• Advances in pediatric surgery
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• 제13권2호
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• pp.105-111
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• 2007

We reviewed the records of 25 patients who were re-operated upon after primary repair of esophageal atresia with or without fistula at the Department of Pediatric Surgery, Seoul National University Children's Hospital, from January 1997 to March 2007. Types of the esophageal atresia anomalies were Gross type A in 5 patients, C in 18, and E in 2. The indications for re-operation were anastomosis stricture (n = 14), tracheo-bronchial remnant (n = 4), persistent anastomosis leakage (n = 3), recurrent tracheo-esophageal fistula (n = 2) and esophageal web (n = 2). The interval between primary and secondary surgery was from 48 days to 26 years 5 months (mean: 2 years and 4 months). Four patients required a third operation. The interval between the second and third operation was between 1 year 1 month and 3 year 10 month (mean: 2 years 5 months). Mean follow up period after last operation was 35 months (1 years-8 years 6 months). The secondary surgery was end-to-end esophageal anastomosis in 15, esophagoplasty in 5, gastric tube replacement in 5. After secondary operation, 6 patients had anastomosis stricture (4 patients were relieved of the symptoms by balloon dilatation, 2 patients underwent tertiary operation). Five patients had leakage (sealed on conservative management in all). Two patients had recurrent tracheo-esophagel fistula (1 patient received chemical cauterization and 1 patient underwent tertiary operation). Currently, only one patient has feeding problems. There were no mortalities. Secondary esophageal surgery after primary surgery for esophageal atresia was effective and safe, should be positively considered when complications do not respond to nonoperative therapy.

• Journal of Genetic Medicine
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• 제8권2호
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• pp.125-129
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• 2011

저자들은 고도근시, 망막이상, 납작한콧등, 구개열, 하악후퇴, 소하악증, 저신장, 양쪽 손가락의 관절구축증(arthrogryposis)이 있고, 방사선 검사상 불규칙한 대퇴골과 경골의 골단면, 척추골단이형성증이 보이는 Stickler 증후군 환자 1례에서 COL2A1 유전자의 새로운 돌연변이를 국내 최초로 증명하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권1호
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• pp.29-36
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• 2019

Background: An inability to cope with threatening dental stimuli, i.e., sight, sound, and sensation of airotor, manifests as anxiety and behavioral management problems. Behavior modification techniques involving pre-exposure to dental equipment will give children a first-hand experience of their use, sounds, and clinical effects. The aim of this study was to compare the techniques of Tell-Show-Play-doh, a smartphone dentist game, and a conventional Tell-Show-Do method in the behavior modification of anxious children in the dental operatory. Methods: Sixty children in the age group of 4-8 years, with Frankl's behavior rating score of 2 or 3, requiring Class I and II cavity restorations were divided into three groups. The groups were Group 1: Tell-Show-Play-doh; Group 2: smartphone dentist game; and Group 3: Tell-Show-Do technique and each group comprised of 20 children. Pulse rate, Facial Image Scale (FIS), Frankl's behavior rating scale, and FLACC (Face, Leg, Activity, Cry, Consolability) behavior scales were used to quantify anxious behavior. Operator compliance was recorded through a validated questionnaire. Results: The results showed lower mean pulse rates, lower FIS and FLACC scores, higher percentage of children with Frankl's behavior rating score of 4, and better operator compliance in both the Tell-Show-Play-doh and smartphone dentist game groups than in the conventional Tell-Show-Do group. Conclusion: The Tell-Show-Play-doh and smartphone dentist game techniques are effective tools to reduce dental anxiety in pediatric patients.

• Clinical and Experimental Pediatrics
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• 제62권4호
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• pp.138-143
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• 2019

Purpose: Prognostic factors of coronary aneurysms in Kawasaki disease have been investigated in many studies. The aim of this study was to identify risk factors associated with early and late coronary artery outcomes in treated patients with Kawasaki disease. Methods: A total of 392 patients diagnosed with Kawasaki disease from January 2012 to December 2015 in Pusan National University Children's Hospital were retrospectively selected as subjects of the present study to determine risk factors for coronary aneurysms and persistence of coronary aneurysms after a 1-year follow-up. Results: Coronary aneurysms were detected in 30 of 392 patients within 1 month after the occurrence of Kawasaki disease. Coronary aneurysms persisted in 5 of 30 patients after a 1-year follow-up. A long duration of fever (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.06-2.02; P=0.018) and high platelet count (adjusted OR, 1.00; 95% CI, 1.00-1.01; P=0.009) were found to be independent factors to predict the development of coronary aneurysms in the early phase. Initial coronary severity (adjusted OR, 46.0; 95% CI, 2.01-1047.80; P=0.016) and a high white blood cell count (adjusted OR, 1.17; 95% CI, 1.01-1.36; P=0.028) were found to be significant factors for the persistence of late coronary aneurysms in univariate analysis. However, no significant factors were found in multivariate analysis. Conclusion: These data are from early and late follow-up of coronary aneurysms in our unit. Further studies are needed to determine the mechanisms involved in the disappearance of coronary aneurysms and related factors.

• 융합정보논문지
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• 제9권9호
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• pp.58-66
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• 2019

본 연구의 목적은 아동병원간호사의 말초정맥주입 관련 중요성 인식을 조사하고 중요성인식에 영향을 미치는 요인을 확인하기 위하여 128명의 아동병원간호사를 대상으로 시행된 서술적 조사연구로 수집된 자료를 SPSS 21.0으로 기술통계, T-test, ANOVA, Pearson's correlation 및 위계적 회귀분석을 시행하였다. 아동병원간호사의 말초정맥주입 관련 중요성 인식 중 교육이 가장 낮았고, 손위생이 가장 높았다. 결혼상태, 근무부서, 직위 및 최종학력에 따른 중요성 인식 하위영역에 부분적으로 유의한 차이가 있었고(p<.001~.046), 교육과 말초정맥주입 중요성인식 간 양의 상관관계가 있었다(p<.001). 중요성 인식에의 영향요인은 교육(${\beta}=.446$)과 근무부서(${\beta}=.247$)이었고, 변수들의 설명력은 31.0%이었다(p<.001). 본 연구결과는 반복 연구 후 아동병원간호사의 말초정맥주입 중요성 인식 관련 교육프로그램의 기초자료로 활용될 수 있다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.100-108
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). Methods: All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. Results: This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. Conclusion: Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권2호
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• pp.63-68
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• 2023

Objectives: The coronavirus disease (COVID-19) pandemic has had various effects on mankind, especially children and adolescents. Because children and adolescents spend a lot of time at school, COVID-19 has had a great impact on school mental health. In this study, we investigated the effect of prolonged COVID-19 on school mental health. Methods: We prepared self-report questionnaires for depression (Children's Depression Inventory, CDI), anxiety (Korean version of the Penn State Worry Questionnaire for Children; Generalized Anxiety Disorder-7, GAD-7), and post-traumatic stress (Primary Care Post-traumatic Stress Disorder, PC-PTSD) for administering to students aged between 7 and 18 years, recruited by a COVID-19 psychological prevention support group in the Gwangmyeong Mental Health Welfare Center for 2 years, in 2020 and 2021. Results: For children aged 7-12 years, there was no significant difference between the years 2020 and 2021 in the assessment of depression, anxiety, and post-traumatic stress. Conversely, for adolescents aged 13-18 years, there was a significant increase in the scale scores (CDI, PC-PTSD, and GAD-7). Conclusion: Prolonged COVID-19 might have had a significant impact on the mental health of adolescents who spent a lot of time at school. When comparing the years 2020 and 2021, middle and high school students were more affected by COVID-19 than elementary school students.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제27권1호
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• pp.77-78
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• 2024

• Child Health Nursing Research
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• 제20권3호
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• pp.215-224
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• 2014

목적 본 연구는 입원 환아의 낙상위험 요인을 확인하여 낙상위험 예측도구를 개발하고 민감도와 특이도를 확인하기 위한 것이다. 방법 문헌고찰과 서울시내 1개 어린이 병원에 2006년 1월부터 2009년 8월까지 3년 8개월 동안 입원한 환아 중 낙상한 경험이 있는 환아 48명 전체와 2009년 5월 25일부터 6월 24일까지 한 달 동안 입원한 환아 중 낙상 경험이 없는 환아 149명을 비교한 자료를 바탕으로 낙상위험요인 8개를 추출하였으며, 로지스틱 회귀분석을 통해 유의한 위험요인 5개를 확인하였다. 8개 문항과 5개 문항으로 구성된 도구를 이용하여 실제 낙상을 경험한 군과 비낙상군을 비교하여 민감도, 특이도, 양성예측도, 음성예측도를 확인하였다. 결과 로지스틱 회귀분석 결과 입원 환아의 낙상 발생 위험의 유의한 예측 요인은 다음의 5가지였다. 연령은 3세 미만인 경우 3.00배, 뇌신경질환 진단이 있는 경우 2.41배, 활동 및 기능은 도움이 필요한 경우 3.18배, 신체발달은 정상인 경우에 7.09배, 위험약품 처방 수가 3개 이상인 경우 3.475배로 낙상위험이 높은 것으로 나타났다. 8개 문항의 경우 12점 이상을 고위험으로 보았을 때 민감도는 76.6%, 특이도는 30.3%였으며, 5개 문항의 경우 7점 이상을 고위험으로 보았을 때 민감도는 93.6%, 특이도는 16.2%로 나타났다. 결론 입원환아의 낙상위험예측도구로서 8개 문항과 5개 문항의 도구 모두 민감도는 높으나 특이도는 낮은 제한점을 갖고 있다. 그러나 낙상위험을 예방하기 위한 목적으로 사용됨을 감안하면 특이도는 낮지만 민감도가 높으므로 임상현장에서 사용 가능할 것으로 판단된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제14권1호
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• pp.45-51
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• 2011

목 적: Helicobacter pylori (H. pylori) 제균 치료의 적절한 항균제 선택의 기반이 되기 위해 소아에서 H. pylori 항균제 내성률을 알아보고자 하였다. 방 법: 2003년 7월부터 2009년 4월까지 상복부 통증으로 본원을 방문한 환자 중 위 문부 생검 조직 배양에서 H. pylori 가 동정된 균주를 대상으로 항균제 감수성 검사를 시행하였다. 감수성 검사는 clarithromycin과 amoxicillin은 디스크 확산법으로, tetracycline과 metronidazole은 E-test를 시행하였다. 치료 원칙은 감수성 결과가 확인 된 환자는 감수성 결과에 따라 항균제를 선택 하였고, BAM (bismuth subsalicylate, amoxicillin, metronidazole) 또는 OAC (omeprazole, amoxicillin, clarithromycin)를 바탕으로 한 경험적 삼제요법을 택하였다. 치료 실패 시에는 bismuth (또는 bismuth subsalicylate)를 포함한 사제요법을 선택하였다. 결 과: 33명의 환자가 배양검사 양성을 보였고 28명의 환자에서 감수성 검사를 시행하였다. 이 중 항균제 내성을 보인 환아는 9명(32.1%)으로 그 중 7명(25%)이 clarithromycin 내성 균주를 보였고 5명(17.8%)이 metronidazole 내성 균주를 보였다. 대상이 적어 통계적인 분석을 하지 못하였으나 Clarithromycin과 metronidazole의 내성률이 시기적으로 감소하는 추세를 보였다. 결 론: 본 연구는 단일 병원에서 소수의 환아를 대상으로 이루어진 연구로 한계가 있으나, 간접적으로 국내소아 환아에서 분리된 H. pylori의 균주에서도 높은 항균제 내성과 시기적으로 내성률이 변하는 것을 알 수있었다. 따라서 소아 환자에서 적절한 항균제 선택을 제시하기 위한 보다 광범위한 연구가 필요한 것으로 생각한다.