Necrotizing enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002. and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease; one of them had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<5.0 × 10⁹/L), Seven had thrombocytopenia (<100 × 10⁹/L), and three severe thrombocytopenia (<50 × 10⁹/L). Laparotomy was required in 10 of the 13 patients. Indications for operation in acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operation for intestinal stricture and fistula. There was no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count (50 × 10⁹/L) (p<0.05). Congenital heart disease and Rota viral infection is associated with NEC in term infants and thrombocytopenia and leucopenia in the course may be surgical indications.

Diagnosing Hirschsprung's disease is a clinical challenge. Hirschsprung's disease should be considered in any child who has a history of constipation dating back to the newborn period. We examined diagnostic methods and their results retrospectively in 37 neonates and infants who underwent both barium enema and anorectal manometry for the diagnosis of Hirschsprungs disease at Asan Medical Center between January 1999 and April 2001. Two radiologists and a surgeon repeatedly reviewed both of the diagnostic results. In anorectal manometry, thirty-four studies were in agreement with the definitive diagnosis, giving an overall diagnostic accuracy of 91.9 % (neonate; 100 %, infant; 85.7 %). The accuracy and specificity of barium enema was lower than those of anorectal manometry, but sensitivity was higher. There was no significant difference between the two methods. Both studies showed findings consistent with the final diagnosis. However, discordant results needed further evaluation or close observation to diagnose accurately. We conclude that Hirschsprungs disease should not be diagnosed by only one diagnostic method.

Eleven children with gastroesophageal reflux disease underwent fundoplication. Eight had neurological impairment, two hiatal hernia and one had history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting (81.8%), followed by recurrent respiratory infections (72.7%) and failure to thrive (72.7%). The most common diagnostic tool was 24 hour esophageal pH study, which showed a pH less than 4 for more than 10% of the total recorded time in 6 among 9 patients. Nissen fundoplication was performed in 10 patients. Thal fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There were one late death of unrelated cause and one recurrence. The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy be considered in a patient with neurological impairment.