syndrome in a 6-year-old female with aphakia. The syndrome is characterized by a bird-like face dental abnormalities hypotrichosis atrophy of the skin bilateral microphthalmia and proportionate dwarfism. A brief review of the literature was conducted. (Korean J Pediatr 2008;51:646-649

A case of congenital vallecular cyst associated with gastroesophageal reflux presenting with stridor feeding cyanosis and failure to thrive

Abstract: = Abstract = Vallecular cyst is an uncommon but potentially dangerous condition causing stridor and has been associated with sudden airway obstruction resulting in death due to its anatomical location in neonates. It may also present with various degrees of feeding problems resulting in failure to thrive. When a vallecular cyst is suspected clinically, endoscopic laryngoscopy is necessary to visualize it. Other conditions leading to neonatal stridor such as laryngomalacia and other laryngotracheal abnor- malities should be ruled out. Marsupialization with a CO 2 laser is the most effective and safest treatment to pre vent recurrence. We report a case of a 1-month-old male infant with a vallecular cyst synchronous with gastroesophageal reflux, and failure to thrive. He was referred to our hospital because of hoarseness, inspiratory stridor, feeding-cyanosis, chest retraction and failure to thrive. Diagnostic workup revealed a cyst at the tongue base, suggesting a vallecular cyst. The cyst was removed by laryngomicrosurgery with CO 2 laser. After the surgery, the symptoms improved and the body weight increased steadily. We report a successfully treated case of neonatal vallecular cyst with symptoms of upper respiratory obstruction, gastroesophageal reflux, and failure to thrive. (Korean J Pediatr 2008;51:775-779)

The pharmacological treatment of patent ductus arteriosus in premature infants with respiratory distress syndrome: oral ibuprofen vs. indomethacin

Abstract: Purpose : Indomethacin is widely used for the prophylaxis and treatment of patent ductus arteriosus (PDA); however, it is associated with side effects such as renal failure, intraventricular hemorrhage, and gastrointestinal bleeding. Intravenous ibuprofen has been shown to be as effective as indomethacin in prompting PDA closure. If treatment with oral ibuprofen is as effective as indomethacin, it would have the advantages of greater availability, simpler administration, and lower cost. We conducted this study to compare the efficacy and side effects of indomethacin with those of oral ibuprofen, vis- a-vis on the pharmacological closure of PDA. Methods : As a randomized double-blind study, 34 preterm infants with respiratory distress syndrome and hemodynamically significant PDA were treated with either intravenous indomethacin or oral ibuprofen. Echocardiography was performed by one cardiologist who was blind to the treatment that any given infant received. The rate of ductal closure, the need for additional drug treatment or surgical ligation, clinical outcome, and the side effects of drug treatment were compared. Results : Ductal closure occurred in 16 of 18 patients (88.9%) from the indomethacin group and in 14 of 16 patients (87.5%) from the ibuprofen group (P>0.05). Three patients in the indomethacin group and four in the ibuprofen group required a second drug treatment (P>0.05). Three patients (i.e., one patient in the indomethacin group and two in the ibuprofen group) underwent surgical ligation (P>0.05). Between the two groups, there was no significant difference vis- a-vis in side effects or clinical outcome. Conclusion : Compared to indomethacin, oral ibuprofen has the advantages of simpler administration and lower cost, while being as effective; in addition, there are no differences between the two drug treatments with regards to side effects or clinical outcomes. Therefore, the widespread use of oral ibuprofen should be considered in treating PDA in preterm infants. (Korean J Pediatr 2008;51:956-963)

The epidemiology and present status of chronic hepatitis B in Korean children

Abstract: Korea is now classified as an area of intermediate endemicity for hepatitis B virus (HBV), due to the implementation of universal HBV vaccination and national preventive programs for HBV infection. A national program of HBV vaccination was launched in Korea in 1988 for school-going children and was listed on a vaccination guideline in 1991. In 1995, universal vaccination for newborn infants was started for the prevention of perinatal HBV transmission. The prevalence of HBsAg among Korean middle school students has shown marked decreased from 3.2% in the late 1990s to 0.44% in 2007. HBsAg positivity in preschool children was 0.9% in 1995, decreased to 0.2% in 2007 by national prevention program of hepatitis B vertical transmission, launched in 2002. Vaccine failure rate of HBV immunoprophylaxis is 4.2% by this program. The infected children should be monitored per 6-12 months interval. Lamivudine and interferon are approved therapies for children with chronic hepatitis B in immune-clearance phase in Korea. (Korean J Pediatr 2008;51:696-703)

Assessment of modifiable lifestyle factors for obese children and adolescents through questionnaires

Abstract: Purpose : The identification of specific behaviors conducive to overeating or inactivity is the cornerstone of obesity management. The Committee on Nutrition of the Korean Pediatric Society developed parent and self-reporting questionnaires about eating behavior and physical activity in 2006. The aim of this study was to evaluate the usefulness of the questionnaires in assessing modifiable lifestyle factors related to obesity. Methods : A retrospective chart review was performed for 177 children (6-11 years old) and 134 adolescents (12-16 years old) from 10 hospitals between May 2006 and January 2007 who had completed parent or self-reporting questionnaires. Cases were divided into normal and overweight groups at or above the age-gender-specific 85th percentile based on 2007 Korean national growth charts. Results : Compared to children, the adolescents tended to have a significantly more sedentary lifestvle and inappropriate dietary behaviors significantly (P

Analysis of online breast-feeding consultation on the website of the Korean Pediatric Society

Abstract: Purpose : Since the infant formula milk has been produced in Korea, it has faced a low rate of breast milk feeding, though breast milk feeding is a little increasing. Therefore, the Korean Pediatric Society launched its website for breast-feeding consultation to provide information to the general public and enhance the health of growing infants. The consultation results were analyzed to identify the problems that mothers encounter during breast-feeding. Methods : From August 1, 2004 to July 31, 2007, 1001 mothers who visited the online consultation webpage (www. pediatrics.or.kr) of the Korean Pediatric Society asked 1,021 questions. The questions were divided into 3 major categories and 14 specific categories. Interesting questions asked more than 100 times were retrospectively analyzed. Results : The results for the major categories were as follows: 413 questions (40.3%) were on how to breast-feed, 315 (30.8%) on problems of feeding mothers, and 293 (28.8%) on problems of the fed babies. In the specific categories, 22.2% of the questions were on how to breast-feed. With the increasing number of working couples and working mothers, many questions were asked on the problems of breast-feeding after returning from work. Conclusion : The author expects that analyses of these consultations will contribute to the enhancement of information on the consultation website, thus enabling to provide clearer answers to people's increased interest in and concerns on breast-feeding. Furthermore, this research will help to establish correct breast-feeding practice.

Current status of neonatal intensive care units in Korea

Abstract: Neonatal intensive care in Korea has improved remarkably since the 1990s, but there is still a shortage of facilities and equipment in NICUs. Only 71.1% of the beds needed for neonatal intensive care are available. Mechanical ventilators are not appropriately distributed to the NICUs that are equipped to handle neonatal intensive care. The number of doctors is far too small, making the number of patients per doctor very high. Nurses, too, need to take care of 7.7 patients per nurse, making it very difficult to provide adequate intensive care. All this is caused by insufficient investment by the hospitals, which, in turn, is caused by inadequate reimbursement from health insurance. Therefore, a government-sponsored effort is necessary to bring the level of neonatal intensive care up to par.

Neuroprotective effects of resveratrol via anti-apoptosis on hypoxic-ischemic brain injury in neonatal rats

Abstract: Purpose : Resveratrol, extracted from red wine and grapes, has an anti-cancer effect, an antiinflammatory effect, and an antioxidative effect mainly in heart disease and also has neuroprotective effects in the adult animal model. No studies for neuroprotective effects during the neonatal periods have been reported. Therefore, we studied the neuroprotective effect of resveratrol on hypoxic-ischemic brain damage in neonatal rats via anti-apoptosis. Methods : Embryonic cortical neuronal cell culture of rat brain was performed using pregnant Sprague-Dawley (SD) rats at 18 days of gestation (E18) for the in vitro approach. We injured the cells with hypoxia and administered resveratrol (1, 10, and 30 µg/mL) to the cells at 30 minutes before hypoxic insults. In addition, unilateral carotid artery ligation with hypoxia was induced in 7-day-old neonatal rats for the in vivo approach. We injected resveratrol (30 mg/kg) intraperitoneally into animal models. Real-time PCR and Western blotting were performed to identify the neuroprotective effects of resveratrol through anti-apoptosis. Results : In the in vitro approach of hypoxia, the expression of Bax, caspase-3, and the ratio of Bax/Bcl-2, indicators of the level of apoptosis, were significantly increased in the hypoxia group compared to the normoxia group. In the case of the resveratrol-treated group, expression was significantly decreased compared to the hypoxia group. And the results in the in vivo approach were the same as in the in vitro approach. Conclusion : The present study demonstrates that resveratrol plays neuroprotective role in hypoxic-ischemic brain damage during neonatal periods through the mechanism of anti-apoptosis.

Epidemiology of the metabolic syndrome among Korean children and adolescents

Abstract: The prevalence of obesity in Korean children is estimated to be around 10%, and has increased significantly over the past 20 years. Metabolic syndrome, which includes central obesity, glucose intolerance, insulin resistance, dyslipidemia, and hypertension, is a well documented risk factor for cardiovascular diseases, but there is no general consensus concerning its definition for children. In this study, ablut 30-40% of overweight or obese children had metabolic syndrome compared to less than 10% in the general population. Dyslipidemia was the most common component and hyperglycemia was the least common component of metabolic syndrome. If the prevalence of childhood obesity continues to increase, it is highly likely that the prevalence of the metabolic syndrome will also increase. These findings emphasize the importance of preventing obesity in addition to the diagnosis and management of metabolic syndrome in Korean adolescents.

Use of herbal medicine in epileptic children

Abstract: Purpose : Herbal medicine is thought to be widely used by children with epilepsy, but there have been few studies. This study aimed to investigate the perceptions and the actual conditions of usage of herbal medicine by children with epilepsy. Methods : From July to August 2007, three hundred seventy eight questionnaires were completed by parents of epileptic children who visited pediatric neurology clinic of Korea University hospital and Kwangmyung-Sungae hospital. Demographic data and patterns of usage of herbal medicine were investigated. Results : Among 378 patients, sixty five (17.2%) reported using herbal medicine. Major reasons for using herbal medicine were 'to enhance general health' and 'belief that it has fewer side effects'. Majority of respondents did not notify their physician about using herbal medicine because 'they did not need to share this with doctor' and 'they thought their doctor would disapprove'. After taking herbal medicine, 33.3% of patients reported that it did not benefit their seizure but they felt healthier. Usage of herbal medicine was significantly related to number of AEDs (antiepileptic drugs), duration of AED treatment, association with psychosomatic disorders and motivation by other people or by mass media. Conclusion : Considerable numbers of epileptic children were using herbal medicine during treatment with AED and did not inform their physician about usage of it. Physicians should be aware of benefits and harms of herbal medicine and actively intervene in the usage of herbal medicine by epileptic patients.

Clinical aspects of injury and acute poisoning in Korean pediatric patients

Abstract: Unintentional injuries are the most important cause of morbidity and mortality in the pediatric population, and the home is the most common site of injury for children in Korea. The most common cause of injury was slip down. Fall down and burn were frequent in infant/toddlers group, automobile and bicycle accident more frequent in preschool children. Findings from the survey could then be used to provide targets for direct educational efforts by medical services and to direct environmental safety modifications tailored to the unique situation of each family. Pediatric toxic ingestions are treated commonly by pediatricians and emergency physicians. Significant injury after these ingestions is infrequent, but identifying the dangerous ingestion is sometimes a difficult task. By performing a detailed history, focused physical examination, and directed laboratory evaluation, an estimation of risk can be developed. According to recent Korean poison papers, there were bimodal peak of age distribution in poisoned children patient on the whole: infant and adolescents group. Various types of materials belonged the classes of drugs, household products, and industrial solvents. Most of the poisoned children patients had been poisoned accidentally, while most cases of adolescents poisoning had been intentional. More than half of the adolescents group had a suicidal purpose in Korea, so an understanding of the demographic factors associated with self-harm poisoning may provide useful information to improve prevention and treatment strategies.

Delayed closure effect in preterm infants with patent ductus arteriosus

Abstract: Purpose : This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d). Methods : Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively. Results : The mean gestational age (GA) was 26±2 weeks (range, 23-32 wk), and the birth weight was 782±146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7±1.7 wk vs. 27.1±2.0 wk, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P

Infantile risk factors for obesity in preschool children

Abstract: Purpose :Childhood obesity is a problem that places a child at great risk for becoming an obese adult. To prevent obesity, it is important to focus on early life risk factors that may contribute to childhood obesity. The aim of this study is to find obesity-causing infantile risk factors in preschool children. Methods :A total of 223 children aged 3 to 5 years old from Busan were the subjects of this study. We calculated their body mass index (BMI) and classified them into two groups (normal weight and overweight/obese children). Information regarding parental weight and height, mother's educational level and employment status, birth weight, feeding patterns, start time of weaning, duration of night feeding, and fosterer was obtained by using questionnaires. Results :There were 68 (30.5%) overweight/obese children and 155 (69.5%) normal weight children. Overweight/obese children were significantly associated with formula milk feeding, rapid weight gain during the first 6 months, and maternal obesity (P<0.05). There were no statistical differences in paternal obesity, mothers educational level and employment status, birth weight, start time of weaning, duration of night feeding, and fosterer between the normal and overweight/obese children. Conclusion :Although healthy diet and regular exercise will remain the cornerstones of weight management in obese children, our data supports the view that education about maintaining a normal weight could be introduced much earlier in families with high-risk children. (Korean J Pediatr 2008;51:804-811)

Relationship between exhaled nitric oxide and pulmonary function test in children with asthma

Abstract: Purpose : Asthma is characterized by reversible airway obstruction and bronchial hyperresponsiveness result from airway inflammation Fraction of nitric oxide in expired air (FeNO) has recently been investigated as a noninvasive measure of airway inflammation FeNO has been reported to correlate with induced sputum eosinophilia and methacholine challenge test that it is represent severity of asthma The purpose of this study was to analyze the relationship of FeNO with pulmonary function tests in patients with intermittent asthma Methods : Eighty children included in this study were diagnosed as asthma from April through August, 2005 in Department of Pediatrics, College of Medicine, Kyunghee University They aged from 4 to 15 years who were able to conduct spirometry and FeNO monitoring They did not have upper respiratory tract infection and did not use an asthma controller which contain corticosteroids within 4 weeks Pulmonary function test was done and FeNO was measured with online tidal breathing method using a chemiluminescence NO analyzer (CLD 88 sp, Eco Medics, Duernten, Switzerland) The correlations between pulmonary function test and FeNO were analyzed using Spearman correlation coefficient method Results : The mean of FeNO of subject was 1688 parts per billion (ppb) The mean of forced expiratory volume in 1 second (FEV1) was 0890±0455 L and forced vital capacity (FVC) was 1071± 0630 L The mean of predicted FEV1% (FEV1%pred) was 9839±3427% and FEV1/FVC was 8853± 1949 FeNO was significantly correlate with FEV1 (r=0345, P<001) and FVC (r=0244, P<005) FeNO did not correlate with FEV1%pred or FEV1/FVC Conclusion : The measurement of FeNO could be a useful marker in the management of childhood asthma and it is evolving to provide a complementary role alongside existing pulmonary function test We propose that measuring technique and establishment of normal reference range are important area for future research (Korean J Pediatr 2008;51:181-187)