반복적인 천음과 호흡곤란을 보인 영아에서 진단된 선천성 심, 폐기형 3례

남효경,변정혜,장기영,정지태,손창성,함수연,라경숙,최익선,유영 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.2

천음은 상기도 폐쇄를 시사하는 것으로, 영아기 비감염성 천음의 가장 흔한 원인은 후두연화증이며 이는 증상이 경미하고 대부분 특별한 치료 없이 호전된다. 그러나 천음이 출생 직후부터 나타나거나 지속적이며 호흡곤란이 동반되는 경우에는 심, 폐기형 등 상기도 협착을 일으킬 수 있는 다른 질환의 동반 가능성을 고려하여야 한다. 이러한 심혈관계, 호흡기계의 기형이 있는 경우 천음, 호흡곤란 등의 증상이 호전되지 않고 심한 호흡곤란과 인공호흡기 이탈장애, 사망에까지 이를 수 있어 조기 진단과 치료에 대한 적극적인 노력이 필요하다. Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long- term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress.

Qualitative assessment of precocious puberty-related user-created contents on YouTube

남효경,방수민,이영준,박상희,이기형 대한소아내분비학회 2015 Annals of Pediatirc Endocrinology & Metabolism Vol.20 No.3

Purpose: User-created content (UCC) has provided a considerable amount of medical information and become an important source. We aimed to evaluate the quality and scientific accuracy of precocious puberty-related UCC on YouTube. Methods: The keywords “precocious puberty,” “early puberty,” “sexual precocity,” and “precocity” were searched for on YouTube during June and July 2014. More than 1,500 UCC matched the keywords. According to the information provider, UCC was classified as medical, oriental, or commercial & others. We evaluated the quality and scientific accuracy of the information provided in UCC using the DISCERN instrument and information scores, respectively. Results: We selected 51 UCC, which were categorized into three types: medical (n=17), oriental (n=17), or commercial & others (n=17). The overall quality score for medical UCC (3.4) was significantly higher relative to those of oriental and commercial & others UCC (2.8 and 2.3, respectively) (P<0.001). In the assessment of scientific accuracy, the mean information score for medical UCC (30.7) was significantly higher than those of oriental and commercial & others UCC (15.9 and 5.1, respectively) (P<0.001). The mean duration of oriental UCC was the longest (P<0.001), however, it was viewed less frequently among them (P=0.086). Conclusion: The quality and accuracy of precocious puberty-related health information in UCC were variable and often unreliable. The overall quality of UCC regarding precocious puberty was moderate. Only medical UCC provided scientifically accurate information. As UCC becomes a popular source of health information, it is important to provide reliable, scientifically accurate information.

진성 성조숙증 여아에서 Gonadotropin-Releasing Hormone Agonist 치료 중 성장속도에 따른 임상 인자들의 비교

남효경,신정연,오연정,이영준,유영,박상희,이기형 대한내분비학회 2010 Endocrinology and metabolism Vol.25 No.3

Background: The aim of this study was to investigate the favorable factors for gonadotropin-releasing hormone (GnRH) agonist treatment with regard to the growth velocity and the predicted adult height (PAH) in central precocious puberty (CPP) girls. Methods: We reviewed the clinical and auxological parameters in 46 CPP girls who were treated with GnRH agonist at the pediatric endocrinology clinic of Korea University Hospital from January 2001 to August 2007. We divided the two groups according to the growth velocity of 5 cm/yr and we assessed the related factors associated with growth velocity. We also assessed the changes in PAH for two years. Results: The pretreatment chronological age and bone age were significantly younger in the high growth velocity group (> 5 cm/yr)compared to that of the low growth velocity group (7.8 ± 0.9 year vs. 8.4 ± 0.5 year, 9.4 ± 1.2 year vs. 10.1 ± 0.9 year, respectively) (P <0.05). The PAH after treatment was significantly greater in the high growth velocity group (> 5 cm/yr)(P < 0.05). Growth velocity during treatment had negative correlation with the pretreatment chronological age and positive correlation with the PAH after one and two years of treatment (r = -0.45, P < 0.05 and r = 0.51, P < 0.01). PAH had positive correlation with the treatment duration (r = 0.31, P < 0.05). Conclusion: In our study, the growth velocity during GnRH agonist treatment was negatively related to age at the initiation of treatment. Therefore, earlier treatment is important to improve the outcomes and to maintain appropriate growth velocity in CPP girls.

Small for gestational age and obesity: epidemiology and general risks

남효경,이기형 대한소아내분비학회 2018 Annals of Pediatirc Endocrinology & Metabolism Vol.23 No.1

Children born small for gestational age (SGA) have several life-long consequences. Previous epidemiological studies investigated from childhood to adulthood reported that a number of chronic diseases originate in the prenatal period. With the emerging era of obesity epidemic, more concerns are related to being obese than being short-statured in SGA children. The exact mechanisms are uncertain; however, growth hormone-insulin-like growth factor axis disturbance by fetal programming and accelerated postnatal weight gain contributed to central adiposity in SGA children. In this review, we summarized the definitions and prevalence of SGA, epidemiology, and general risks of obesity in SGA children. Early interventions, before and after birth, are needed for healthy catch-up growth to prevent later obesity and related complications.

Serum Anti-Müllerian Hormone Levels in Precocious Puberty Girls according to Stage of GnRH Agonist Treatment

남효경,김혜련,이영준,이기형 대한의학회 2017 Journal of Korean medical science Vol.32 No.3

Few studies have investigated the long-term effects of gonadotropin-releasing hormone (GnRH) agonist treatment on the reproductive function of central precocious puberty (CPP) girls. In this cross-sectional study, we assessed the ovarian function by analyzing the serum anti-Müllerian hormone (AMH) levels of CPP girls. Our study included 505 CPP girls subdivided into 5 groups according to the GnRH agonist treatment stage: group A (before treatment, n = 98), group B (3 months after initiation, n = 103), group C (12 months after initiation, n = 101), group D (24 months after initiation, n = 101), and group E (6 months after discontinuation, n = 102). We compared the serum AMH levels of the CPP girls with those of 100 bone age-matched controls (before treatment: n = 55; after discontinuation: n = 45). At baseline, the mean AMH level of the CPP girls was 5.9 ± 3.6 ng/mL. The mean AMH level after 3 months of the GnRH agonist treatment was lower (4.7 ± 3.2 ng/mL, P = 0.047) than that at baseline and recovered after 12 months of treatment. Six months after discontinuation, the AMH levels were similar to those at pre-treatment. Before and after the GnRH agonist treatment, the AMH levels were similar to those of the bone age-matched controls. In the precocious puberty girls, the AMH levels based on the GnRH agonist treatment stage were all within the normal reference range. The results of this study suggest that GnRH agonist treatment has no adverse effects on the reproductive function.

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

남효경,조원경,김재현,이영준,정소정,이기형,서병규 대한의학회 2018 Journal of Korean medical science Vol.33 No.12

Background: Oral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth. Methods: This retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6–6.9 mmol/L; 2-hour glucose 7.8–11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determine using the area under the receiver operating characteristic curve (AUC). Results: At diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabete and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1 was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected. Conclusion: Pediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.

Factors to Predict Positive Results of Gonadotropin Releasing Hormone Stimulation Test in Girls with Suspected Precocious Puberty

남효경,이영준,손창성,박상희,이기형 대한의학회 2012 Journal of Korean medical science Vol.27 No.2

Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.

저신장 소아청소년의 임상적 접근

남효경 이화여자대학교 의과학연구소 2021 EMJ (Ewha medical journal) Vol.44 No.4

Growth represents a sentinel for general health state in children and adolescent. Linear growth in children and adolescent is a complex process influenced by numerous factors including genetic, prenatal, postnatal, and environmental factors. When children less than 2 standard deviation score below the average height for age and sex, they are considered as short stature. Accurate measurement of body profile and determination of height velocity over time are fundamental step. Whether the growth pattern is appropriate or deviated from standardized growth chart is a key point in approaching to short stature in children. Evaluation includes a detailed past medical and family history, physical examination, laboratory test and radiologic evaluation. Recent advances in genetic approaches are allowing for improved diagnosis for idiopathic short stature and various genetic syndromes. Growth hormone is the main treatment option for short stature. It is generally safe but has potential side effects. Individualized growth hormone treatment should be initiated under consideration of both efficacy and safety by pediatric endocrinologists. Early diagnosis and prompt initiation of treatment result in a good prognosis. This article reviews an overview of the diagnostic approach to children and adolescents with short stature, and summarizes etiologies and growth hormone treatment.

반복적인 천음과 호흡곤란을 보인 영아에서 진단된 선천성 심, 폐기형 3례

남효경 ( Hyo Kyoung Nam ),라경숙 ( Kyong Suk La ),변정혜 ( Jung Hye Byeon ),최익선 ( Ic Sun Choi ),장기영 ( Gi Young Jang ),유영 ( Young Yoo ),정지태 ( Ji Tae Choung ),손창성 ( Chang Sung Son ),함수연 ( Soo Youn Ham ) 대한소아알레르기호흡기학회 2009 소아알레르기 및 호흡기학회지 Vol.19 No.2

Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long-term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress. [Pediatr Allergy Respir Dis(Korea) 2009; 19:183-190]

인터뷰 : 김형걸 명예회장과의 인터뷰

백효경,김형걸(토론자),윤재옥(토론자),정순영(토론자),남선영(토론자) 대한건축학회 2008 建築 Vol.52 No.5