Current use of safety restraint systems and front seats in Korean children based on the 2008-2015 Korea National Health and Nutrition Examination Survey

Kong, Seom Gim The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.12

Purpose: The use of proper safety restraint systems by children is vital for the reduction of traffic accident-related injury and death. This study evaluated the rates of use of safety restraint systems and front seats by Korean children. Methods: Based on data from the National Health and Nutrition Examination Survey from 2008 to 2015, I investigated the frequencies of safety restraint systems and front seat use by children under six and 12 years of age, respectively. Results: The percentage of respondents who said they always use safety restraint systems increased from 17.7% in 2008 to 45.0% in 2015. The rate of children who did not use the front seats at all was 47.3 % in 2008 compared to 33.4% in 2015. Multivariate logistic regression analysis showed a decrease in safety-restraint-system use as age increased (odds ratio, 0.63; 95% confidence interval [CI], 0.51-0.77). The use rate of front-passenger seat belts by the mother is significantly correlated with the safety-restraint-system use rate by children (odds ratio, 2.14; 95% CI, 1.12-4.06). Conclusion: Although the rate of safety-restraint-system use for children is increasing annually, it remains low. Additionally, the use rate of front passenger seats for children is high. To reduce the rates of injury and death of children from traffic accidents, it is necessary to educate on the appropriate use of safety restraint systems according to age and body size and to develop stronger regulations.

Influence of creatinine levels on survival in patients with veno-occlusive disease treated with defibrotide

( Seom Gim Kong ),( Je-hwan Lee ),( Young Tak Lim ),( Ji Hyun Lee ),( Hyeon-seok Eom ),( Hyewon Lee ),( Do Young Kim ),( Sung-nam Lim ),( Sung-soo Yoon ),( Sung-yong Kim ),( Ho Sup Lee ) 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.1

Background/Aims: Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is one of the most fatal complications of hematopoietic cell transplantation (HCT), and defibrotide is the only curative drug. We conducted this study to confirm the survival rate of VOD/SOS patients diagnosed in Korea and assess the efficacy of defibrotide. Methods: Patients diagnosed with VOD/SOS after allogenic HCT between 2003 and 2020 were enrolled. We investigated day +100 survival rates and associated risk factors in patients who satisfied the modified Seattle criteria within 50 days of HCT. Results: A total of 110 patients satisfied the modified Seattle criteria, of which 65.5% satisfied the Baltimore criteria. Thirty-seven patients were treated with defibrotide. The day +100 survival rate of the 110 patients was 65.3%. The survival rates in patients who did not meet the Baltimore criteria and in those who did were 86.8% and 53.7%, respectively (p = 0.001). The day +100 survival rate of patients treated with defibrotide was 50.5%. Among the patients receiving defibrotide, those whose creatinine levels were more than 1.2 times the baseline had a significantly lower survival rate at 26.7% (p = 0.014). On multivariate regression analysis, the hazard ratio of satisfaction of the Baltimore criteria was 4.54 (95% confidence interval [CI], 1.69 to 12.21; p = 0.003). In patients treated with defibrotide, the hazard ratio was 8.70 (95% CI, 2.26 to 33.45; p = 0.002), when creatinine was more than 1.2 times the baseline on administration. Conclusions: The day +100 survival rate was significantly lower when the Baltimore criteria were satisfied, and when there was an increase in creatinine at the time of defibrotide administration.

First case report of latent tuberculosis reactivation complicating treatment with nilotinib in chronic myeloid leukemia

김다정,정세리,Seom Gim Kong,Ho Sup Lee 대한혈액학회 2019 Blood Research Vol.54 No.2

.

최근 6년간 단일 신생아중환자실에서 발생한 패혈증 환자의 분석

천베드로,공섬김,변신연,박수은,이형두,Chun, Peter,Kong, Seom-Gim,Byun, Shin-Yun,Park, Su-Eun,Lee, Hyung-Du 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

목 적: 신생아 패혈증은 1개월 미만의 신생아 특히 미숙아, 저체중 출생아에서 사망률과 이환률의 중요한 원인이다. 저자는 최근 6년간 단일 신생아중환자실에서 패혈증으로 진단된 환자의 발생빈도, 원인균 및 임상적 특징을 알아보고자 하였다. 방 법: 2003년 1월부터 2008년 12월까지 신생아중환자실에 입원한 환자 중 혈액에서 균이 배양된 175명을 대상으로 하였다. 환자들의 성별, 재태 주수, 출생 시 체중, Apgar 점수, 총 입원기간, 총정맥영양 기간, 중심도관 유무, 기저 질환, 혈액검사 소견, 배양된 균 종류, 합병증, 사망률을 후향적으로 분석하였고 2005년 1월부터 2008년 12월까지 신생아중환자실의 재원환자 일수에 대한 병원감염률도 분석하였다. 결 과: 1) 6년간 패혈증 발생빈도는 4.7%, 1,000명당 46.7명 이었다. 2004년에 가장 높은 패혈증 발생빈도를 보였고 이후 점차 감소하다 2007년부터 다시 증가하는 추세이다. 그람 양성균패혈증이 그람 음성균보다 많았다. 2) 총 175명의 환자 중 남 녀비는 1.2:1 이었고, 그람음성균군에서 재태 주수와 출생체중이 의미있게 더 작았다. Apgar 점수, 총 입원 기간, 총정맥영양 기간, 중심도관 유무는 두 군간에 유의한 차이가 없었다. 3) 기저질환이 있었던 경우는 총 129명(73.7%)이었고, 이 중 심혈관 질환이 가장 많았다. 배양된 균들 중 그람양성균은 MRSA가 50명(28.6%)으로 가장 많았고, 그람음성균은 $Serratia$ $marcescens$가 14명(8.0%)으로 가장 많았다. 4) 혈액검사 소견에서 그람음성균군의 혈소판이 의미있게 더 낮았으며($P$<0.05) 다른 소견은 유의한 차이가 없었다. 5) 합병증은 32명(18.3%)에서 나타났고, 패혈성 쇼크가 16명(50.0%)으로 가장 많았다. 원인균별로 분석했을 때 MRSA 패혈증에서 합병증의 빈도가 가장 높았다. 6) 패혈증으로 사망한 경우는 총 13명(7.4%)으로 그람양성균군의 사망률은 6.5%, 그람음성균군의 사망률은 10.8% 였으며 MRSA에 의한 사망이 가장 많았다. 7) 각 연도별 월별 재원환자일수에 대한 병원감염률을 보면 월별의 차이가 뚜렷하게 나타났다. 결 론: 패혈증으로 진단된 환자의 발생빈도 및 원인균의 분석, 임상적 특징, 합병증과 사망률에 영향을 주는 원인균에 대한 논의는 향후 신생아중환자실의 감염 발생을 감소시키는데 기여할 것으로 생각되고, 이에 대한 더 많은 연구가 필요할 것이다. Purpose : Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm. The objective of this study was to analyze the incidence rate, causative pathogens and clinical features of neonatal sepsis in one neonatal intensive care unit (NICU) for 6 years. Methods : This study was retrospectively performed to review the clinical and laboratory characteristics including sex, gestational age, birth weight, Apgar score, length of hospitalization, length of total parenteral nutrition, presence of central venous catheter, underlying diseases, laboratory findings, microorganisms isolated from blood culture, complications and mortality in 175 patients between January 2003 and December 2008. Results : 1) Sepsis was present in 175 of 3,747 infants for 6 years. There were more gram-positive organisms. 2) The gram-negatives were more prevalent in preterm. There were no significant differences of other clinical features between two groups. 3) Underlying diseases were found in 73.7%, and the most common disease was cardiovascular disease. The most common organisms of gram-positives and gram-negatives were methicillin resistant Staphylococcus aureus (MRSA) and Serratia marcescens. 4) There was statistically significant difference on platelet counts between two groups (P<0.05). 5) Complications were found in 18.3% and septic shock was the most common. MRSA was the most common pathogen in sepsis with complication. 6) The mortality rate was 7.4%. 7) There were differences in monthly blood stream infection/1,000 patient-days. Conclusion : The studies about the factors that can influence neonatal sepsis will contribute to decrease the infection rates in NICUs.

Loeys-Dietz Syndrome with Type 1 Diabetes Mellitus

Daro Jeong,Jung Hyun Lee,Seom Gim Kong 대한소아혈액종양학회 2023 Clinical Pediatric Hematology-Oncology Vol.30 No.2

Loeys-Dietz syndrome is a hereditary connective-tissue disorder first reported in 2005. It is caused by genetic defects in the transforming growth factor-beta (TGF-β) signaling pathway. TGF-β signaling plays an important role in connective-tissue de-velopment, differentiation, and homeostasis. Dysregulation of TGF-β signaling causes various defects in the skull, face, skeletal system, skin, and blood vessels. Symptoms of Loeys-Dietz syndrome include scoliosis, spider finger, joint laxity, club foot, hy-pertelorism, and cleft palate. In addition, aortic aneurysm, aortic dissection, bleeding tendency, delayed wound healing, allergic disease, and autoimmune disease have been reported. Here, we describe an 11-year-old male with type 1 diabetes mellitus who had frequent epistaxis and easy bruising from an early age, along with skin and joint hyperextension, atrophic scars, and long limbs. He was suspected of having a hereditary connective-tissue disorder and was diagnosed with Loeys-Dietz syndrome type 1 by next-generation sequencing. Similar to Marfan syndrome and Ehlers-Danlos syndrome, this disease has a high risk of aortic aneurysm and aortic dissection. In addition, because aortic dissection can occur at a young age, early diagnosis and periodic examination and treatment for cardiovascular diseases are necessary.

단일 병원에서 소아 기도 이물 흡인에 대한 30년의 임상 경험

김혜영 ( Hye Young Kim ),공섬김 ( Seom Gim Kong ),박희주 ( Hee Ju Park ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.4

목적: 소아 기도 이물 흡인은 치명적일 수 있는 응급질환이며 진단이 늦어진 경우 장기적인 합병증을 유발할 수 있다. 이에 기도 이물 흡인에 대한 임상 자료를 분석하여 진단과 치료에 기여하고자 하였다. 방법: 1980년부터 2009년까지 약 30년간 부산대학병원 소아 청소년과에서 기왕력,흉부 방사선검사,기관지 내시경 검사 등을 시행하여 기도 내 이물 흡인으로 진단 받은 15세 미만 206명을 대상으로 임상 경과를 후향적으로 분석하였다. 급성 중증 호흡기 폐색 증상이 있었던 16명의 임상 자료를 분석하여 위험도를 평가하였다. 또한 기도 내 이물 흡인 후 진단 및 치료까지의 기간을 기준으로 24시간 이내인 경우를 조기 진단,24시간 이상인 경우를 지연 진단으로 나누어 임상 자료를 비교 분석하였으며, 7일 이상 진단이 늦어진 환아들을 대상으로 지연된 진단의 원인을 조사하였다. 결과: 기도 이물 흡인 환아의 평균 연령은 22.3개월이며 3세 미만이 76.2%로 대부분이었고, 남녀 비는 2.12:1였다. 첫 내원시 임상증상은 기침이 67.9%, 진찰시 호흡음 감소가 43.6%로 가장 많았다. 흉부 방사선 소견에서 폐기종이 50.0%로 가장 흔하였다. 이물 종류는 식물성이 63.6%로 이중 땅콩이 45.6%로 가장 많았고,이물 위치는 주 기관지가 66.5%로 가장 흔하였다. 심한 급성 호흡곤란은 3세 미만이 어린 영아에서 더 흔하였다. 조기 진단 군에서 사래걸림 증상과 후두와 기관에 이물이 위치한 경우가 유의하게 많았고, 지연 진단 군은 발열, 반복적인 폐렴,기관지 확장증 증상이 유의하게 높았다. 7일 이상 진단이 지연된 환아들은 천식 및 기도 감염으로 오인된 경우가 흔하였다. 결론: 기도 이물 흡인은 3세 이하의 소아들에서 호발하며 어릴수록 호흡기 폐색 증상이 심각하게 나타날 수 있어 영아의 이물 흡인 예방을 위한 적극적인 보호자 교육이 필요하다. 또한 기왕력이 없고 흉부 방사선 소견이 정상이더라도 비특이적인 호흡기 증상들이 지속된 경우 기도 이물 흡인의 감별을 위해 기관지 내시경 검사를 적극적으로 고려해야 한다. Purpose: This study aimed to analyze the clinical spectrum of foreign body aspiration in children and explore the clinical features which could facilitate early diagnosis. Methods: We studied 206 pediatric patients who had aspirated foreign bodies in Pusan National University Hospital between 1980 and 2009. Age, sex, symptoms, signs, the type and location of foreign bodies, radiologic findings and clinical courses were investigated retrospectively. We compared these findings of children diagnosed within 24 hours (early-diagnosis group: EDG) with those of the delayed-diagnosis group (DDG). Results: The majority of patients (76.2%) were yonger than 3 years of age. Cough (67.9%) and decreased breathing sound (43.6%) were the predominant symptoms and signs. Obstructive emphysema (50.0%) was the most frequent radiologic finding. Peanut was the most common foreign body. Acute severe airway obstruction by aspirated foreign bodies tended to occur in younger children because of their small airway. Choking was more frequent in the EDG group than in the DDG group (P=0.018). For the location of foreign bodies, the larynx and trachea were more common in the EDG group (P=0.031). Fever (P=0.024), persistent pneumonia (P=0.011) and bronchiectasis (P=0.041) were more common in the DDG group than in the EDG group. Bronchial asthma, upper respiratory infection and pneumonia were the most common wrong diagnosis. Conclusion: Reducing the number of accidents associated with foreign body aspiration is the best way to promote public prevention policies. Physicians must consider the possibility of foreign body aspiration in children with chronic respiratory symptoms. [Pediatr Allergy Respir Dis(Korea) 2009;19:383-391]

Changes in the prevalence of anemia in Korean adolescents, 1998-2018

An, Jun Young,Hong, Yoo Rha,Kong, Seom Gim The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.2

Background: Anemia is an important health problem affecting approximately 25% of the global population. Although its prevalence is decreasing worldwide, few studies have examined the prevalence of anemia in Korean adolescents. Purpose: This study aimed to determine the prevalence of anemia in Korean adolescents over the past 21 years using data from the Korea National Health and Nutrition Examination Survey. Methods: We investigated the prevalence of anemia in adolescents aged 10-18 years for the period 1998-2018 according to sex, age, residential area, and household income. The effects of menarche age and menstruation were examined in female adolescents for the period 2001-2018. Results: Among the total 11,782 participants, the weighted prevalence of anemia was 4.0%. The prevalence of anemia in male participants significantly decreased (from 3.0% to 0.5%, P<0.001), whereas that in female participants did not change significantly over time (from 7.9% to 8.5%, P=0.054). The average age at menarche was 12.4±0.0 years; the prevalence of anemia in females increased from age 13 years onward. Multivariate analysis revealed that anemia was more common in female than male participants (odds ratio [OR], 9.88; 95% confidence interval [CI], 7.19-13.57; P<0.001). In female adolescents, the prevalence of anemia increased with age (OR, 1.26; 95% CI, 1.15-1.38, P<0.001) and was 3.6 times higher after than before menarche (OR, 3.65; 95% CI, 2.21-6.05, P<0.001). Conclusion: Over the 21-year study period, the prevalence of anemia decreased among male adolescents but did not change in female adolescents. In female adolescents, age and menarche were identified as significant risk factors that require continued attention.

Nonfatal injuries in Korean children and adolescents, 2007–2018

Yeon Gyu Min,Hong Yoo Rha,Kong Seom Gim 대한소아청소년과학회 2022 Clinical and Experimental Pediatrics (CEP) Vol.65 No.4

Background: Injury is the leading cause of death or disability in children and adolescents. Rates of deaths from injuries have recently declined, but studies of the occurrence of nonfatal injuries are lacking.Purpose: This study aimed to investigate nonfatal injuries in children and adolescents younger than 20 years based on data from the Korean National Health and Nutrition Survey, 2007–2018.Methods: A questionnaire survey was conducted to determine whether children and adolescents had experienced an injury requiring a hospital visit in the previous year. We investigated each injury’s risk factors and characteristics.Results: Of a total of 21,598 children and adolescents, 1,748 (weighted percentage, 8.1%) experienced one or more injuries in the previous year. There was no yearly difference in the proportion of injuries experienced. Among the male subjects, 10.0% had an injury experience; among the female participants, 6.1% had an injury experience (P<0.001). The highest rate was 9.0% in children aged 1–4 years. In multivariate logistic regression analysis, male sex; having an urban residence; having restricted activity due to visual, hearing, or developmental impairment; and attention deficit/hyperactivity disorder were significant risk factors for injury experience. The characteristics of up to 3 injuries per patient were investigated, and 1,951 injuries were analyzed. Falls and slips accounted for 34.9%, collisions for 34.1%, and motor vehicle accidents for 11.3% of the total injuries. Ninety-six percent of injuries were unintentional, 20% caused school absences, and 10% required hospitalization.Conclusion: Among Korean children and adolescents, 8.1% experienced injuries at least once a year with no significant differences in incidence over the past 12 years. Greater attention and effort to prevent injuries are needed.

Clinical Characteristics of Pandemic Influenza A (H1N1) 2009 Pediatric Infection in Busan and Gyeongsangnam-do: One Institution

Lee, Myung-Chul,Kim, Hye-Young,Kong, Seom-Gim,Kim, Young-Mi,Park, Su-Eun,Im, Young-Tak,Park, Hee-Ju The Korean Academy of Tuberculosis and Respiratory 2012 Tuberculosis and Respiratory Diseases Vol.72 No.6

Background: This study investigated the clinical characteristics and risk factors of the severity of pandemic influenza A (H1N1) 2009 infection in pediatric patients in Busan and Gyeongsangnam-do. Methods: Cases of influenza A (H1N1) 2009 in patients under the age of 18 years, confirmed by reverse transcription polymerase chain reaction, at Pusan National University Hospital and Pusan National University Yangsan Hospital from the last week of August 2009 through the last week of February 2010 were retrospectively analyzed. Results: Of the 3,777 confirmed cases of influenza A (H1N1) 2009, 2,200 (58.2%) were male and 1,577 (41.8%) were female. The average age of the patients was $8.4{\pm}4.8$ years. The total cases peaked during 44th to 46th week. Most of the patients were in the 5- to 9-year-old age group. Oseltamivir was administered to 2,959 (78.3%) of the patients. 221 patients (5.9%) were hospitalized, age an average of $6.7{\pm}4.5$ years. The average duration of hospitalization was $7.4{\pm}5.6$ days. One hundred cases (45.2%) had pneumonia. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. Children with asthma were at very high risk of hospitalization, over 20 times the non-asthmatic children (odds ratio [OR], 21.684; confidence interval [CI], 13.295~39.791). Likewise the children with neurologic deficits faced a 16 times higher risk (OR, 15.738; CI, 7.961~31.111). Ten of the patients (4.5%) were admitted to the intensive care unit, and eight (3.6%) required mechanical ventilation. Conclusion: Of the pediatric patients with pandemic influenza A (H1N1) 2009, most of the patients were in the 5- to 9-year-old age group. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. The most common complication was pneumonia. The very high risk of severe morbidity in children with asthma or neurologic disease shows the critical importance of targeted vaccine coverage, special awareness and swift care by both guardians and primary care providers.

급성 뇌염의 초기 뇌파소견과 예후와의 관계

오재민(Jae Min Oh),공섬김(Seom Gim Kong),이윤진(Yun Jin Lee),남상욱(Sang Ook Nam) 대한소아신경학회 2011 대한소아신경학회지 Vol.19 No.1

목적 : 급성 뇌염 환자의 예후를 초기 뇌파검사로 예측할 수 있는가를 확인하고자 하였다. 방법 : 2007년 1월부터 2010년 3월까지 부산대 학교병원 및 부신대학교 어린이병원 소아청소년과에서 급성 뇌염으로 진단되어 치료받은 18세 이하의 환자를 대상으로 하였다. 총 31명의 환자를 완전히 회복된 군(A군, 20명)과 후유증이 남은 군(B군, 11명)으로 나누었다. 두 군 간에 초기 진단 시 뇌파 상 이상소견의 심한 정도 및 간질양파, 뇌파경련, 정상수면파, 외부자극에 대한 뇌파의 변화 등의 출현여부를 비교하였다. 뇌파 상 이상소견의 정도를 평가하는 데에는 Synek의 분류를 이용하였다. 결과 : A군에 비해 B군 환자들이 Synek의 분류 상 더 높은 단계의 뇌파 상 이상소견을 보였다(P=0.004) 간질양파의 출현(P=0.004), 뇌파경련(P=0.049) 등은 B군에서 더 높은 빈도로 나타났다. 외부자극에 대한 뇌파상의 변화는 완전히 회복된 A군에서 더 많이 나타났다(P=0.002). 정상 수면파는 통계학적인 유의성은 없으나 A군에서 더 많이 나타나는 경형을 보였다(P=0.081). 결론 : 초기 뇌파에서 이상소견의 심한 정도를 평가하는 것은 일반적인 혼수 환자에서 뿐만 아니라 급성 뇌염 환자의 예후를 예측하는 데 있어서도 유용한 수단이 될 수 있다. 또한, 간질양파가 나타나는 경우, 뇌파경란을 보이는 경우, 외부 자극에 대한 뇌파의 변화를 보이지 않는 경우 더 많은 후유증을 가지게 되는 것으로 나타났다. 정상수면파가 출현하는 경우는 통계적 유의성은 없으나 양호한 예후와 연관되는 경향을 보였다. Purpose : This study aimed to identify the usefulness of initial electroencephalograms (EEG) in the prediction of neurological outcomes of acute encephalitis. Methods : Thirty-one patients diagnosed with acute encephalitis between January 2007 and March 2010 were included in the study. all of whom were less than 18 years old. Patients were divided into two groups. Those who had recovered completely were designated group A, and those who had neurological sequalae were designated group B. We compared the severity of EEG background abnormalities according to the Synek classification, and the incidence of interictal epileptiform discharges, electrographic seizures, normal sleep features, and EEG reactivity to pain stimuli between the two groups upon initial EEGs. Results : Compared with group A, group B showed a higher grade of EEG background abnormalities (P=0.004). The incidence of interictal epileptiform discharge (P=0.004) and electrographic seizure (P=0.049) were also higher in group B. Further, Group A had more EEG reactivity (P=0.002) and the incidence of normal sleep features tended to be higher in group A (P=0.081). Conclusion : Initial EEG features including the severity of EEG background abnormalities are helpful in predicting the prognosis of acute encephalitis.