두 개 대학병원에서 진단된 학동기 소아 및 청소년 폐결핵의 임상 양상과 접촉자 검진의 실태

배미혜,송보경,김경민,손승국,박수은 대한소아감염학회 2014 Pediatric Infection and Vaccine Vol.21 No.3

목적: 본 연구는 2개 대학 병원에서 폐결핵으로 진단 받고 치료 받았던 학동기 소아와 청소년들을 대상으로 임상 양상과 접촉 병력을 파악하고 접촉자 검진 실태에 대하여 알아보고자 하였다. 방법: 2008년부터 2012년까지 부산대학교어린이병원과 부산대학병원에서 활동 폐결핵으로 진단 받고 치료 받은 10-18세, 54명의 환자를 대상으로 하였다. 환자들의 의무기록을 통하여 진단 당시 임상 양상, 추정 감염 경로, 감염원과의 관계와 미생물학적 검사, 영상학적 검사, 접촉자 검진의 여부, 잠복결핵감염 치료 여부, 노출 후 결핵 발병까지의 기간 등을 후향적으로 조사하였다. 결과: 연령 중앙값은 16세였으며, 10-14세가 11명(20.4%), 15-18세가 43명(79.6%)이었다. 54명 중 35명(64.8%)은 전염성 결핵 환자와 접촉력이 없었고, 19명(35.2%)에서 접촉력이 있었다. 19명 중 가족 접촉자 군은 10명(52.6%)였고, 비가족 접촉자 군은 9명(47.4%)으로 학교 급우였다. 결핵 노출 후 접촉자 검진을 받은 환자는 가족 접촉자 군에서 10명 중 1명 이었고, 비가족 접촉자 군에서 9명 중 6명 이었다. 접촉자 검진을 받은 7명 중 3명이 활동 폐결핵, 1명이 잠복결핵감염, 3명은 결핵감염의 소견은 없었다. 활동 결핵 환자와 노출 후 폐결핵으로 진단되기까지의 기간은 가족 접촉자 군에서 중간값이 2년, 비가족 접촉자 군에서 중간값 0.23년이었다. 결론: 학교 내 접촉자 검진과 같이 접촉자 검진이 적절하게 시행된다면 청소년 결핵을 조기에 발견하고 치료할 수 있게 되며, 이는 결핵의 확산 방지에 도움이 될 것이다. Purpose: The aim of this study was to evaluate the clinical manifestations, contact history, and status of tuberculosis contact investigations in school-age children and adolescents with pulmonary tuberculosis (TB) at two centers. Methods: This study was conducted with 54 patients in the age ranging from 10 to 18 years, who were diagnosed with pulmonary TB at the Pusan National University Hospital and Pusan National University Children’s Hospital, January 2008 to December 2012. We retrospectively reviewed the medical records of the patients. Results: The median age of the patients was 16 years old; 11 patients were aged 10 to 14 and 43 patients were aged 15 to 18. Among 54 patients, 19 had history of contact with pulmonary TB, 10 had contact with house members (household), and remaining 9 had contact with classmates (non-household). One out of 10 patients who had household contacts and 6 out of 9 patients who had non-household contacts were evaluated with contact investigation after the exposure to pulmonary TB. Among 7 patients who were evaluated with contact investigation, 3 were diagnosed with active pulmonary TB, 1 had latent tuberculosis infection (LTBI), and 3 had no evidence of TB or LTBI. The median period of diagnosis after the exposure to active pulmonary TB was 2 years in patients with household contacts and 0.23 years in patients with non- household contacts. Conclusion: This study suggested that if the contact investigation conducted properly, it would be helpful for early diagnosis and prevention of pulmonary TB.

3년간 단일기관 신생아실의 위장관 질환의 분석

권경아,배미혜,박경희,변신연,조용훈,김해영,성시찬 대한신생아학회 2011 Neonatal medicine Vol.18 No.2

Purpose: To report our experience of gastrointestinal operations performed in neonates including low birth weight infants and to evaluate their clinical characteristics. Methods: We retrospectively reviewed the medical records of patients who underwent neonatal gastrointestinal surgery or had necrotizing enterocolitis (NEC) or inguinal hernia from January 2008 to December 2010 at Pusan National University School of Medicine. Results: The main disease was anorectal malformation and male patients were dominant. Twenty four patients (19.2%) had one or more associated anomalies including hydronephrosis and congenital heart disease. Eighteen patients (43.9%) of anorectal malformation had other anomalies. Seventy six percent of NEC cases were very low birth weight infants. Concerning mean days of full enteral feeding after operation, NEC patients needed 30.8 days, which was the longest period. Overall mortality of operation (except NEC and inguinal hernia operation) was 1.6%. The mortality of NEC with surgical treatment was 18.8%. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC patients. Conclusion: The morbidity and mortality after neonatal gastrointestinal surgery were excellent. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC. 목적: 신생아 시기에 수술적 치료를 한 위장관계 질환과 저체중 출생아에서 발생 빈도가 높은 위장관계 질환에 대한 이해를높이고자 한다. 방법: 2008년 1월부터 2010년 12월까지 부산대학교병원과부산대학교 어린이병원 신생아실에 입원한 환아 중 위장관계 질환으로 진단되고 외과적 치료를 받은 125명과 괴사성 장염과 서혜부 탈장으로 진단받은 환아 40명을 대상으로 원인 질환 및 빈도, 출생력, 성별, 동반 기형과 혈청학적 결과를 살펴보았다. 결과: 괴사성 장염과 서혜부 탈장을 제외한 총 125명 환아 중에서 항문 직장 기형이 가장 흔하였고, 남성이 우세하였다. 24명(19.2%)에서 타기형이 동반되었고 수신증, 선천성 심장 기형이많았으며, 항문 직장 기형에서는 43.9%에서 동반 기형이 있었다. 출생체중을 보면 괴사성 장염의 경우 76.0%가 1,500 g 미만으로 대부분을 차지하였다. 술 후 완전 장관 영양까지의 기간은괴사성 장염이 평균 30.8일로 가장 길었다. 술 후 합병증은 담즙정체증, 패혈증과 유착 등이 있었다. 괴사성 장염을 제외한 위장관계 질환으로 수술적 치료를 받았던 환자들은 1.6%의 사망률을 보였으며 수술적 치료를 받은 괴사성 장염의 사망률은18.8%였다. 괴사성 장염의 수술군에서 보존적 치료군보다 직접빌리루빈이 의미있게 더 높았다. 결론: 수술적 치료를 받은 위장관 질환의 생존율은 높고 수술적 치료의 성과도 우수하였다. 괴사성 장염 환아 중 수술군에서직접 빌리루빈이 유의하게 더 높았다.

Comparative observational study of aminophylline with prophylactic and therapeutic uses for clinical outcomes in preterm infants

박경희,배미혜,이나래,한영미,변신연 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.3

Objectives: Aminophylline has been used for prevention or treatment of apnea in preterm infants with idiopathic apnea of prematurity. The aim of this study was to assess the clinical usefulness of prophylactic in comparison with therapeutic aminophylline therapy. Methods: This retrospective observational study included infants born with a birth weight of < 2,500 g or at < 36 weeks of gestation. Infants born between August 2013 and July 2014 who received aminophylline therapy within 24 hr after birth were assigned to the prophylactic group, while infants born between August 2014 and July 2015 who received aminophylline therapy after obvious apnea were assigned to the therapeutic group. We compared clinical characteristics, including days of ventilator and oxygen therapy and bronchopulmonary dysplasia (BPD) between both groups. Results: Sixty—four patients and 25 infants were identified in the prophylactic and therapeutic groups, respectively. The mean gestational age and birth weight were 32.57 ± 1.96 weeks and 1765 ± 205 g, respectively, in the prophylactic group and 32.46 ± 1.82 weeks and 1770 ± 250 g, respectively, in the therapeutic group. No significant differences in clinical characteristics were found between the two groups. Similar clinical outcomes, including days of ventilator and oxygen therapy, intraventricular hemorrhage (IVH), periventricular leukomalacia, and BPD, were observed between the two groups. Conclusions: The present study showed that the prophylactic use of aminophylline does not improve the clinical outcomes, including BPD, IVH, and ventilator dependency as compared with therapeutic use. In other words, routine prophylactic use of aminophylline is unnecessary.

Merosin-Deficient Congenital Muscular Dystrophy with Polymicrogyria and Subcortical Heterotopia: A Case Report

한영미,이나래,배미혜,박경희,신진홍,김대성,변신연 대한신생아학회 2016 Neonatal medicine Vol.23 No.3

This paper reports the brain magnetic resonance imaging (MRI) findings of a case of merosin-deficient congenital muscular dystrophy (MDCMD) in a neonate and dis- cusses the spectrum of brain involvement in MDCMD. A neonate presented hypo- tonia, increased serum creatine kinase levels, and polymicrogyria and subcortical heterotopia on brain MRI involving both posterior temporal and occipital lobes. Al- though these findings suggested Fukuyama muscular dystrophy, muscle biopsy show- ed dystrophic changes and an absence of merosin staining. We found that compound heterozygous mutation for c.2049_2050delAG (p.R683fs) and c.5866-2A>G in the LAMA2 gene which encodes Laminin-α2. To our knowledge, this is the second Korean case of MDCMD with polymicrogyria and subcortical heterotopias. This case shows that a range of brain structural malformations can be found in children with MDCMD and that the classification of congenital muscular dystrophy (CMD) is not complete yet, as indicated previously in reports suggesting other unclassified forms of CMD.

단일 기관 태변 흡인 증후군의 인공호흡기 사용여부에 따른 임상적 특성

임령경 ( Ryoung Kyoung Lim ),배미혜 ( Mi Hye Bae ),김아영 ( Ah Young Kim ),한영미 ( Young Mi Han ),박경희 ( Kyung Hee Park ),변신연 ( Shin Yun Byun ) 대한주산의학회 2015 Perinatology Vol.26 No.2

Purpose: Meconium aspiration syndrome is an important cause of neonatal morbidity and mortality, and sometimes patients need mechanical ventilator therapy. The aim of this study was to identify the risk factors which required mechanical ventilation. Methods: We retrospectively analyzed 44 infants diagnosed as meconium aspiration syndrome from January 2009 to December 2013. We divided into 2 groups (ventilator group and oxygen therapy group) and analyzed the clinical characteristics, vital signs, laboratory findings and clinical courses. Results: Ventilator group and oxygen therapy group included each 22 infants, and there were no significant differences in clinical characteristics between two groups. Time to transfer and time to start oxygen therapy were longer in ventilator group but not statistical difference. Initial mean blood pressure and pH were significantly lower in ventilator group than in oxygen therapy group (P=0.026, P=0.003). Ventilator group had longer treatment period and worse prognosis than oxygen therapy group. Conclusion: If the infants with meconium aspiration and respiratory distress represent low pH and hypotension, we have to pay close attention to early oxygen supplementation and proper treatment to prevent poor clinical course.

소아 호산구 증가증의 원인과 빈도: 1년간 단일 기관 연구

김경민 ( Kyung Min Kim ),배미혜 ( Mi Hye Bae ),김영미 ( Young Mi Kim ),조민정 ( Min Jung Cho ),곽민정 ( Min Jung Kwak ),김성헌 ( Seong Heon Kim ),손승국 ( Seung Kook Son ),박희주 ( Hee Ju Park ),김혜영 ( Hye Young Kim ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.5

Purpose: Eosinophilia may be associated with various primary and reactive conditions. However, studies on the cause and incidence of eosinophilia in Korean children are rare. This study aimed to evaluate the cause and incidence of eosinophilia in patients at a single university hospital. Methods: We studied 8,285 pediatric patients under the age of 18 years who had eosinophilia at Pusan National University Hospital. Premature and newborn infants were excluded. Eosinophilia was defined as an absolute eosinophil count greater than 450/μL. Eosinophilia was categorized as mild (450-1,500/μL), moderate (1,500-5,000/μL), and severe (>5,000/μL). The underlying conditions of eosinophilia were retrospectively investigated. Results: Of 8,285 patients who had a hematology profile, 497 (5.9%) were found to have eosinophilia. Of patients with eosinophilia, 333 patients (67.0%) had identifiable and possible causes. The major causes of eosinophilia were allergic diseases (61.3%), infectious diseases (19.8%), immunologic diseases (9.0%) and hemato-oncologic disease (5.1%). Immunological disease such as Idiopathic hypereosinophilic syndrome, drug induced hypersensitivity syndrome and Graft-versus-host disease was the common condition with moderate to severe eosinophilia in which eosinophil count in peripheral blood was more than 1,500/μL. Conclusion: The most common cause of eosinophilia was allergic disease. Immunological disease was the common condition with moderate to severe eosinophilia.(Allergy Asthma Respir Dis 2014;2:358-361)

Extended Red Blood Cell Genotyping to Investigate Immunohematology Problems

신경화,이현지,박경희,배미혜,장철훈,김형회 대한진단검사의학회 2018 Annals of Laboratory Medicine Vol.38 No.4

Red blood cell (RBC) genotyping is recommended to limit alloimmunization in patients with sickle cell disease or thalassemia [1]. RBC genotyping can resolve the serologic weak D phenotype and inconclusive RhD typing in obstetrics and identify the RBC phenotype in patients with autoantibodies or a positive direct antiglobulin test (DAT) [2]. DNA-based RBC typing has better accuracy and provides more information on RBC antigens than typical phenotyping [1]. We report a challenging case of a pregnant patient in whom a lack of compatible RBCs, based on RBC genotyping, suggested the presence of anti-Dib and anti-E specificities. To our knowledge, extended RBC genotyping was used to obtain compatible RBC units for the first time in Korea.

소아에서 뇌연화증에 동반한 뇌전증의 발생 양상

류수영(Soo Young Lyu),배미혜(Mi Hye Bea),이윤진(Yun Jin Lee),김영미(Young Mi Kim),남상욱(Sang Ook Nam) 대한소아신경학회 2014 대한소아신경학회지 Vol.22 No.3

Purpose: Encephalomalacia is one of the major causes of symptomatic epilepsy. However, no previous study has examined the correlation between encephalomalacia and epilepsy in children. In this study, we aimed to quantify the prevalence, clinical features, and risk factors of epilepsy associated with encephalomalacia. Methods: We performed a retrospective review of the medical records of 95 patients who were diagnosed with encephalomalacia by neuroimaging techniques at Pusan National University Children's Hospital between November 2008 and July 2013. Patients were classified into two groups: epilepsy (Group A) and non-epilepsy (Group B). We compared the demographics, underlying causes, and distribution of encephalomalacic lesions of these two groups. Results: Groups A and B comprised 35 (36.8%) and 60 (63.1%) patients, respectively. Compared to Group B, Group A showed shorter mean gestational period (35.99±4.63 vs. 38.09±3.70, P=0.02), lower birth weight (2.60±0.94 vs. 3.02±0.64, P=0.02), and earlier onset of encephalomalacia (2.74±3.52 vs. 5.60±5.96, P=0.01). In comparing the underlying cause of encephalomalacia, the occurrence of epilepsy was lower after cerebrovascular disease (P〈0.01), but trended towards a higher incidence after a central nervous system infection (P=0.09). Multifocal encephalomalacic lesions were significantly higher in Group A (P=0.04). Conclusion: The risk factors for epilepsy associated with encephalomalacia are early gestational age, low birth weight, early onset of encephalomalacia, and multifocal encephalomalacic lesions. It may be necessary for clinicians to search for these risk factors, and make a particularly close observation on these patients.

Transient Abnormalities on Magnetic Resonance Imaging after Absence Seizures

유혜원,윤리라,김혜영,곽민정,박경희,배미혜,이윤진,남상욱,김영미 대한소아신경학회 2018 대한소아신경학회지 Vol.26 No.4

Magnetic resonance imaging (MRI) is recommended for patients with epileptic seizures to rule out an underlying focal lesion. However, abnormalities in idiopathic generalized epilepsy, including childhood absence epilepsy, cannot usually be identified using brain imaging modalities such as MRI. Peri-ictal MRI abnormalities have been most commonly reported secondary to status epilepticus and are rarely observed in patients with focal seizures and generalized tonic-clonic seizures. Transient peri-ictal MRI abnormalities in absence epilepsy are extremely rare. A five-year-old girl presented with a three-day history of absence seizures that persisted despite continued treatment with sodium valproate. Electroencephalography showed bursts of generalized 3-Hz spike-and-wave discharges, during and after hyperventilation. Abnormal cortex thickening in the left perisylvian region was detected on T2-weighted brain MRI, and cortical dysplasia or a tumor was suspected. The patient started treatment with lamotrigine and was seizure-free after one month. The abnormal MRI lesion was completely resolved at the two-month follow-up. We report on a patient with childhood absence epilepsy and reversible brain MRI abnormalities in the perisylvian region. To our knowledge, this is the first report of transient MRI abnormalities after absence seizures. Transient peri-ictal MRI abnormalities should be considered for differential diagnosis in patients with absence seizures and a focal abnormality on brain MRI.

Comparison of conservative therapy and steroid therapy for Bell’s palsy in children

유혜원,윤리라,김혜영,곽민정,박경희,배미혜,이윤진,남상욱,김영미 대한소아청소년과학회 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.10

Purpose: Bell’s palsy is characterized by sudden onset of unilateral facial weakness. The use of corticosteroids for childhood Bell’s palsy is controversial. This study aimed to identify clinical characteristics, etiology, and laboratory findings in childhood Bell’s palsy, and to evaluate the efficacy of corticosteroid treatment. Methods: We conducted a retrospective analysis of children under 19 years of age treated for Bell’s palsy between January 2009 and June 2017, and followed up for over 1 month. Clinical characteristics, neuroimaging data, laboratory findings, treatments, and outcomes were reviewed. Patients with Bell’s palsy were divided into groups with (group 1) and without (group 2) corticosteroid treatment. Differences in onset age, sex, laterality, infection and vaccination history, degree of facial nerve palsy, and prognosis after treatment between the groups were analyzed. Results: One hundred patients were included. Mean age at presentation was 7.4±5.62 years. A total of 73 patients (73%) received corticosteroids with or without intravenous antiviral agents, and 27 (27%) received only supportive treatment. There was no significant difference in the severity, laboratory findings, or neuroimaging findings between the groups. Significant improvement was observed in 68 (93.2%) and 26 patients (96.3%) in groups 1 and 2, respectively; this rate was not significantly different between the groups (P=0.48). Conclusion: Childhood Bell’s palsy showed good prognosis with or without corticosteroid treatment; there was no difference in prognosis between treated and untreated groups. Steroid therapy in childhood Bell’s palsy may not significantly improve outcomes.