• Quality Improvement in Health Care
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• v.14 no.2
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• pp.117-123
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• 2008

문제: 장기 입원 치료를 받은 미숙아의 퇴원교육을 퇴원당일 짧은 시간에 시행함으로써 간호사는 제한된 인력으로 교육시간을 길게 할애하지 못하고, 표준화된 지침의 부재로 인해 퇴원교육을 누락하는 경우가 있으며 보호자는 교육내용을 충분히 이해할 시간이 부족하여 퇴원에 대한 필요 이상의 두려움을 가지고 있었다. 목적: 미숙아에 대한 퇴원교육을 표준화된 지침에 따라 단계적이고 체계적인 방법으로 개선함으로써 불필요한 퇴원지연을 예방하여 재원일수 단축시키고 보호자의 양육 자신감을 향상시킨다. 의료기관: 부산광역시에 소재한 대학병원의 신생아실 질 향상 활동: 미숙아의 퇴원을 지연시키는 원인을 분석하고 개선된 미숙아 퇴원교육 방법을 적용한 후 미숙아 재원일수와 보호자의 양육자신감을 측정하였다. 개선효과: 개선 활동 후 미숙아의 재원일수가 11.33일에서 8.28일로 3.05일 단축되었고 보호자 양육자신감 점수는 68점에서 76.25점으로 8.25점 향상되었다. 교훈: 퇴원을 앞둔 미숙아들이 좀 더 개방적으로 가족과 함께 지내면서 퇴원준비를 할 수 있는 여건과 미숙아의 성장과 발달에 대한 보호자들의 이해를 돕기 위한 인터넷강좌나 공개 강좌 등이 필요하다. 보호자들의 양육 자신감 향상과 정보교환을 위해 자조조직을 활성화하고 보다 질 높은 서비스를 위해서는 현실적으로 간호사의 인원 충원이 필요하다.

• Neonatal Medicine
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• v.28 no.3
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• pp.116-123
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• 2021

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU). Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed. Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004). Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

• The Korean journal of internal medicine
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• v.33 no.6
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• pp.1143-1149
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• 2018

Background/Aims: The purpose of this study was to compare maternal and neonatal outcomes in Korean women with type 2 diabetes and nondiabetic controls. Methods: We performed a retrospective survey of 200 pregnancies in women with type 2 diabetes (n = 100) and nondiabetic controls (n = 100) who delivered from 2003 to 2010 at Cheil General Hospital & Women's Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups matched by age, pre-pregnancy weight, body mass index, parity, and gestational age at delivery. Results: The number of infants that were small for gestational age and the rate of major congenital malformations were not significantly different. However, women with type 2 diabetes showed a slightly higher risk for primary caesarean section (35.0% vs. 18.0%, p = 0.006) as well as pre-eclampsia (10.0% vs. 2.0%, p = 0.017), infections during pregnancy (26.0% vs. 2.0%, p < 0.001), neonatal weight ($3,370{\pm}552.0$ vs. $3,196{\pm}543.3$, p = 0.025), large for gestational age (22.0% vs. 9.0%, p = 0.011), and macrosomia (15.0% vs. 5.0%, p = 0.018) compared to nondiabetic controls. Conclusions: Maternal and neonatal outcomes for women with type 2 diabetes were worse than those for nondiabetic controls. Diabetic women have a higher risk for primary caesarean section, pre-eclampsia, infections during pregnancy, large neonatal birth weight, large for gestational age, and macrosomia.

• The Journal of Korean Academic Society of Nursing Education
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• v.27 no.3
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• pp.261-273
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• 2021

Purpose: This study used a descriptive investigative design to identify educational needs for developmental supportive care for the purpose of establishing a developmental supportive care education program for nurses in neonatal intensive care units. Methods: A survey was conducted on 93 nurses working in neonatal intensive care units located in a metropolitan area, and the collected data were analyzed using descriptive statistics and a paired t-test with the SPSS 25.0 program. For the purpose of analyzing educational needs, we further analyzed data through an importance-performance analysis (IPA) and the Borich needs assessment and the locus for focus models. Results: The average importance of the developmental supportive care of nurses in neonatal intensive care units was 3.74±0.78 out of 5, and the average performance was 3.46±0.81 out of 5. A t-test on the difference between the IPA and Borich needs assessment showed the highest educational need in the categories of 'individualized care', and 'I serve on the Developmental Care Committee at my institution'. In addition, according to the results of deriving the priorities of educational needs using the Borich needs assessment and the locus for focus model, the highest priority was 'I provide appropriate pain management when noxious procedures are necessary'. Conclusion: These findings can be used as basic data to design a developmental supportive care program suitable for nurses in neonatal intensive care units to meet the educational needs for developmental supportive care.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.1-6
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• 2017

Purpose: We investigated the effectiveness of the delta neutrophil index (DNI) for the prediction of neonatal bacteremia and compared it to other indices. Methods: A total of 146 pediatric patients, aged less than 31 days, admitted to the neonatal intensive care unit of Wonju Severance Christian Hospital with fever before or during hospitalization were enrolled in this study. We divided the patients into two groups based on the existence of neonatal bacteremia and performed blood culture tests on both groups. We examined white blood cell count, absolute neutrophil count, DNI, platelet count, and C-reactive protein (CRP) test. We used a receiver operating characteristic (ROC) curve to evaluate their diagnostic significance. Results: Seventy-seven patients were diagnosed with neonatal bacteremia. The mean gestational age was 38.74 weeks and the mean birth weight was 3.20 kg. The mean gestational age of the control group was 33.34 weeks and the mean birth weight was 2.20 kg. Causative organisms of bacteremia included Staphylococcus aureus (n=22), Staphylococcus epidermidis (n=18), and Streptococcus agalactiae (n=8). Both DNI and CRP were significantly associated with neonatal bacteremia after adjusting for gestational age and birth weight. The area under the ROC curve (AUC) for DNI (0.70) was higher than that for CRP (0.68). Conclusions: The DNI can be used to effectively predict neonatal bacteremia. The prediction will be more accurate if DNI is used in conjunction with other indices. In future, it will be useful to compare DNI with other indices and investigate its relationship with prognosis.

• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.369-375
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• 2005

Purpose : Many inborn errors of metabolism can be completely cured with early detection and early treatment. This is why neonatal screening on inborn errors of metabolism is implemented worldwide. In this study, a cost-benefit analysis was performed on the neonatal screening of phenylketonuria and congenital hypothyroidism in Korea. Methods : This study included 2,908,231 neonates who took the neonatal screening on phenylketonuria and congenital hypothyroidism in Korea from January 1991 to December 2003. From those neonates, the incidence rates of phenylketonuria and congenital hypothyroidism were measured. Furthermore, based on 495,000 babies born in 2002, were calculated and compared the total costs in case when neonatal screening on phenylketonuria and congenital hypothyroidism is implemented, and when not. Results : If the neonatal screening on phenylketonuria and congenital hypothyroidism is implemented, benefits far exceed costs at a ratio of 1.77 : 1 in phenylketonuria, and 11.11 : 1 in congenital hypothyroidism. In terms of wons, the present neonatal screening on phenylketonuria and congenital hypothyroidism will gain us more than 29 billion wons every year. Conclusion : This study only concerns the monetary aspects of the neonatal screening. Therefore, the benefits of the neonatal screening is underestimated by ignoring precious but not measurable values such as quality of life. However, the present neonatal screening on phenylketonuria and congenital hypothyroidism is found to be beneficial and should continue for the good of the nation as well as that of the patients.

• Proceedings of the PSK Conference
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• 2003.10a
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• pp.104-105
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• 2003

Hypoxic-ischemic (H-I) encephalopathy in the prenatal and perinatal period is a major cause of morbidity and mortality and often results in cognitive impairment, seizures, and motor impairment (cerebral palsy). Many studies of neonatal H-I brain injury have utilized the well characterized Levine model in which unilateral carotid ligation is followed by exposure to hypoxia. (omitted)

• Pediatric Infection and Vaccine
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• v.6 no.2
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• pp.194-202
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• 1999

Background : Group B ${\beta}$-hemolytic Streptococcus(GBS) has been the major pathogen of neonatal sepsis in western country. In contrast, GBS has played little role in neonatal sepsis in Korea. But recently, neonatal GBS infections are encountered more frequently. It is important to characterize the clinical and epidemiological features of GBS infection in Korean children. Methods: We reviewed retrospectively the medical records of twenty-seven infants and children with GBS infection experienced at the Seoul National University Children's Hospital during 14 year-period from June, 1985 to June, 1999. Fourteen strains isolated from blood and cerebrospinal fluid were serotyped. Minimum inhibitory concentrations of 10 strains were determined by agar dilution method for penicillin, ampicillin, ampicillin with sulbactam, cefarolin, cefuroxime, and cefuiaxone. Results: The numbers of cases with GBS infection increased in 1990s. Among twenty seven cases, twenty-five cases were under three months of age and both of two cases with underlying disease occurred at three years of age. All neonatal infections were late-onset type and meningitis predominated. Serotypes were III(6 strain), Ib(4), Ia(l) and V(2). All of the strain were susceptible to all of the antibiotics tested. Conclusion: GBS infections in infants were increasingly recognized. GBS should be considered as an etiological agent of neonatal sepsis or meningitis in Korea. Maternal screening and prophylactic antibiotic therapy may be considered.

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.2
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• pp.188-193
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• 2017

Natal teeth that are already present at birth and neonatal teeth that erupt shortly after birth may cause various complications. The purpose of this study is to evaluate the characteristics of natal/neonatal teeth in Korean infants who visited to Kyung Hee University Dental Hospital from 2006 to 2015. A retrospective review of clinical data, including the sex of the patients, chief complaints of the mothers, clinical appearances and locations of the natal/neonatal teeth, and associated complications and treatments, was collected. Overall, a total of 75 teeth were found in 48 patients and 69% of the infants had natal teeth, while 31% had neonatal teeth, all of which were mandibular incisors. Females showed more natal/neonatal teeth than males. Major reasons for visiting the dental clinic were parental anxiety, referrals from other clinics, Riga-Fede disease, and pain during breastfeeding. Extraction was the most common treatment choice; observation and grinding were also used.

• Neonatal Medicine
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• v.18 no.2
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• pp.337-344
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• 2011

Purpose: To report our experience of gastrointestinal operations performed in neonates including low birth weight infants and to evaluate their clinical characteristics. Methods: We retrospectively reviewed the medical records of patients who underwent neonatal gastrointestinal surgery or had necrotizing enterocolitis (NEC) or inguinal hernia from January 2008 to December 2010 at Pusan National University School of Medicine. Results: The main disease was anorectal malformation and male patients were dominant. Twenty four patients (19.2%) had one or more associated anomalies including hydronephrosis and congenital heart disease. Eighteen patients (43.9%) of anorectal malformation had other anomalies. Seventy six percent of NEC cases were very low birth weight infants. Concerning mean days of full enteral feeding after operation, NEC patients needed 30.8 days, which was the longest period. Overall mortality of operation (except NEC and inguinal hernia operation) was 1.6%. The mortality of NEC with surgical treatment was 18.8%. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC patients. Conclusion: The morbidity and mortality after neonatal gastrointestinal surgery were excellent. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC.