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

공섬김 대한소아청소년과학회 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 accidentrelated 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 safetyrestraint-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.

Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation

공섬김,서정호,전소은,이병기,임영탁 대한혈액학회 2014 Blood Research Vol.49 No.1

Background Hyperleukocytosis caused by acute lymphoblastic leukemia (ALL) is associated with early morbidity and mortality due to hyperviscosity arising from the excessive number of leukocytes.This study was designed to assess the incidence of hyperleukocytosis, survival outcomes, and adverse features among pediatric ALL patients with hyperleukocytosis. Methods Between January 2001 and December 2010, 104 children with previously untreated ALL were enrolled at the Pusan National University Hospital. All of them were initially stratified based on the National Cancer Institute (NCI) risk; 48 (46.2%) were diagnosed with high-risk ALL. The medical charts of these patients were retrospectively reviewed. Results Twenty (19.2%) of the 104 children with ALL had initial leukocyte counts of >100×10⁹/L, and 11 patients had a leukocyte count of >200×10⁹/L. Male gender, T-cell phenotype, and massive splenomegaly were positively associated with hyperleukocytosis. Common early complications during induction therapy included renal dysfunction, and central nervous system hemorrhage. The complete remission (CR) rate for the pediatric ALL patients with hyperleukocytosis (94.1%) was similar to the overall CR rate (95.6%). The estimated 3-year event free survival (EFS) and overall survival of ALL children with hyperleukocytosis were 75.0% and 81.2%, respectively. However, patients with initial leukocyte counts >200×10⁹/L had a lower EFS than those with initial leukocyte counts 100‒ 200×10⁹/L (63.6% vs. 100%; P=0.046). Conclusion The outcome of pediatric ALL cases with an initial leukocyte count >200×10⁹/L was very poor, probably due to early toxicity-related death during induction therapy.

Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation

공섬김,서정호,전소은,이병기,임영탁 대한혈액학회 2014 Blood Research Vol.49 No.1

Background Hyperleukocytosis caused by acute lymphoblastic leukemia (ALL) is associated with early morbidity and mortality due to hyperviscosity arising from the excessive number of leukocytes.This study was designed to assess the incidence of hyperleukocytosis, survival outcomes, and adverse features among pediatric ALL patients with hyperleukocytosis. Methods Between January 2001 and December 2010, 104 children with previously untreated ALL were enrolled at the Pusan National University Hospital. All of them were initially stratified based on the National Cancer Institute (NCI) risk; 48 (46.2%) were diagnosed with high-risk ALL. The medical charts of these patients were retrospectively reviewed. Results Twenty (19.2%) of the 104 children with ALL had initial leukocyte counts of >100×10⁹/L, and 11 patients had a leukocyte count of >200×10⁹/L. Male gender, T-cell phenotype, and massive splenomegaly were positively associated with hyperleukocytosis. Common early complications during induction therapy included renal dysfunction, and central nervous system hemorrhage. The complete remission (CR) rate for the pediatric ALL patients with hyperleukocytosis (94.1%) was similar to the overall CR rate (95.6%). The estimated 3-year event free survival (EFS) and overall survival of ALL children with hyperleukocytosis were 75.0% and 81.2%, respectively. However, patients with initial leukocyte counts >200×10⁹/L had a lower EFS than those with initial leukocyte counts 100‒ 200×10⁹/L (63.6% vs. 100%; P=0.046). Conclusion The outcome of pediatric ALL cases with an initial leukocyte count >200×10⁹/L was very poor, probably due to early toxicity-related death during induction therapy.

Antibiotic resistance of Staphylococcus aureus colonized in children with staphylococcal scalded skin syndrome

공섬김 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.1

Objectives: Systemic antibiotic therapy with semisynthetic penicillinase-resistant penicillin or vancomycin and clindamycin are recommended for the treatment of staphylococcal scalded skin syndrome (SSSS). This study assessed the rate of antibiotic resistance of Staphylococcus aureus isolated from the anterior nares or skin of children diagnosed with SSSS. Methods: A retrospective review of the medical records of 25 patients with SSSS between July 2010 and October 2014 was conducted. The clinical characteristics of patients were collected and the antibiotic susceptibility of S. aureus were analyzed using automated systems. Results: The median age of the patients was 22 months (range: 2-95). Ninety-two percent of patients were less than 5 years of age. Nasal swab samples of all patients and skin swab samples of 17 patients were cultured to isolate S. aureus . Twenty-one (84%) of 25 patients were colonized with methicillin-resistant S. aureus (MRSA). The results of swab samples of the other four patients were no growth or isolation of bacteria other than S. aureus . Among 20 strains isolated from the anterior nares, 1 strain (5%) was methicillin-susceptible S. aureus . All 15 strains isolated from the skin were MRSA. All 21 strains isolated from anterior nares or skin were found to be resistant to clindamycin upon evaluation using automated systems. Conclusions: The rates of methicillin and clindamycin resistance in S. aureus colonized in children with SSSS were very high. Further studies evaluating proper antibiotic regimens and the effectiveness of systemic antibiotic therapy are needed.

단일 병원에서 소아 기도 이물 흡인에 대한 30년의 임상 경험

김혜영,공섬김,박희주 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

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. 목 적 : 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. 방 법 : 1980년부터 2009년까지 약 30년간 부산대학병원 소아청소년과에서 기왕력, 흉부 방사선 검사, 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. 결 과 : 기도 이물 흡인 환아의 평균 연령은 22.3개월이며 3세 미만이 76.2%로 대부분이었고, 남녀비는 2.12:1 였다. 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. 결 론 : 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.

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.

소아 대상 혈액배양검사 현황 파악을 위한 국내 다기관 설문조사

이영준,이지영,공섬김,연규민,홍유라,오지은,Lee, Young Joon,Lee, Ji Young,Kong, Seom Kim,Yeon, Gyu Min,Hong, Yoo Rha,Oh, Chi Eun 대한소아감염학회 2018 Pediatric Infection and Vaccine Vol.25 No.1

Purpose: Blood culture is an essential diagnostic tool and requires clear indications, proper techniques, and quality control. We aimed to investigate whether blood cultures in children are appropriate for indications, are performed correctly, and receive proper quality control. Methods: We conducted an online survey targeting pediatric infectious diseases (ID) specialists working in general hospitals and neonatologists (Neo) working at hospitals operating a neonatal intensive care unit in Korea. Results: Approximately 81.1% (30/37) of pediatric ID specialists and 72.2% (52/72) of Neo responded to the survey. Some of the respondents (33.3% of ID and 59.6% of Neo) performed blood culture as a regular test irrespective of the indication. Approximately 40% of ID and 65.4% of Neo ordered only one set of blood culture in patients suspected with bacteremia. The most commonly used disinfectant for skin preparation was povidone-iodine, while the skin preparation method varied by institution. Approximately two-thirds of the institutions were monitoring the blood culture contamination rate, whereas relatively few provided staff with feedback on that rate. In addition, less than half of the institutions were providing regular staff training on blood culture (40% of ID and 28.8% of Neo). Conclusions: The indication and methods of blood culture for children varied according to institution, and few hospitals exert effort in improving the quality of blood culture. Institutions have to strive constantly toward improvement of blood culture quality and evidence-based recommendations for pediatric blood cultures should be standardized.

PHACE Syndrome with Large Facial Segmental Hemangioma and Cerebellar Hypoplasia

이영준,연규민,공섬김 대한소아혈액종양학회 2017 Clinical Pediatric Hematology-Oncology Vol.24 No.2

Infantile hemangiomas are the most common benign tumors in infants. Facial segmental hemangiomas are often accompanied by other anomalies, and pre-treatment evaluation is needed. PHACE syndrome is associated with Posterior fossa anomalies, Hemangiomas, Arterial anomalies, Cardiac anomalies, and Eye anomalies (PHACE). PHACE syndrome is diagnosed in about 30% of patients with facial segmental hemangiomas. In PHACE syndrome, facial hemangioma usually requires initial treatment; propranolol use is increasing as a first-line treatment despite the risk of stroke. We report a case of PHACE syndrome in a patient with large facial hemangiomas, left cerebellar hypoplasia, and an absent A1 segment of the anterior cerebral artery. After 1 year of treatment with oral propranolol, facial hemangiomas improved and normal development was observed until 24 months of age. Evaluation of PHACE syndrome is important in patients with large facial segmental hemangiomas, and propranolol can be considered a first-line therapy for hemangioma.

문제기반학습 교육과정 개편에 따른 과정 만족도 및 학생평가 결과 비교 분석 연구

김세진,김민정,공섬김,정호중,Kim, Sejin,Kim, Minjeong,Kong, Seom Gim,Jeong, Ho Joong 연세대학교 의과대학 2022 의학교육논단 Vol.24 No.2

The purpose of this study was to redesign a problem-based learning (PBL) curriculum and compare the differences between the previous and redesigned PBL based on the results of course satisfaction and student assessments. The PBL was redesigned using curriculum design guidelines (including revisions of curriculum objectives, learning components, learning environments, and assessment methods) that were developed based on previous studies and evaluation results. A comparative study was employed using course satisfaction surveys from the previous and redesigned curricula, and a total of 45 students participated. We also compared student assessment results from concept mapping, learning issue reports, modified essay questions, and reflection journals. We identified four key findings. First, we explored the possibility that the redesigned PBL could be implemented by student facilitators without professors as tutors. Second, the redesigned PBL fostered group dynamics that facilitated developing communication skills and collaborative learning through small-group discussions. Third, the new learning elements added in the redesigned PBL made a meaningful contribution to enhancing students' clinical reasoning based on hypothetico-deductive reasoning. Fourth, concept maps in redesigned PBL contained more complex and various nodes and connections, and the levels of the nodes were more appropriate. The implications of this study can provide meaningful preliminary information for redesigning PBL curricula for medical students to develop their essential competencies through PBL.

Massive Fetomaternal Hemorrhage Diagnosed with High-performance Liquid Chromatography

이지영,김경하,공섬김 대한소아혈액종양학회 2016 Clinical Pediatric Hematology-Oncology Vol.23 No.2

Massive fetomaternal hemorrhage (FMH) is a major cause of unexplained fetal death and neonatal anemia. FMH can be diagnosed using the Kleihauer-Betke test or flow cytometry by identifying the presence of fetal red cells in the maternal blood. However, timely diagnosis is a challenge because many hospitals lack the equipment needed to perform such tests. The authors experienced a case of FMH diagnosed via high-performance liquid chromatography (HPLC) which is generally used in measuring glycated hemoglobin (HbA1c) in a patient with unexplained neonatal anemia. A girl aged 2 days was transferred to our hospital for showing pallor and a hemoglobin level of 5.0 g/dL. HPLC revealed 3% fetal hemoglobin (HbF) in the maternal blood. HPLC is a quick test for quantifying HbF that is readily available in many hospitals and could serve as a promising alternative for diagnosing FMH.