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Lee HA, Park B, Park EA, Cho SJ, Kim HS, Choi EJ, Kim NE, Park H. Blood Pressure Curve for Children Less than 10 Years of Age: Findings from the Ewha Birth and Growth Cohort Study. J Korean Med Sci 2020; 35:e91. [PMID: 32233160 PMCID: PMC7105512 DOI: 10.3346/jkms.2020.35.e91] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Routine blood pressure (BP) measurement is recommended to begin at 3 years of age, but there are no national BP reference values for Korean children less than 7 years of age. Therefore, we developed sex-, age-, and height-specific BP reference values for non-overweight children aged 3-9 years. METHODS We analyzed the data of 416, 340, 321, 323, and 332 subjects aged 3, 5, 7, 8, and 9 years, respectively, who participated in the Ewha Birth and Growth Cohort Study. BP percentile curves were generated using generalized additive models for location, scale, and shape. Reference values for the 50th, 90th, and 95th percentiles of BP were determined according to sex, age, and height percentiles. RESULTS In both boys and girls, a gradual increase in systolic blood pressure (SBP) with age was more pronounced than that in diastolic blood pressure (DBP). In boys, the reference values for 90th percentile of SBP/DBP at median height for children aged 3 and 9 years were 105/69 and 118/70, respectively. In girls, the reference values corresponding to the above conditions were 105/69 and 116/70, respectively. Among children aged 7-9 years of median height, the 90th percentile of SBP in the current study was lower and that of DBP was similar to the national reference values of Korea. For children aged < 7 years of median height, the reference value for SBP, but not that for DBP, was similar to that developed in the European study. CONCLUSION Although further research is needed, our findings could be used to help identify high BP in children less than 10 years of age.
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Affiliation(s)
- Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Korea
| | - Bohyun Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Jeong Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Nam Eun Kim
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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Lee J, Kim SK, Kang HG, Ha IS, Wang KC, Lee JY, Phi JH. High prevalence of systemic hypertension in pediatric patients with moyamoya disease years after surgical treatment. J Neurosurg Pediatr 2020; 25:131-137. [PMID: 31703203 DOI: 10.3171/2019.9.peds1986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although an association between moyamoya disease (MMD) and renovascular hypertension has been acknowledged, the literature on systemic hypertension without renal artery stenosis among patients with MMD is scarce. The authors aimed to evaluate the prevalence and risk factors of hypertension using data from MMD patients who visited an outpatient clinic of a pediatric neurosurgical department in 2016. METHODS The authors evaluated the blood pressure (BP) of pediatric MMD patients at their postsurgical appointment following the American Academy of Pediatrics clinical practice guideline on high BP, in which hypertension was defined as BP measurements higher than the value of age-, sex-, and height-specific 95th percentile of the general population from at least 3 separate visits. Growth of patients was determined using 2017 Korean National Growth Charts for children and adolescents. The cutoff value of the 95th percentile of BP was determined by referring to normative BP tables of Korean children and adolescents. A logistic regression model was used to assess the associations between patients' clinical characteristics and prevalent hypertension. RESULTS In total, 131 surgically treated pediatric MMD patients were included, of whom 38.9% were male and the median age at diagnosis was 8.0 years (range 1.2-15.0 years). The definition of hypertension was met in 38 patients, with a prevalence of 29.0% (95% CI 21.2%-36.8%). A tendency was observed for a higher prevalence of hypertension in male patients (31.4%), in patients with posterior cerebral artery (PCA) involvement (47.8%), and in cases in which infarction was shown on initial MRI (37.3%). Age at diagnosis (adjusted OR [aOR] 0.82, 95% CI 0.70-0.97), PCA involvement (aOR 3.81, 95% CI 1.29-11.23), body mass index (aOR 1.30, 95% CI 1.13-1.51), and years of follow-up since surgery (aOR 0.80, 95% CI 0.68-0.94) were related to systemic hypertension. CONCLUSIONS A high prevalence of hypertension was demonstrated in pediatric MMD patients. Therefore, adequate attention should be paid to reduce BP and prevent subsequent events.
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Affiliation(s)
- Joongyub Lee
- 1Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University
- 2Incheon Regional Cardiocerebrovascular Disease Center, Incheon
| | | | - Hee Gyung Kang
- 4Department of Pediatrics, Seoul National University Children's Hospital; and
| | - Il-Soo Ha
- 4Department of Pediatrics, Seoul National University Children's Hospital; and
| | | | - Ji Yeoun Lee
- 3Division of Pediatric Neurosurgery and
- 5Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
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Kang NR, Ahn YH, Park E, Choi HJ, Kim SH, Cho H, Cho MH, Shin JI, Lee JH, Park YS, Cheong HI, Kang HG, Ha IS, Kwack YS, Han KH. Mental health and psychosocial adjustment in pediatric chronic kidney disease derived from the KNOW-Ped CKD study. Pediatr Nephrol 2019; 34:1753-1764. [PMID: 31222663 DOI: 10.1007/s00467-019-04292-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychosocial development of pediatric chronic kidney disease (CKD) patients is substantially affected due to growth retardation, frequent school absences, and difficulties engaging in normal peer relationship activities. While many studies focus on specific issues such as depression, anxiety, or neurocognitive function, few evaluate prevalence of various types of mental health and psychosocial adjustment problems among children with CKD. This study aimed to investigate these within the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). METHODS One hundred sixty-six subjects who completed the Korean-Child Behavioral Checklist (K-CBCL) were included. The clinical group comprised subjects with scores indicating psychosocial adjustment or mental health problems using the T scores for the 14 subscales of the K-CBCL. We analyzed associations between mental health or adjustment problems in pediatric CKD and each variable. RESULTS Mean age was 11.1 (± 3.9) years, number of males was 117 (70.5%), and 20.5% and 22.3% of children had significant mental health problems and psychosocial adjustment problems, respectively. Overall, 33.1% were assigned to the clinical group, and exhibited short stature and higher rates of preterm birth history compared to the non-clinical group. Subjects with adjustment problems had higher comorbidities such as CNS disease, developmental delay, cardiovascular disease, and multi-organ involvement. Logistic regression analysis revealed preterm birth and developmental delay correlated highly with clinical group. CONCLUSIONS A significant proportion of children and adolescents with CKD experience mental health and adjustment problems. In particular, patients with developmental delay or preterm birth history require screening and targeted follow-up.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eujin Park
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Republic of Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Sook Kwack
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Kyoung Hee Han
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea.
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Baek HS, Hoon Han M, Jin Kim Y, Hyun Cho M. Clinical Relevance of C4d Deposition in Pediatric Immunoglobulin A Nephropathy. Fetal Pediatr Pathol 2018; 37:326-336. [PMID: 30273085 DOI: 10.1080/15513815.2018.1504841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Few studies have reported the association between the complement cascade and pediatric immunoglobulin A nephropathy (IgAN). This study aimed to investigate the association between C4d staining positivity and the clinical/histopathological characteristics of pediatric patients with IgAN. METHODS Children diagnosed with IgAN through renal biopsy were retrospectively reviewed. Renal biopsy specimens were stained using C4d immunohistochemistry. RESULTS Among the 56 patients, 31 (55.4%) showed positive mesangial or peripheral capillary C4d staining in glomeruli. Urine protein-to-creatinine ratio was significantly higher in C4d-positive patients (p = 0.001). The severity of mesangial proliferation according to the Haas and Oxford classification was positively associated with positive C4d staining (p < 0.001). CONCLUSION Positive C4d staining was found to be significantly associated with the clinical/histopathological severity of IgAN.
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Affiliation(s)
- Hee Sun Baek
- a Department of Pediatrics, School of Medicine , Kyungpook National University , Daegu , Korea
| | - Man Hoon Han
- b Department of Pathology, School of Medicine , Kyungpook National University , Daegu , Korea
| | - Yong Jin Kim
- b Department of Pathology, School of Medicine , Kyungpook National University , Daegu , Korea
| | - Min Hyun Cho
- a Department of Pediatrics, School of Medicine , Kyungpook National University , Daegu , Korea
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Is the association between ACE genes and blood pressure mediated by postnatal growth during the first 3 years? Early Hum Dev 2012; 88:425-9. [PMID: 22082670 DOI: 10.1016/j.earlhumdev.2011.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 10/07/2011] [Accepted: 10/18/2011] [Indexed: 11/23/2022]
Abstract
Unlike the defined role of angiotensin-converting enzyme (ACE) gene in adult hypertension, ACE gene did not show direct influence on childhood blood pressure (BP), rather, seemed to be related to childhood growth with age-dependent characteristics. Thus, we examined intermediate effects of postnatal growth between the ACE polymorphisms and BP. We analyzed data from 257 children born in 2001-04 at Ewha Womans University Hospital in Seoul, Korea, and followed them up until 3 years of age. Children with excessive adiposity had higher BP, as rapid growers did to no-change and decelerated growers. The ACE II genotype was associated with greater growth acceleration than the DD genotype (II: 46.8% vs. DD: 23.9%), and with a higher BP. The interactions between ACE genotype and adiposity at age 3 were significant on the BP levels. The highest BP increase with the same degree of adiposity was observed in those with the II genotype [β (SE) for BMI: 1.9 (0.9), p=0.04]; particularly, only rapid grown II carriers demonstrated statistical significance on this linear association. These results suggested that ACE polymorphisms and BP association are mediated by postnatal growth. Further studies are required to determine the age-specific ACE genetic effects and its undefined biological mechanism.
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