Kapok fiber composites minimizing secondary waste and disposal costs for large-scale radioactive liquid treatment

Conventional liquid treatments for large-scale, low-level radioactive wastewater, such as ion exchange and waste solidification, face challenges due to the large amounts of secondary waste and high disposal costs. A new large-scale decontamination method is proposed that uses kapok fiber composites for rapid radionuclide adsorption and high volume reduction to minimize secondary waste. The composite consists of natural zeolite and kapok holocellulose, which has high water-soaking ability and low-temperature pyrolysis. The kapok composites, fabricated using a commercial wet-laid nonwoven manufacturing process, absorbs 99% of low-level radioactive cesium in 20 min, reducing the volume by 98% and the weight by 47% at 300 °C. The low-temperature pyrolysis process below 300 °C prevents cesium desorption and gasification by avoiding zeolite destruction. The mass-producible kapok composites can be used for adsorbing various radionuclides in large-scale wastewater by attaching specific adsorbents for target isotopes to the composites.

Neurodevelopmental Outcomes at 18-24 Months of Corrected Age in Very Low Birth Weight Infants with Late-onset Sepsis

BACKGROUND

Preterm infants are prone to sepsis owing to their immature innate immunity and prolonged hospitalization. We aimed to evaluate the association between late-onset sepsis (LOS) during hospitalization and neurodevelopmental delay at 18-24 months of corrected age in very low birth weight infants (VLBWIs), and to ascertain this association when adjusted for perinatal risk factors.

METHODS

This is a population-based study of VLBWIs born at 23-32 weeks of gestation between January 2014 and December 2017 who were enrolled in the Korean Neonatal Network. Bayley scales of infant development were evaluated at 18-24 months of corrected age in 2,098 infants. To test for LOS as a risk factor for neurodevelopmental delay, multiple logistic regression was used and adjusted for parental education status and clinical variables.

RESULTS

Blood culture positive LOS was identified in 419 (20.0%) infants. Cognitive and motor delays were found in 392 (18.7%) and 347 (16.5%) infants, respectively. When multivariate analysis was performed, LOS had a significant association with cognitive delay (odds ratio, 1.48; 95% confidence interval, 1.02-2.16), but no association with motor delay in VLBWIs. Both delays were significantly more frequent in cases of intraventricular hemorrhage (IVH) ≥ grade 3, periventricular leukomalacia (PVL), and intrauterine growth restriction (IUGR) and duration of mechanical ventilation. Male sex and necrotizing enterocolitis ≥ grade 2 had an effect on motor delay, whereas paternal college graduation affected cognitive delay.

CONCLUSION

In VLBWIs with LOS, there is a heightened risk of cognitive delays at 18-24 months of corrected age. Brain injury, such as severe IVH and PVL, duration of mechanical ventilation, and IUGR, were also associated with cognitive and motor delays.

P–153 Comparison outcome of vitrified human embryos stored in vapor phase liquid nitrogen (LN2) and direct LN2

Study question

Is vapor cryopreserved LN2 storage beneficial for clinical outcomes of vitrified human embryos that are frozen compared to vitrified human embryos having direct contact with LN2.

Summary answer

There are no significant differences compared to clinical outcomes of human embryos stored in LN2 vapor and direct store in LN2.

What is known already

There has been concerned about potential cross-contamination and biohazard issues of embryos for long term storage using direct LN2. This study aimed to compare clinical outcomes of human embryos transfer between vapor phase and liquid LN2.

Study design, size, duration

The embryo has undergone vitrification for long term storage with vapor or direct contact in LN2. After the thawing of the embryo, we checked on the survival rates. We transferred only one or two embryos per patient and kept analyzing the implantation and pregnancy rates

Participants/materials, setting, methods

This retrospective study was carried out from January 2018 to December 2019 with 3272cycles 4713embryos; vitrified for long term storage in vapor phase or direct contact with LN2. We compared the clinical outcomes of frozen embryo transfer cycles using vitrified for long term storage in vapor phase and direct contact with LN2. Clinical outcomes monitored were embryo survival, subsequent implantation and pregnancy after single or double embryo transfer

Main results and the role of chance

A total of 4713 fertilized human embryos are vitrified and then stored in LN2 vapor (n = 2520 cycles) or direct contact LN2 (n = 752 cycles). The study showed that the blastocyst stored in vapor able to retain full development. Survival was 97.8% (vapor) and 97.6% (direct contact LN2), and the vapor storage of human embryos had no significant difference in survival rates after a long term storage. For single blastocyst transfer, pregnancy and implantation rates were 51.5%, 52.4% in vapor, 54.6%, 54.9% in direct LN2; respectively (p=NS). In double blastocyst transfer, the pregnancy and implantation rates were 61.8%, 42.0% in vapor and 64.7%, 44.5% in direct LN2; respectively (p=NS). There were also no significant differences between two groups.

Limitations, reasons for caution

The study showed that the blastocyst stored in vapor can retain full development. A vapor storage system thus is safe and effective for long term vapor storage of vitrified human embryos.Within the limits of this study, there was no detection of an adverse effect of vapor storage.

Wider implications of the findings: Vapor storage systems thus represent a useful alternative for safe and effective long-term storage of vitrified human embryos that can avoid cross contamination chances from having direct contact with LN2.

Trial registration number

Not applicable

P–657 Prostaglandin D2 is correlated with follicles development and a reliable marker of ovarian reserve of poor ovarian responder patients

Study question

Is the prostaglandin D2 (PGD2) associated with growing follicles and ovarian reserve of poor ovarian responders?

Summary answer

PGD2 is correlated with ovarian stimulation activity and follicle growth. Especially, poor ovarian responders show a significant decrease in the level of follicular fluid.

What is known already

Prostaglandins (PGs) are involved in the female reproductive process, mainly ovulation, fertilization, and implantation.

Study design, size, duration

We investigated the PGD2 level in the follicular fluid of poor ovarian responders. The collection of human follicular fluid was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. Follicular fluid was collected from patients with normal ovarian response and patients with POR.

Participants/materials, setting, methods

We studied whether prostaglandin has related to POR in the clinical key factor by measuring human follicular fluid. Follicular fluid was collected from patients with normal ovarian response and patients with POR. The concentration of PGD2 in follicular fluid was determined with ELISA kits following the manufacturer’s protocol.

Main results and the role of chance

We analyzed the level of PGD2 in the follicular fluid of patients with normal ovarian response and patients with POR using an ELISA. The PGD2 concentration was significantly lower in the follicular fluid of patients with POR than in the follicular fluid of young and old patients with normal ovarian response.

Limitations, reasons for caution

This study has an identification of biomarker of the clinical samples as POR criteria patients. Therefore, further investigations aimed at specific recovery of low PGD2 metabolic activity in the CCs during control ovarian stimulation.

Wider implications of the findings: Until now there is no specific biomarker of POR. AMH is just an ovary reserve marker for an indication of ovary function. PGD2 is one of the metabolites in steroid metabolism in the ovary. Therefore, we can find some cure through further study for improved PGD2 production to POR patients.

Trial registration number

none

P–658 Lovastatin promotes the expression of LDL receptor and enhances E2 production in the cumulus cells

Study question

Lovastatin enhanced E2 productive ratios in the cumulus cells through promoted expression of Low-density lipoprotein receptor (LDLR).

Summary answer

Lovastatin up-regulated gene expression of LDLR in the CCs. And the high expression of LDLR promoted E2 productive ratios from CCs.

What is known already

We already reported that the up-regulation of LDLR correlated with clinical pregnancy. Therefore, we found lovastatin as an up-regulator of LDLR expression of clinical pregnancy.

Study design, size, duration

This is an expended study of LDLR to enhance steroidogenesis regarding the effect of lovastatin in the CCs. The collection of human cumulus cells was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. The CCs were collected from 12 patients with normal ovarian response after oocyte denudation for ICSI.

Participants/materials, setting, methods

We studied whether lovastatin has up-regulated LDLR expression in human CCs. Cumulus cells were collected from patients with young (∼ 36) and old aged patients (37 ∼). After culturing human CCs, they were treated lovastatin for one day. The concentration of E2 in culture medium was measured using Chemiluminescence immunoassay. The mRNA isolated from CCs was analyzed gene expression level through real time-PCR.

Main results and the role of chance

The concentration of E2 was significantly increased in the culture medium treated with lovastatin. The CCs treated with lovastatin increased the expression of LDLR and StAR which are components of the steroidogenesis pathway.

Limitations, reasons for caution

We have found that the role of lovastatin promotes the E2 production by increasing the ldlr gene of CCs. Therefore, further investigations aimed at lovastatin effect on human oocytes embryo whether enhanced quality of oocytes or not.

Wider implications of the findings: Previous data show that high activation of LDLR and StAR was associated with embryo quality and clinical pregnancy in infertile women. Our data suggest that lovastatin is stimulated LDLR expression to enhanced pregnancy ratios of IVF patients.

Trial registration number

none

The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

BACKGROUND

Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs).

METHODS

Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data.

RESULTS

After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly.

CONCLUSION

From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN.

Cohort profile: the Ewha Birth and Growth Study

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child's growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Combined effects of dietary zinc at 3 years of age and obesity at 7 years of age on the serum uric acid levels of Korean children

BACKGROUND/OBJECTIVES

To assess the longitudinal associations of the antioxidant capacity of zinc and body mass index (BMI) with serum uric acid (SUA) in South Korean children.

SUBJECTS/METHODS

Using follow-up data from the Ewha Birth and Growth Cohort, we included subjects who were seen at 3 and 7 years of age (n = 183; 90 boys, 93 girls). Daily zinc intake and BMI were assessed at 3 and 7 years of age. SUA measured at 7 years was used as the outcome variable. Using a general linear model, the effects of dietary zinc intake and BMI on SUA were assessed. We also assessed the combined effect of early dietary zinc intake and BMI on SUA in children.

RESULTS

The dietary zinc intake at 3 years of age was negatively correlated (ρ = −0.18, P = 0.04), whereas the BMI at 7 years of age was positively correlated (r = 0.18, P = 0.01), with the SUA level at 7 years of age. The dietary zinc intake level at 3 years of age and the BMI level at 7 years of age were, together, significantly related to SUA in children at 7 years of age. SUA was lower in group 1 (normal-weight, high-zinc group) than in the other two groups (group 2: normal-weight, low-zinc and overweight, high-zinc group; and group 3: overweight, low-zinc group). Our results demonstrate the combined effect of zinc intake and BMI on SUA. The combined association remained significant in both the crude and adjusted models (P < 0.01).

CONCLUSIONS

SUA was related to combined BMI and dietary zinc intake, and increased zinc intake and normal body weight had a beneficial effect on reducing SUA in children.

Blood Pressure Curve for Children Less than 10 Years of Age: Findings from the Ewha Birth and Growth Cohort Study

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.

P1603 Changes of cardiac function in cirrhotic patients after liver transplantation

Funding Acknowledgements

This study was supported by the grant of CJ healthcare 2016 research fund.

Background

Liver cirrhosis (LC) has been known to affect cardiovascular performance. Limited study have evaluated the alteration of myocardial function in patients with LC after liver transplantation (LT).

Purpose

The aim of study was to evaluate changes of cardiac function in patients with cirrhosis following LT using conventional and speckle-tracking echocardiography and late gadolinium enhancement (LGE) of cardiac magnetic resonance (MR).

Methods

Thirty-five patients with cirrhosis (mean age, 57.1 ± 9.0; male, 75%) who were listed for LT were prospectively enrolled. Patients underwent conventional, speckle-tracking echocardiography, and cardiac MR imaging with LGE. Echocardiography and cardiac MR were performed at pre and 1 year after LT. Cirrhotic patients were compared with normal control (n = 20, mean age, 65.0 ± 14.8; men, 11(55%)) and echocardiographic and cardiac MR data were compared pre and post LT.

Results

Conventional and speckle-tracking echocardiography and Cardiac MR imaging demonstrated hyperdynamic left ventricular (LV) function in patients with cirrhosis (LV ejection fraction (EF) with cardiac MR 67.8 ± 7.0% in LC vs. 63.4 ± 6.4% in control, P = 0.028; global longitudinal strain (GLS) -24.3 ± 2.6% in LC vs. -18.6 ± 2.2% in control, P &lt; 0.001). There were no LGE in patients with cirrhosis and no significant differences in LV size, LV wall thickness, LV mass index, and diastolic function between cirrhotic patients and control group (all P &gt; 0.1). Corrected QT interval (QTc) in electrocardiogram was prolonged in LC patients (P &lt; 0.001). One-year after LT, LV end-diastolic diameter and LV end-diastolic volume significantly decreased (P = 0.016 and 0.022, respectively). Although LVEF showed no significant changes 1 year post-LT (P = 0.362), LV-GLS (from -24.7 ± 1.8% to -20.8 ± 3.4%, P &lt; 0.001) significantly decreased. QTc interval also decreased 1 year after LT (from 470.4 ± 29.6msec to 428.2 ± 31.6msec, P = 0.001).

Conclusions

The present study demonstrated that cirrhotic patients showed hyperdynamic circulation and prolonged QTc interval compared with normal controls. After 1 year LT, LV size reduced and augmented LV function was normalized. Given that no LGE in cardiac MR and normalized GLS and QTc after LT, cardiac dysfunction in LC patients could be reversed by LT.

MC4R and HNF4α promoter methylation at birth contribute to triglyceride levels in childhood: A prospective cohort study

Although the changes in DNA methylation are assumed to be due to the association between adverse intrauterine conditions and adult metabolic health, evidence from human studies is rare. Little is known about the changes in DNA methylation present at birth that affect metabolic profiles in childhood. Previous studies have shown that the melanocortin 4 receptor (MC4R) and hepatocyte nuclear factor 4 alpha (HNF4α) genes are associated with obesity and metabolic disorders. Thus, we investigated the associations of the DNA methylation statuses of MC4R and HNF4α in cord blood with metabolic profiles in childhood.We collected data from 90 children 7 to 9 years of age included in the Ewha Birth & Growth Cohort Study in Korea. DNA methylation was analyzed by pyrosequencing. The children were split into 2 groups according to the cutoff triglyceride (TG) levels (<110 and ≥110 mg/dL).The methylation statuses of MC4R and HNF4α at birth were significantly associated with the TG level in childhood (P < .05). It was interesting to note that the methylation statuses of MC4R and HNF4α in cord blood were significantly decreased, whereas childhood body mass index was significantly increased, in children with high TG levels compared with children with low TG levels (P < .05).Our findings show that the methylation statuses of MC4R and HNF4α at birth are associated with metabolic profiles in childhood. These epigenetic modifications occurring in early life may contribute to subsequent metabolic-related disorders. Thus, we suggest that DNA methylation status in cord blood may be predictive of the risk of developing metabolic syndrome.

Effects of Prenatal Growth Status on Subsequent Childhood Renal Function Related to High Blood Pressure

BACKGROUND

Hypertension is one of the major causes of chronic diseases. The effect on high blood pressure (BP) with fetal growth restriction is now well-established. Recent studies suggest that a reduced number of nephrons programmed during the intrauterine period contribute to a subsequently elevated BP, due to a permanent nephron deficit. However, few studies have examined this in children. We investigated the effects of low birth weight (LBW) and preterm birth on the renal function markers related to a high BP in childhood.

METHODS

We used data from 304 children aged 7-12 years who participated in the 2014 Ewha Birth and Growth Cohort survey in Korea. We assessed the serum uric acid, cystatin C, blood urea nitrogen (BUN), creatinine levels, and the estimated glomerular filtration rate (eGFR) in childhood. Anthropometric characteristics, BP in childhood, birth weight and gestational age were collected.

RESULTS

The serum uric acid was significantly higher in LBW children (4.0 mg/dL) than in normal birth weight children (3.7 mg/dL). The cystatin C levels were highest among children who were very preterm (0.89 mg/dL) compared with those who were not (preterm, 0.84 mg/dL; normal, 0.81 mg/dL), although the result was only borderline significant (P for trend = 0.06). Decreased birth weight was found to be significantly associated with an increased serum BUN level in childhood. In the analysis of the effects of renal function on BP, subjects with an eGFR lower than the median value had a significantly higher diastolic BP in childhood (difference = 2.4 mmHg; P < 0.05).

CONCLUSION

These findings suggest that LBW and preterm birth are risk factors for increased serum levels of renal function markers in childhood. Reduced eGFR levels were significantly associated with elevated diastolic BP in childhood. It is necessary to identify vulnerable individuals during their life and intervene appropriately to reduce the risk of an increased BP in the future.

Long-term effects of the SLC2A9 G844A and SLC22A12 C246T variants on serum uric acid concentrations in children

BACKGROUND

We evaluated the effects of two single-nucleotide polymorphisms on UA concentrations in the first decade of life using repeated-measures data.

METHODS

We included all subjects who were followed-up at least once and for whom we had both UA and genotypic data (i.e., 375, 204, 307, and 363 patients aged 3, 5, 7, and 9 years, respectively). All participated in the Ewha Birth and Growth Cohort study. We used a mixed model analysis to estimate the longitudinal association of serum UA concentration due to the rs3825017 (SLC22A12 c. 246C > T) and rs16890979 (SLC2A9 c. 844G > A) genotypes.

RESULTS

Overall, the tracking coefficient of UA concentrations in children 3 to 9 years of age was 0.31, and was higher in boys than in girls (0.34 vs. 0.29, respectively). Regarding individual variance, serum UA concentrations decreased as age increased (β = - 0.07, p < 0.05), but there were no significant differences by sex. The effects of rs3825017 on UA concentration were significant in boys, but not in girls. Boys with the T allele of rs3825017 had higher concentrations than their counterparts regardless of the time of follow-up. The rs16890979 genotypes were not significantly associated with serum UA concentration in either sex.

CONCLUSION

This study showed that rs3825017 in the SLC22A12 gene was associated with UA concentration in childhood.

Gestational age-specific sex difference in mortality and morbidities of preterm infants: A nationwide study

This study aims to determine whether male sex has adverse effect on mortality and morbidities in very low birth weight infants (VLBWI) <30 weeks of gestation and to ascertain this sex effect, stratified by gestational age, adjusting for perinatal risk factors. This is a population-based study from Korean Neonatal Network for VLBWI born at 23+0 and 29+6 weeks of gestation between January 2013 and December 2014. The primary outcome was gestation-specific sex difference in the occurrence of mortality, combined morbidities, and individual morbidity. A total of 2228 VLBWI were enrolled (males, 51.7%). Mortality was not different between sexes. The risk of bronchopulmonary dysplasia and combined morbidities was significantly higher in males ≤25 weeks of gestation (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.35-3.20 and OR 2.00, CI 1.19-3.39, respectively). Males had a significantly higher incidence of periventricular leukomalacia at 23 and 29 weeks of gestation. The risk of severe retinopathy of prematurity was higher in females >25 weeks of gestation. Although both sexes have similar risk for mortality, male sex remains an independent risk for major morbidities, especially at ≤25 weeks of gestation. The risk of each outcome for males has a specific pattern with increasing gestational age.

Functional variation of SHP-2 promoter is associated with preterm birth and delayed myelination and motor development in preterm infants

Src homology 2 domain-containing protein tyrosine phosphatase 2 (SHP-2) is a cytoplasmic tyrosine phosphatase that is highly expressed in hematopoietic cells and in the CNS and exerts opposite effects on signal transduction by exerting a neuroprotective or proapoptotic effect. Several mutations of SHP-2 have been found in children with myeloproliferative disorders or malignant leukemia, and some of these can affect brain development. In the present study, we aimed to identify and functionally characterize genetic variations in SHP-2 in 72 preterm and 58 full-term infants and to evaluate the effect of the variations on neurodevelopment in preterm infants. Twelve genetic variations were identified. Among them, two variations in the SHP-2 promoter, g.-317C > T and g.-273G > A, were found to significantly increase promoter activity, and the frequency of g.-273G > A was higher in preterm infants than in full-term infants. Two transcription factors, NF-κB and GABPα, were found to be involved in the transcriptional regulation of SHP-2 by the two above-mentioned variations. In particular, we found that g.-273G > A was significantly associated with delayed myelination and poor motor development in preterm infants. Our results suggest that a functional promoter variation in SHP-2 is associated with spontaneous preterm birth itself as well as white matter myelination and neurodevelopment.

Association Between Serum Levels of Uric Acid and Blood Pressure Tracking in Childhood

BACKGROUND

Recent studies suggest that high levels of serum uric acid of very early life are a result of the in-utero environment and may lead to elevated blood pressure (BP) in adulthood. However, serum uric acid levels can change throughout life. We investigated the effect of serum uric acid levels in childhood on the BP tracking and analysed BP according to changes in serum uric acid levels in early life.

METHODS

A total of 449 children from the Ewha Birth and Growth Cohort study underwent at least 2 follow-up examinations. Data were collected across 3 check-up cycles. Serum uric acid levels, BP, and anthropometric characteristics were assessed at 3, 5, and 7 years of age.

RESULTS

Children with a serum uric acid level higher than the median values had significantly increased systolic BP (SBP) and diastolic BP at 3 years of age. Baseline serum uric acid levels measured at 3 years of age, significantly affected subsequent BP in the sex and body mass index adjusted longitudinal data analysis (P < 0.05). Considering the changing pattern of serum uric acid over time, subjects with high uric acid levels at both 3 and 5 years of age had the highest SBP at 7 years of age.

CONCLUSIONS

These findings suggest the importance of maintaining an adequate level of serum uric acids from the early life. Appropriate monitoring and intervention of uric acid levels in a high-risk group can reduce the risk of a future increased BP.

Effects of Adrenal Androgen Levels on Bone Age Advancement in Prepubertal Children: Using the Ewha Birth and Growth Cohort Study

Bone age (BA) advancement in prepubertal children may be associated with earlier onset of puberty and obesity. This study aimed to define the effects of adrenal androgen levels on the advancement of BA in prepubertal children, independent of obesity. During July and August 2011, we examined BA in 200 prepubertal children aged 7-9 years who were part of the Ewha Birth & Growth Cohort Study. BA was assessed by the Greulich-Pyle method. An index of BA advancement was calculated as the ratio of BA to chronological age (CA) (BA/CA), and this ratio was classified into 3 tertiles. We analyzed the relationship between BA advancement and anthropometric characteristics and adrenal hormone levels. The number of overweight children increased from the first group to the third group (P(Trend) = 0.03). The levels of adrenal androgens showed a significant positive correlation with the tertile groups after adjusting for age and sex (testosterone: r = 0.26, P < 0.001; dehydroepiandrosterone: r = 0.21, P < 0.001; androstenedione: r = 0.20, P < 0.001). Further, after controlling for body mass index (BMI), sex, and age, the BA/CA was found to be positively correlated with androstenedione (β = 0.04, R² = 3.7%) and testosterone levels (β = 0.05, R² = 4.7%). Based on our results, it is suggested that adrenal androgen levels are associated with BA advancement independent of BMI.

Prediction of serum theophylline concentrations and cytochrome P450 1A2 activity by analyzing urinary metabolites in preterm infants

AIMS

The purpose of this study was to explore clinical markers reflecting developmental changes in drug clearance by preterm infants.

METHODS

Preterm infants administered aminophylline or theophylline to treat apnoea of prematurity were enrolled in this study. Trough and one of 2 h, 4 h or 6 h post-dose blood samples and urine samples were collected during steady state, to determine the concentrations of theophylline and its targeted metabolites. CYP1A2*1C and CYP1A2*1F genotypes were analyzed. Total, renal and nonrenal clearances of theophylline were calculated, and cytochrome P450 1A2 (CYP1A2) activity was obtained from the ratio of 1-methyluric acid and 3-methylxanthine to theophylline in urine. Multiple linear regression analysis was performed to evaluate the relationships between theophylline clearance and the clinical characteristics of preterm infants.

RESULTS

A total of 152 samples from 104 preterm infants were analyzed. A strong association between the serum trough and urine theophylline concentrations was found (P < 0.001). Total, renal and nonrenal clearances of theophylline were 0.50 ± 0.29 ml kg^-1  min^-1 , 0.16 ± 0.06 ml kg^-1  min^-1 and 0.34 ± 0.28 ml kg^-1  min^-1 , respectively. CYP1A2 activity correlated positively with the postnatal age and postmenstrual age. However, CYP1A2 genotype was not associated with CYP1A2 activity, which was significantly associated with nonrenal clearance. CYP1A2 activity, postnatal age , weight and 24-h urine output were significantly associated with total theophylline clearance.

CONCLUSIONS

CYP1A2 activity can be monitored using noninvasive random urine samples, and it can be used to assess developmental changes in theophylline clearance by preterm infants.

Which Diet-Related Behaviors in Childhood Influence a Healthier Dietary Pattern? From the Ewha Birth and Growth Cohort

This study was performed to examine how childhood dietary patterns change over the short term and which changes in diet-related behaviors influence later changes in individual dietary patterns. Using food frequency questionnaire data obtained from children at 7 and 9 years of age from the Ewha Birth and Growth Cohort, we examined dietary patterns by principal component analysis. We calculated the individual changes in dietary pattern scores. Changes in dietary habits such as eating a variety of food over two years were defined as “increased”, “stable”, or “decreased”. The dietary patterns, termed “healthy intake”, “animal food intake”, and “snack intake”, were similar at 7 and 9 years of age. These patterns explained 32.3% and 39.1% of total variation at the ages of 7 and 9 years, respectively. The tracking coefficient of snack intake had the highest coefficient (γ = 0.53) and that of animal food intake had the lowest (γ = 0.21). Intra-individual stability in dietary habits ranged from 0.23 to 0.47, based on the sex-adjusted weighted kappa values. Of the various behavioral factors, eating breakfast every day was most common in the “stable” group (83.1%), whereas consuming milk or dairy products every day was the least common (49.0%). Moreover, changes in behavior that improved the consumption of milk or dairy products or encouraged the consumption of vegetables with every meal had favorable effects on changes in healthy dietary pattern scores over two years. However, those with worsened habits, such as less food variety and more than two portions of fried or stir-fried food every week, had unfavorable effects on changes in healthy dietary pattern scores. Our results suggest that diet-related behaviors can change, even over a short period, and these changes can affect changes in dietary pattern.

Particulate matter and early childhood body weight

Concerns over adverse effects of air pollution on children's health have been rapidly rising. However, the effects of air pollution on childhood growth remain to be poorly studied. We investigated the association between prenatal and postnatal exposure to PM10 and children's weight from birth to 60months of age. This birth cohort study evaluated 1129 mother-child pairs in South Korea. Children's weight was measured at birth and at six, 12, 24, 36, and 60months. The average levels of children's exposure to particulate matter up to 10μm in diameter (PM10) were estimated during pregnancy and during the period between each visit until 60months of age. Exposure to PM10 during pregnancy lowered children's weight at 12months. PM10 exposure from seven to 12months negatively affected weight at 12, 36, and 60months. Repeated measures of PM10 and weight from 12 to 60months revealed a negative association between postnatal exposure to PM10 and children's weight. Children continuously exposed to a high level of PM10 (>50μg/m(3)) from pregnancy to 24months of age had weight z-scores of 60 that were 0.44 times lower than in children constantly exposed to a lower level of PM10 (≤50μg/m(3)) for the same period. Furthermore, growth was more vulnerable to PM10 exposure in children with birth weight <3.3kg than in children with birth weight >3.3kg. Air pollution may delay growth in early childhood and exposure to air pollution may be more harmful to children when their birth weight is low.

Cerebellar Development in Preterm Infants at Term-Equivalent Age Is Impaired after Low-Grade Intraventricular Hemorrhage

OBJECTIVES

To investigate cerebellar development in preterm infants at term-equivalent age compared with healthy full-term infants and to examine the effect of a low-grade intraventricular hemorrhage (IVH) on cerebellar development.

STUDY DESIGN

This study used 3T magnetic resonance and diffusion tensor imaging (DTI) at 36-41 weeks' postmenstrual age (PMA) in 72 preterm infants without severe brain injury and 16 full-term infants. Cerebellar volumes and DTI parameters of the cerebellar peduncles including fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity, and radial diffusivities were measured. Clinical variables that may affect brain development were collected.

RESULTS

Compared with full-term infants, preterm infants showed smaller cerebellar volumes and a lower FA, greater ADC, and increased radial diffusivities in the cerebellar peduncles (all P < .05). This cerebellar impairment was associated significantly with PMA and IVH grade 2 but was independent of gestational age at birth. When we adjusted for clinical variables, an IVH grade 2 was related with 1.73 cm(3) reduction in cerebellar volumes and altered DTI parameters in the cerebellar peduncles, including decreased FA and increased radial diffusivities in the superior cerebellar peduncle and increases in ADC, axial diffusivity, and radial diffusivities of the middle cerebellar peduncle (all P < .05). Cerebellar hemispheric volumes were associated with both ipsilateral and contralateral IVH grade 2.

CONCLUSION

Preterm infants without severe brain abnormalities showed impaired cerebellar development at term-equivalent age after we controlled for PMA at the time of the scan, and this is associated with IVH grade 2. These findings suggest that even a low-grade IVH has potential harmful effects on cerebellar development.

Combined effect of folate and adiposity on homocysteine in children at three years of age

BACKGROUND/OBJECTIVES

Cardiovascular diseases is a major cause of death and is responsible for 23.8% of deaths in Korea. Clinical symptoms manifest in adulthood, but susceptibility begins in utero. Elevated homocysteine levels and adiposity might be linked to a greater risk in children as well as adults. We hypothesized that those who have simultaneous risk for folate and adiposity would be affected with elevated homocysteine levels at 3 years of age.

SUBJECTS/METHODS

From the ongoing birth cohort at Ewha Womans University Mok-Dong Hospital, we compared adiposity parameters, serum homocysteine, and folate levels in 238 children (118 boys and 120 girls) at three years of age. The relationship between birth outcome, current weight and body mass index (BMI), postnatal growth, and homocysteine level were assessed using correlation and general linear model. Additionally, we assessed the combined effect between blood folate status and adiposity on current homocysteine levels.

RESULTS

Birth characteristics were not correlated with homocysteine. Current weight, BMI, upper-arm circumference, skinfold thickness, waist circumference, and hip circumference were positively correlated with homocysteine at three years of age (P < 0.05). Folate level was negatively correlated with homocysteine at three years of age (P < 0.0001). A relative high anthropometric measure which is compatible with adiposity and low folate level was associated with high homocysteine levels.

CONCLUSION

We found a combined effect of adiposity and folate levels with homocysteine levels at three years of age. This implicates the beneficial role of folate supplementation in the high-risk population at an early age.

Real-time Data Display System of the Korean Neonatal Network

Real-time data reporting in clinical research networks can provide network members through interim analyses of the registered data, which can facilitate further studies and quality improvement activities. The aim of this report was to describe the building process of the data display system (DDS) of the Korean Neonatal Network (KNN) and its basic structure. After member verification at the KNN member's site, users can choose a variable of interest that is listed in the in-hospital data statistics (for 90 variables) or in the follow-up data statistics (for 54 variables). The statistical results of the outcome variables are displayed on the HyperText Markup Language 5-based chart graphs and tables. Participating hospitals can compare their performance to those of KNN as a whole and identify the trends over time. Ranking of each participating hospital is also displayed in terms of key outcome variables such as mortality and major neonatal morbidities with the names of other centers blinded. The most powerful function of the DDS is the ability to perform 'conditional filtering' which allows users to exclusively review the records of interest. Further collaboration is needed to upgrade the DDS to a more sophisticated analytical system and to provide a more user-friendly interface.

Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution

Purpose

In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations.

Methods

The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed.

Results

Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4±1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed.

Conclusion

Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Indoor total volatile organic compounds exposure at 6 months followed by atopic dermatitis at 3 years in children

BACKGROUND

Exposure to indoor air pollutants is thought to cause allergic inflammation. Volatile organic compounds (VOCs) are one of the aggravating factors of asthma and other allergic diseases. However, the influence of VOCs on development of atopic dermatitis is ambiguous in the clinical field. We therefore investigated the associations of indoor total volatile organic compounds (TVOCs) and development of atopic dermatitis in young Korean children.

METHODS

From the birth cohort of a MOthers and Children's Environmental Health (MOCEH) study, 257 infants, whose parents agreed with the environmental measurement, were enrolled. Total VOCs were measured in infant's bedrooms at the age of 6 month. A total of 105 parents answered a questionnaire at 36 month. Concentrations of TVOCs were divided into two groups by third quartile (75th). Associations between the high VOCs exposure group and development of atopic dermatitis at the age of 36 months were estimated by multivariate logistic regression.

RESULTS

The average concentration of TVOCs was 174.7 ± 115.1 ㎍/m(3) . We defined the high TVOCs exposure group by those with more than 75 percentile of the distribution (242.1 ㎍/m(3) ). An increased risk of atopic dermatitis was observed in the high TVOCs exposure group, after adjustment for parents history of allergy, household income, breast-feeding longer than 6 month (OR = 3.116, 95% Cl 1.041-9.323). Risk of atopic dermatitis was increased when the family bought new furniture within 1 yr.

CONCLUSION

Our results showed that exposure to high concentration of VOCs during infancy, an indoor pollutant, increased the risk of atopic dermatitis at 36 months.

Relationship of serum 25-Hydroxyvitamin D (25[OH]D) levels and components of metabolic syndrome in prepubertal children

OBJECTIVE

The relationship between 25-hydroxyvitamin D (25[OH]D) levels and the lipid and metabolic levels of the prepubertal normal population is unclear. Our goals were to investigate the association of serum 25(OH)D concentrations with lipid and metabolic levels in Korean prepubertal children ages 7-9 y.

METHODS

We followed 205 children, ages 7-9 y in the Ewha Birth and Growth Cohort study, a prospective cohort sample established in 2001-2006, from July to August 2011. We studied the association of serum 25-hydroxyvitamin D (25[OH]D) levels with components of metabolic syndrome and insulin resistance indices using multivariate regression analysis adjusted for body mass index (BMI) z-scores.

RESULTS

The mean age of the 205 subjects was 7.89 ± 0.85 y, and the sample included 109 boys (53.2%). The average 25(OH)D levels of all participants was 25.0 ± 5.4 ng/mL. After adjustment for age and sex, triacylglycerol levels were significantly associated with 25(OH)D (β = -0.02, P = 0.02) concentrations even after adjustment for BMI z-scores (β = -0.02, P = 0.04). However, other metabolic components were not correlated with 25(OH)D status. Those with the lowest quartile of 25(OH)D levels had the highest serum triacylglycerol levels (P = 0.04, Ptrend = 0.01).

CONCLUSIONS

We found that serum 25(OH)D levels were negatively associated with serum triacylglycerol levels, even independently of adiposity, in prepubertal children. This study suggests that 25(OH)D insufficiency is related to metabolic syndrome via the derangement of triacylglycerol metabolism.

Early aggressive nutrition enhances language development in very low-birthweight infants

BACKGROUND

Inadequate nutrition in very-low-birthweight (VLBW) infants is known to be associated with growth failure and poor neurological outcomes. We aimed to investigate the association of early aggressive protein and energy intakes with weight gain and 18-month neurodevelopmental outcomes in VLBW infants.

METHODS

A total of 90 infants among 129 infants who survived to discharge were included and divided into two groups (early aggressive nutrition [n = 52] vs conventional nutrition [n = 38]). Clinical findings were compared between the two groups and daily protein and energy intakes were collected for the first 4 weeks of life. Multiple regression analyses tested the association between weekly protein or energy intakes and the result of each category of the Denver Developmental Screening Test II at 18 months' corrected age or weight gain.

RESULTS

The early aggressive nutrition group had higher rates of normal language development and lower rates of growth failure (<10th percentile) at both 40 weeks' and 18 months' corrected age compared to the conventional nutrition group. After controlling for the confounding variables, higher first week protein and energy intakes each independently contributed to normal language development (odds ratio [95% confidence interval]; 9.4 [1.8-49.6] per 1 g/kg of protein increase and 1.7 [1.1-2.8] per 10 kcal/kg of energy increase). Higher first-week protein intake was associated with a higher weight at 40 weeks' corrected age (r = 0.41, P = 0.005).

CONCLUSIONS

This study demonstrates the importance of the protein and energy intakes in VLBW infants in the first week of life not only for growth but also for better language development.

Association of mid-pregnancy antioxidative vitamin and oxidative stress levels with infant growth during the first 3 years of life

Objective

Numerous studies have revealed the impacts of maternal nutritional status on subsequent birth outcome, but much less is known about the long-term impacts on infant growth after birth. We investigated the association between maternal micronutrient levels/oxidative stress status in pregnancy and infant growth during the first 3 years of life.

Design

Prospective cohort study.

Setting

The Ewha Birth & Growth Cohort study was constructed for women who had been recruited between 24 and 28 weeks’ gestation and their offspring at Ewha Womans University Hospital.

Subjects

Maternal serum vitamin and urinary oxidative stress levels were measured, and infant weight, height, and head circumference were measured repeatedly at birth and at 6, 12, 18, 24, and 36 months of age.

Results

Maternal vitamins A and C were positively associated with infant head circumference and infant weight, respectively, during the first 3 years of life, even after controlling for potential confounding factors. But, maternal oxidative stress was not related to infant growth.

Conclusions

The effects of maternal vitamin levels on subsequent infant growth during the first 3 years of life necessitate interventions to supplement antioxidative vitamins during pregnancy.

The relationship between eosinophilia and bronchopulmonary dysplasia in premature infants at less than 34 weeks' gestation

Purpose

Eosinophilia is common in premature infants, and its incidence increases with a shorter gestation period. We investigated the clinical significance of eosinophilia in premature infants born at <34 weeks gestation.

Methods

We analyzed the medical records of premature infants born at <34 weeks gestation who were admitted to the neonatal intensive care unit at Ewha Womans University Mokdong Hospital between January 2003 and September 2010. Eosinophilia was defined as an eosinophil percentage of >3% of the total leukocytes. Perinatal parameters and clinical parameters were also analyzed.

Results

Of the 261 infants born at <34 weeks gestation, 22.4% demonstrated eosinophilia at birth. The eosinophil percentage peaked in the fourth postnatal week at 7.5%. The incidence of severe eosinophilia increased after birth up to the fourth postnatal week when 8.8% of all patients had severe eosinophilia. Severity of eosinophilia was positively correlated with a lower gestational age, birth weight, and Apgar score. Respiratory distress syndrome, bronchopulmonary dysplasia, nephrocalcinosis, intraventricular hemorrhage, and sepsis were associated with a higher eosinophil percentage. The eosinophil percentage was significantly higher in infants with bronchopulmonary dysplasia from the first postnatal week and the percentage was the highest in the fourth postnatal week, with the maximal difference being 4.1% (P<0.001).

Conclusion

Eosinophilia is common in premature infants and reaches peak incidence and severity in the fourth postnatal week. The eosinophil percentage was significantly higher in bronchopulmonary dysplasia patients from the first postnatal week. Severe eosinophilia was significantly associated with the incidence of bronchopulmonary dysplasia even after adjusting for other variables.

Mendelian randomization analysis of the effect of maternal homocysteine during pregnancy, as represented by maternal MTHFR C677T genotype, on birth weight

Background

We used Mendelian randomization analysis to investigate the causal relationship between maternal homocysteine level, as represented by maternal methylenetetrahydrofolate reductase (MTHFR) C677T genotype, with the birth weight of offspring.

Methods

We recruited women at 24 to 28 weeks’ gestation who visited Ewha Womans University Hospital for prenatal care during the period from August 2001 to December 2003. A total of 473 newborns with a gestational age of at least 37 weeks were analyzed in this study. We excluded twin births and children of women with a history of gestational diabetes, gestational hypertension, or chronic renal disease. The association of maternal homocysteine concentration with the birth weight of infants was analyzed using 2-stage regression.

Results

MTHFR C677T genotype showed a dose–response association with homocysteine concentration for each additional T allele (P_trend < 0.01). Birth weight decreased from 120 to 130 grams as maternal homocysteine level increased, while controlling for confounding factors; however, the association was of marginal significance (P = 0.06).

Conclusions

Our results suggest an adverse relationship between maternal homocysteine level and birth weight. A reduction in homocysteine levels might positively affect birth outcomes.

A girl with sternal malformation/vascular dysplasia association

Sternal malformation/vascular dysplasia association is a rare congenital dysmorphology, which has not yet been reported in Korea. Its typical clinical features include a sternal cleft covered with atrophic skin, a median abdominal raphe extending from the sternal defect to the umbilicus, and cutaneous craniofacial hemangiomata. We report a case of a full-term newborn who presented with no anomalies at birth, except for a skin defect over the sternum and a supraumbilical raphe. Multiple hemangiomas appeared subsequently on her chin and upper chest wall, and respiratory distress due to subglottic hemangioma developed during the first 2 months of life. Her symptoms were controlled with oral prednisolone administration. No respiratory distress have recurred during the 3-year follow-up period.

Association of vitamin D concentrations with adiposity indices among preadolescent children in Korea

BACKGROUND AND OBJECTIVE

We aimed to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) and anthropometric indicators of adiposity among Korean preadolescent children aged 7-9 years.

SUBJECTS AND METHODS

Children aged 7 to 9 from the Ewha Birth & Growth Cohort were followed up from July to August 2011. Serum 25(OH)D concentration was measured using radio immunoassay. We assessed the magnitude of cross-sectional association with vitamin D concentrations and indicators of adiposity [body mass index (BMI), waist circumference (WC), mid-arm circumference (MAC), body fat mass (BFM), percent body fat (PBF), and triceps skinfold thickness (TSF)] using multiple linear and logistic regression analyses adjusted for sex, age, birth order, maternal education, and fruit/fruit juice intake.

RESULTS

Thirty-two (16%) out of a total of 205 children showed an optimal level of serum 25(OH)D, but most children did not reach a sufficient level (<30 ng/mL) even in summer. The level of 25(OH)D was inversely associated with BMI (β=-0.10, p<0.01), WC (β=-0.28, p<0.01), and BFM (β=-0.12, p=0.02) after adjusting for confounding factors and showed marginal boundary with PBF (β=-0.20, p=0.06) and TSF (β=-0.11, p=0.08). Regarding the risk of overweight, a 13% protective effect per 1 ng/mL increase of 25(OH)D was shown even after adjusting for relevant confounding factors (adjusted odds ratio=0.87, 95% confidence interval 0.78-0.98).

CONCLUSIONS

We found that the 25(OH)D concentrations were inversely associated with adiposity indices in preadolescent children. This study suggests that adequate vitamin D intake in growing children is crucial to maintain an optimal vitamin D level to prevent obesity and obesity-related health problems later in life.

Immunogenicity and safety of LBVH0101, a new Haemophilus influenzae type b tetanus toxoid conjugate vaccine, compared with Hiberix™ in Korean infants and children: a randomized trial

BACKGROUND

The World Health Organization (WHO) recommends that all countries adopt Haemophilus influenzae type b (Hib) vaccine into routine child immunization programs to protect children from the significant burden of life-threatening pneumonia and meningitis.

METHODS

In this blind, comparative, randomized, phase-III Korean multicenter study, we assessed immunogenicity and safety following primary vaccination of a new H. influenzae type b tetanus toxoid conjugate vaccine, LBVH0101 (LG Life Sciences, Ltd., Seoul, Korea) compared with Hiberix™ (GSK, Rixensart, Belgium) in Korean children at 2, 4 and 6 months of age followed by a booster vaccination at 12-15 months. Serum anti-PRP IgG concentration and bactericidal activity were determined. Local/systemic symptoms were assessed after vaccination. Serious adverse events were recorded throughout the study.

RESULTS

A total of 185 infants were included in immunogenicity evaluations. After the second and third doses of LBVH0101, 90.32% and 100% of infants achieved an antibody level ≥1 μg/mL, respectively, compared with 78.26% and 96.74% of those who received Hiberix™. After the second vaccination, the geometric mean concentration (GMC) of LBVH0101 recipients was 7.34 μg/mL and was higher than that of Hiberix™ recipients (3.55 μg/mL). After the third vaccination, the GMCs were 14.59 μg/mL and 12.15 μg/mL in the LBVH0101 and Hiberix™ recipients, respectively. The booster dose produced higher antibody concentrations: 30.25 μg/mL and 71.64 μg/mL for LBVH0101 and Hiberix™ recipients, respectively. Bactericidal capacity and antibody potency of anti-PRP IgG induced by LBVH0101 was 35.05 and 116.27 after the second and third vaccinations, respectively, compared with 53.76 and 79.64 for Hiberix™. Anti-PRP IgG seroprotection rate and GMC were similar post-primary immunization between the groups; both showed functional maturation and similar booster responses. LBVH0101 had comparable safety results as the control vaccine, Hiberix™, as most of the solicited adverse events and unsolicited adverse events upon LBVH0101 administration were mild in severity. No serious vaccination-related adverse reactions were observed.

CONCLUSIONS

LBVH0101 showed a good immunogenicity and safety profile in infants and children. The two-dose infant-priming schedule with a booster dose may suffice for Hib immunization in Korean infants (Clinical trial registration numbers: NCT01019772 and NCT01251133).

The association of histological chorioamnionitis and antenatal steroids on neonatal outcome in preterm infants born at less than thirty-four weeks' gestation

BACKGROUND

Despite continuous research on the prevention of preterm labor, preterm delivery still occurs often. Different neonatal outcomes in association with chorioamnionitis might occur with the introduction of antenatal steroids.

OBJECTIVE

The purpose of this study was to determine the effect of chorioamnionitis on the outcome of preterm infants and the association of antenatal steroids in the presence of histological chorioamnionitis (HC).

METHODS

Two hundred and fifty-seven infants born at <34 weeks and admitted to Ewha Womans University Hospital from 2005 to 2010 were enrolled. They were divided into 2 groups, one with HC (n = 89) and the other without HC (n = 168). The clinical characteristics and outcomes of the preterm infants including sepsis, respiratory distress syndrome, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD) were analyzed.

RESULTS

HC was associated with IVH (p = 0.019) and early-onset sepsis (p = 0.038). In the HC group, the infants exposed to antenatal steroids developed BPD less than those without steroid exposure. The duration of mechanical ventilation was significantly decreased in the group with antenatal steroids.

CONCLUSION

HC increased the incidence of early-onset sepsis and IVH in preterm infants of less than 34 weeks' gestation with a high odds ratio of 9.54. In the presence of HC, antenatal steroids significantly decreased the incidence of BPD.

A model for prediction of spontaneous preterm birth in asymptomatic women

BACKGROUND

Preterm birth is a complex health problem with social, environmental, behavioral, and genetic determinants of an individual's risk and remains a major challenge in obstetrics. Recent research has caused improvements in predicting preterm birth; however, there is still controversy about the prediction of preterm birth in asymptomatic women. The purpose of this study was to determine if Bayesian filtering can be used in a clinical setting to predict spontaneous preterm birth in asymptomatic women.

METHODS

A model of predicting spontaneous preterm birth using PopBayes based on a Bayesian filtering algorithm was developed using a previously collected dataset, then applied to a prospectively collected cohort of asymptomatic women who delivered singleton live newborns at or after 24 weeks of gestation. Cases complicated with major congenital malformations were excluded.

RESULTS

The proportion of patients with spontaneous preterm birth was 18.4% (96 of 522) at <37 weeks gestation, 5.4% (28 of 522) at <34 weeks gestation, and 2.7% (14 of 522) at <32 weeks gestation. The match rates with the combination of demographic, clinical, and genetic factors using a Bayesian filtering method (PopBayes) were higher than the match rates using demographic and clinical factors only, including maternal age, maternal body mass index (BMI), prior preterm birth, education, occupation, income, and active and passive smoking. The match rates in preterm delivery before 32 weeks of gestation were higher than the match rates in preterm delivery before 37 and 34 weeks of gestation (94.3% vs. 84.7% and 82.0%, respectively). The negative predictive values for demographic, clinical, and genetic factors in predicting preterm delivery using PopBayes were consistently >90%.

CONCLUSIONS

We suggest that Bayesian filtering (PopBayes) is a customizable and useful tool in establishing a model for the prediction of preterm birth.

Reappraisal of MMR vaccines currently used in Korea

BACKGROUND

Although MMR vaccine is widely used in Korea, there are limited studies on the currently used vaccines. We evaluated the immunogenicity and safety of MMR vaccines in Korean children.

METHODS

For first and second dose immunization, children aged 12-23 months and 4-6 years were enrolled. All subjects received a single dose of either Priorix™ (Glaxo Smithkline Biologicals, Rixensart, Belgium) or MMRII® (Merck & Co., Inc., West Point, PA, USA). Pre- and postvaccine sera were collected from all participants. Antibody levels were determined by ELISA (Enzygnost®; Dade Behring, Schwalbach, Germany). Safety monitoring included local adverse events for 5 days and systemic adverse events for 42 days following vaccination.

RESULTS

One hundred twenty-one subjects were enrolled in the 12-23 months age group and 39 in the 4-6 years age group. The seroconversion rate in the 12-23 months age group was 97.9-100.0% for measles, 85.1-88.9% for mumps and 100.0% for rubella. All children 4-6 years of age previously seronegative showed seroconversion for measles, mumps and rubella. Local adverse events were reported in 8.3-16.1% (12-23 months age) and 27.8-31.6% (4-6 years age), and 40.0-48.2% (12-23 months age) and 42.1-61.1% (4-6 years age) experienced at least more than 1 systemic adverse reaction. No vaccine-related serious adverse events were reported. Among the same age groups, there was no significant difference in adverse events between the two vaccines.

CONCLUSION

The MMR vaccines are safe and show good immunogenic responses in children. These data will be invaluable when we introduce diverse vaccines in the following future.

Body weight at birth and at age three and respiratory illness in preschool children

OBJECTIVES

The purpose of this study was to examine the associations of current body weight and body mass index (BMI) at age three and birth weight in developing chronic respiratory illness in childhood and identify possible interaction underlying its mechanism.

METHODS

The study was carried out with 422 children who were enrolled in a hospital-based birth cohort. Birth related anthropometric data were collected at birth. At age 3 years, the presence of respiratory symptoms was evaluated by using the Korean version of core questionnaire for wheezing and asthma from the International Study of Asthma and Allergies in Childhood (ISAAC). Physical examination was carried out to measure the child's weight and height.

RESULTS

Children in the lowest birth weight tertile (aOR = 3.97, 95% CI = 0.94-16.68) or highest BMI tertile (aOR = 3.68, 95% CI = 1.24-10.95) at three years of age were at an increased risk of chronic respiratory illness. Children who were initially in the lowest birth weight tertile but now belong in the highest weight tertile had higher risk of chronic respiratory illness compared to those who had remained in the middle tertile (OR=16.35, 95% CI=1.66-160.57).

CONCLUSIONS

Children with lower birth weight or higher BMI were at an increased risk of chronic respiratory illness. In addition, children who were initially in the lowest birth weight tertile but are now in the highest weight tertile had higher risk of chronic respiratory illness compared to those who remained in the middle tertile.

OBSERVATIONS WITH REGARD TO THE ACTION OF EPINEPHRIN ON THE CORONARY ARTERY

1. Excised rings of the coronary artery of the ox properly weighted react to epinephrin by dilatation. 2. This reaction of the ox coronary is not an active dilatation, but is in the nature of a sudden lowering from a high to a relatively low degree of tonus. The tonus is not, however, entirely abolished by epinephrin. 3. The degree of relaxation produced by epinephrin is not constant. It depends on several factors other than the concentration of epinephrin used. 4. It is possible to increase the sensitiveness of the coronary artery to epinephrin. 5. There is no evidence of any primary constrictor effect on the ox coronary from epinephrin in most dilute solutions, nor can the existence in this artery of any constrictor mechanism of sympathetic origin be determined by the excised ring method.