Congenital heart disease in the newborn requiring early intervention

Yun, Sin-Weon The Korean Pediatric Society 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.5

Although antenatal diagnostic technique has considerably improved, precise detection and proper management of the neonate with congenital heart disease (CHD) is always a great concern to pediatricians. Congenital cardiac malformations vary from benign to serious conditions such as complete transposition of the great arteries (TGA), critical pulmonary and aortic valvular stenosis/atresia, hypoplastic left heart syndrome (HLHS), obstructed total anomalous pulmonary venous return (TAPVR), which the baby needs immediate diagnosis and management for survival. Unfortunately, these life threatening heart diseases may not have obvious evidence early after birth, most of the clinical and physical findings are nonspecific and vague, which makes the diagnosis difficult. High index of suspicion and astute acumen are essential to decision making. When patent ductus arteriosus (PDA) is opened Widely, many serious malformations may not be noticed easily in the early life, but would progress as severe acidosis/shock/cyanosis or even death as PDA constricts after few hours to days. Ductus dependent congenital cardiac lesions can be divided into the ductus dependent systemic or pulmonary disease, but physiologically quite different from each other and treatment strategy has to be tailored to the clinical status and cardiac malformations. Inevitably early presentation is often regarded as a medical emergency. Differential diagnosis with inborn error metabolic disorders, neonatal sepsis, persistent pulmonary hypertension of the newborn (PPHN) and other pulmonary conditions are necessary. Urgent identification of the newborn at such high risk requires timely referral to a pediatric cardiologist, and timely intervention is the key in reducing mortality and morbidity. This following review deals with the clinical presentations, investigative modalities and approach to management of congenital cardiac malformations presenting in the early life.

microRNAs, Past, Present and Future

윤신원 ( Sin Weon Yun ) 중앙대학교 의학연구소 2017 中央醫大誌 Vol.42 No.1

미숙아, 부당 경량아 및 과체중아에서 생후 2개월까지의 철상태에 관한 연구

윤신원,임인석,김철하,이동근,최응상,유병훈 중앙대학교 의과대학 의과학연구소 1995 中央醫大誌 Vol.20 No.2

The iron status of neonatal perioand shows variable changes dependent upon gestational age and birth weight. In general, compared with TAGA(term appropriate for gestational age), prematurity has been known to have exacerbated from of physiologic anemia and one of the possible contributable factor have been thought to e the lowered iron storage. But the iron status of TSGA(term small for gestational age) and TLGA(term large for gestational age) in early few months of life has not been clearly known yet. The purpose of this study was to compare the changes four groups. The iron status of the newborn was assessed cord blood hemogloin, corrected reticulocyte count, iron, TIBC, ferritin in TAGA(n=20), TSGA(n=11), TLGA(n=22) and prematurity(n=50) that were admitted to the Department of pediatrics, Chung-Ang University Hospital from June 1994 to February 1995. The follow up examinations were performed at 1, 2 months of postnatal period. The results are as follows 1) Mean cord blood hemoglobin levels in TAGA, prematurity, TSGA, TLGA at birth were 15.6±1.4 g/dl, 16.3±1.4 g/dl, 17.8±2.2 g/dl, 16.4±1.5 g/dl. There was statistical significances between TAGA and other three groups(P<0.05). 2) Mean cord blood iron level in TAGA, prematurity, TSGA, TLGA at birth were 229±48㎍/dl, 194±14㎍/dl. But there was no statistical significances. 3) mean cord blood TIBC levels in TAGA, prematurity, TSGA, TLGA at birth were 194±71㎍/dl,, 210±60㎍/dl, 280±80㎍/dl, 304±96㎍/dl. There was statistical significances between TAGA and other three groups(P<0.05). 4) Mean cord blood ferritin levels in TAGA, prematurity, TSGA, TLGA at birth were 170±48㎍/dl, 107±87㎍/dl, 108±68㎍/dl, 170±48㎍/dl. There was statistical significances TAGA and other three groups(P,0.05). 5) As a results of 2 months follow-up examination, the hemoglobin, corrected reticulocyte count, iron, ferritin levels were decreased and TIBC levels were increased in all groups and compared with TAGA, there was significant differences the othere three groups(P<0.05). In conclusion, blood hemoglobin, corrected reticulocyte count, iron, ferritin levels were significantly decreased and TIBC levels were significantly increased not only prematurity but also in TSGA, TLGA, so the marked impaired iron storage was noted in these groups in early few months of life. Further studies need to assess the postnatal affect of prolonged iron redistribution on fetal tissue, to prevent the exacervated form of iron storage and metabolic derangement, we speculate that this particular group of infant may be candidates for early few months of life iron supplementation.

대장직장암 근치수술 후 흉부단순촬영은 폐전이 진단에 유용한가?

윤성현,박승배,강신재,박치민,정극원,장원영,이우용,전호경 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.3

Changes in the Occurrence of Gastrointestinal Infections after COVID-19 in Korea

Ahn So Yun,Park Ji Young,Lim In Seok,Chae Soo Ahn,Yun Sin Weon,Lee Na Mi,Kim Su Yeong,Choi Byung Sun,Yi Dae Yong 대한의학회 2021 Journal of Korean medical science Vol.36 No.24

Background: After the global epidemic of coronavirus disease 2019 (COVID-19), lifestyle changes to curb the spread of COVID-19 (e.g., wearing a mask, hand washing, and social distancing) have also affected the outbreak of other infectious diseases. However, few studies have been conducted on whether the incidence of gastrointestinal infections has changed over the past year with COVID-19. In this study, we examined how the incidence of gastrointestinal infections has changed since COVID-19 outbreak through open data. Methods: We summarized the data on the several viruses and bacteria that cause gastrointestinal infections from the open data of the Korea Disease Control and Prevention Agency for 3 years from March 2018 to February 2021 (from Spring 2018 to Winter 2020). Moreover, we confirmed three most common legal gastrointestinal infectious pathogens from March 2016. Results: From March 2020, when the COVID-19 epidemic was in full swing and social distancing and personal hygiene management were heavily emphasized, the incidence of infection from each virus was drastically decreased. The reduction rates compared to the averages of the last 2 years were as follows: total viruses 31.9%, norovirus 40.2%, group A rotavirus 31.8%, enteric adenovirus 13.4%, astrovirus 7.0%, and sapovirus 12.2%. Among bacterial pathogens, the infection rates of Campylobacter and Clostridium perfringens did not decrease but rather increased in some periods when compared to the average of the last two years. The incidence of nontyphoidal Salmonella, Staphylococcus aureus, or enteropathogenic Escherichia coli somewhat decreased but not significantly compared to the previous two years. Conclusion: The incidence of infection from gastrointestinal viruses, which are mainly caused by the fecal-to-oral route and require direct contact among people, was significantly reduced, whereas the incidence of bacterial pathogens, which have food-mediated transmission as the main cause of infection, did not decrease significantly.

Acute Appendicitis: A Rare But Probable Manifestation of Kawasaki Disease

Choi Wonshik,Yun Sin Weon,Hong Mineui,Suh Suk-Won,Yi Dae Yong,Park Ji Young 대한소아감염학회 2023 Pediatric Infection and Vaccine Vol.30 No.2

Kawasaki disease (KD) is an acute, systemic inflammatory disorder that often targets coronary arteries. Being the common cause of acquired heart disease in children, timely diagnosis and intravenous immunoglobulin treatment are crucial. However, it is challenging for physicians to diagnose KD if it presents with atypical manifestations. We report the case of a 5-year-old boy who initially presented with appendicitis; after an appendectomy, he had a prolonged fever. He was finally diagnosed with atypical KD and successfully recovered after intravenous immunoglobulin treatment. Through a literature review, we found 21 cases of appendicitis associated with KD. In most cases, the patients were male with a mean age of 5.3 years. Most had higher proportions of incomplete KD and coronary artery complications than expected for typical KD. In conclusion, appendicitis could be a rare complication of KD; therefore, multidisciplinary cooperation and early recognition of atypical KD are essential for timely diagnosis.

Identification of <i>LEF1</i> as a Susceptibility Locus for Kawasaki Disease in Patients Younger than 6 Months of Age

Kim, Hea-Ji,Yun, Sin Weon,Yu, Jeong Jin,Yoon, Kyung Lim,Lee, Kyung-Yil,Kil, Hong-Ryang,Kim, Gi Beom,Han, Myung-Ki,Song, Min Seob,Lee, Hyoung Doo,Ha, Kee Soo,Sohn, Sejung,Ebata, Ryota,Hamada, Hiromichi Korea Genome Organization 2018 Genomics & informatics Vol.16 No.2

<P>Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (<I>LEF1</I>) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; p<SUB>combined</SUB> = 1.10 × 10<SUP>-5</SUP>), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the <I>LEF1</I> gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the <I>LEF1</I> gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.</P>

재발성 폐렴 소아에서 혈청 알레르기 검사의 의의

심윤희,윤신원,채수안,이동근 대한소아과학회 2004 小兒科 Vol.47 No.6

Identification of rare coding variants associated with Kawasaki disease by whole exome sequencing

Kim, Jae-Jung,Hong, Young Mi,Yun, Sin Weon,Lee, Kyung-Yil,Yoon, Kyung Lim,Han, Myung-Ki,Kim, Gi Beom,Kil, Hong-Ryang,Song, Min Seob,Lee, Hyoung Doo,Ha, Kee Soo,Jun, Hyun Ok,Choi, Byung-Ok,Oh, Yeon-Mok Korea Genome Organization 2021 Genomics & informatics Vol.19 No.4

Kawasaki disease (KD) is an acute pediatric vasculitis that affects genetically susceptible infants and children. To identify coding variants that influence susceptibility to KD, we conducted whole exome sequencing of 159 patients with KD and 902 controls, and performed a replication study in an independent 586 cases and 732 controls. We identified five rare coding variants in five genes (FCRLA, PTGER4, IL17F, CARD11, and SIGLEC10) associated with KD (odds ratio [OR], 1.18 to 4.41; p = 0.0027-0.031). We also performed association analysis in 26 KD patients with coronary artery aneurysms (CAAs; diameter > 5 mm) and 124 patients without CAAs (diameter < 3 mm), and identified another five rare coding variants in five genes (FGFR4, IL31RA, FNDC1, MMP8, and FOXN1), which may be associated with CAA (OR, 3.89 to 37.3; p = 0.0058- 0.0261). These results provide insights into new candidate genes and genetic variants potentially involved in the development of KD and CAA.

Influence of proton pump inhibitor therapy on intestinal inflammation assessed by fecal calprotectin in pediatric patients

Kim, Su Yeong,Lee, Na Mi,Yun, Sin Weon,Chae, Soo Ahn,Lim, In Seok,Choi, Eung Sang,Yi, Dae Yong The Korean Pediatric Society 2019 Clinical and Experimental Pediatrics (CEP) Vol.62 No.10

Background: An increase in the numbers of patients with gastrointestinal symptoms has recently been observed. Purpose: To investigate the effects of proton pump inhibitor (PPI) therapy on intestinal inflammation in children and adolescents as confirmed by clinical manifestations and objectively assessed by fecal calprotectin (FC) level measurement. Methods: Consecutive children (aged 3-18 years) who presented with gastrointestinal symptoms and were treated with or without PPI for at least 1 month were enrolled. Patients were divided into PPI and non-PPI groups. The PPI group was further subdivided by treatment duration and type of PPI used. Stool samples were collected for FC evaluation at baseline and after treatment and clinical data and FC levels were compared between the groups. Results: Fifty-one patients (15 boys, 36 girls) were enrolled in the study. The PPI group included 37 patients, while the non-PPI group included 14 patients. Clinical symptoms were not significantly different. FC levels and laboratory results, including C-reactive protein levels, white blood cell count, and absolute neutrophil count, were not statistically different before versus after PPI treatment. After treatment, FC levels decreased to 8.1 mg/kg (-575.4 to 340.3 mg/kg) in the PPI group and increased to 5.6 mg/kg (-460.0 to 186.9 mg/kg) in the non-PPI group compared to those before treatment (P=0.841). The number of patients with increased FC levels was not significantly different between the 2 groups (48.6% vs. 64.3%, P=0.363), similar to that observed in patients with an FC level > 50 mg/kg (24.3% and 7.1%, P=0.250). PPI therapy type and duration did not affect the FC levels (P=0.811 and P=0.502, respectively). Conclusion: Although we aimed to confirm the evidence of intestinal inflammation due to PPI use in children and adolescents through clinical symptoms and FC measurement, no significant changes were observed.