Laryngomalacia is the most common cause of stridor in infants.It usually resolves without therapy by 12 to 18 months of age.In severe cases, however, it results in feeding difficulty, failure to thrive and obstructive apnea.Our experience of 11 infants (age: 1 manth-16 months) with severe laryngomalacia who underwent YAG (Yttrium-Alminium-Garnet) laser laryngoplasty is reviewed.All 11 infants demonstrated significant clinical improvements, and feeding difficulty and obstructive apnea disappeared after laser laryngoplasty.No intra-or postoperative complications were observed.Pulmonary function tests showed limitation of peak inspiratory flow before laser laryngoplasty, and it disappeared after laser laryngoplasty.One patient required additional laser laryngoplasty after upper respiratory infection.Including the above mentioned case, all patients had a good clinical course after laser laryngoplasty.Laser laryngoplasty is considered to be an appropriate therapy for treatment of severe laryngomalacia.

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We analyzed 1087 samples of sputum in less than 7 year-old children diagnosed as pneumonia or bronchitis for four years during 2000-2003.As compared with Streptococcus pneumoniae or Moraxella catarrhalis strains, the degree of tolerance to antibiotics was advancing in Haemophilus influenzae strains.And it was especially for cephalosporins.In inpatients diagnosed as pneumonia or bronchitis caused by Haemophilus influenzae, there was no significant tendency in the rate of invalid cases to initial treatment.However, the rate for which β-lactamase negative ampicillin resistant Haemophilus influenzae (BLNAR) strains accounts among invalid cases was increasing explosively from 10% in 2000 to 70% in 2003.From now on, it is expected that invalid or troubled cases increase for BLNAR strains.Insufficient serum concentration of oral cephalosporins prescribed for immunological immature pediatric patients accelerate the increase of BLNAR strains.In pediatric practice, proper use of antibiotics is required.

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We have investigated whether low birth weight (LBW) influenced the severity of bronchial asthma (BA) by a retrospective case control study.We chose 15 LBW children (1500≤ birth weight <2500g) with BA visiting our hospital as the case group, and chose 2 BA children to each case as the control group (total 30 children) on the basis of following criteria: 1) the same age at the first visit to our hospital and 2) birthday was almost same, 3) he/she attended our hospital at 8 years old, 4) birth weight was more than 2500g.There were no significant differences in the asthma severity at the first visit between the case group and the control group, but the symptoms at the age of 8 were significantly more severein the LBW group than in the control group (p<0.01).Inhaled corticosteroid was used in 8 out of 15 patients in the LBW group, although 4 out of 30 in the control group (p<0.01). These results suggest that LBW is a risk factor for the severity of BA.

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We experienced two neonatal cases of pneumomediastinum presenting cystic appearance lesion.Case 1 was a girl who was born by spontaneous cephalic delivery at 40 weeks of gestation. Cloudy amniotic fluid was showed.Shortly after birth, she presented alinasal breathing.On the following day, she suffered from respiratory distress and the ultrasonogram showed pneumothorax in the right lung and pneumomediastinum.In the right upper mediastinum, there was a round cystic lesion with a septum.By detaining thoracostomy tube, her respiratory distress improved gradually. On 16 days of age, the cystic lesion disappeared on chest CT.Case 2 was a boy who was born by cesarean section at 36 weeks of gestation because of oligoamniosis progression.His chest roentgenogram showed pneumothorax and a round cystic lesion with a septum on the right side of her lung field.The cystic lesion disappeared on chest CT few days later.Through these two cases, we propose that neonatal pneumomediastinum is likely to been seen as round and cystic on imaging in case of increasing air leak volume or pressure, due to the roughness of the mediastinal interstitial connective tissue.

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