• Advances in pediatric surgery
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• 제7권2호
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• pp.112-117
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• 2001

With the advances in neonatal intensive care, pediatric surgeons experience very low birth weight infants, weighing <1,500 g, more frequently. We report our 14 cases of very low birth weight infants with intestinal perforations without congenital causes, at the Asan Medical Center during the 11-year period from 1989 to 2000. The average birth weight was 919 g(563-1,490), and average gestational age was 206 days(161-286). There were nine males and five females, Operation was performed at an average age of 14.0 days(3-38). Ten neonates with symptomatic PDA were given indomethacin in an attempt to close the ductus. Bowel perforation involved the jejunum in two and ileum in twelve. At laparotomy, there were seven focal intestinal perforations, five typical NEC, one intussusception, and an unknown cause, Four neonates underwent resection and anastomosis of the bowel, and nine underwent exteriorization. One underwent resection and anastomosis after peritoneal drainage. Four patients had postoperative complications; two leakage of anastomosis, one stoma necrosis, and one internal herniation. Seven of fourteen patients survived(50.0 %). Seven patients died of septic complication. There was a significant difference in the birth weight and gestational age in survivors compared with those who died(p<0.05). There was an increased risk of bowel perforation in indomethacin treatment for PDA. Careful clinical observation and keen judgment are essential for this particular group of infants.

• Clinical and Experimental Pediatrics
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• 제49권9호
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• pp.966-971
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• 2006

목 적 : 성인의 심혈관질환은 태아발달 동안이나 이른 어린이 시기부터 시작된다는 태아프로그래밍 개념과 출생시 작게 태어난 경우에 성인기에 혈압이 상승된다는 연구들을 고려하여 볼 때, 출생시기부터의 혈압 변화에 대한 연구가 필요함을 느꼈다. 본 연구에서는 신생아의 여러 자궁내 발육 지표와 신생아의 혈압 관련성에 대해 살펴보고자 하였다. 방 법 : 이화여자대학교 목동병원에 내원한 임산부 중 연구참여에 동의한 산모를 대상으로 코호트를 구축하고 이들의 127명의 출생아에 대한 의무기록에 근거하여 자료를 추적, 수집하였고, 생후 24시간 이내에 신생아의 혈압을 측정하였다. 결 과 : 신생아 수축기 혈압과 태내 성장지표는 유의한 양의 상관관계를 보였다; 출생체중(r=0.4), 머리둘레(r=0.4), 출생신장(r=0.3). 그러나 체중대비 머리둘레 비는 신생아 혈압과 유의한 음의 상관관계를 보였다(r=-0.4). 아기의 성과 엄마의 혈압수준, 재태연령을 보정한 상태에서도 신생아 수축기 혈압은 태내 성장지표와 연관성을 보였다. 수축기 혈압은 출생체중이 가장 높은 군에서(90 백분위수 이상) 낮은 군과 비교하여(10 백분위수 미만) 7 mmHg 높았다, 한편 출생체중 대비 머리둘레의 비가 가장 높은 군(90 백분위수 이상)에서 낮은 군(10 백분위수 미만)에 비해 17 mmHg 낮게 나타났다. 결 론 : 우리 연구 결과 자궁내 성장 지연이 신생아의 혈압을 높이는데 영향을 미치는 것을 관찰할 수 없었다. 혈압 프로그래밍은 출생 이후에 성장기간에 시작되는 것으로 생각된다. 자궁내 성장지연으로 인해 혈압이 상승하는 주요 시작 지점이 언제인지 알아보기 위해서 출생 이후부터 따라잡기 성장과 함께 아동기시기 혈압 변화에 대한 지속적인 연구가 필요하다.

• Child Health Nursing Research
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• 제19권3호
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• pp.198-206
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• 2013

목적 본 연구는 신생아중환자실에 입원해 있는 저출생체중아를 대상으로 '어머니의 노래 들려주기 중재'의 효과를 규명하기 위해 수행되었다. 방법 서울 시내에 소재하는 일개 대학병원의 신생아중환자실에 입원한 대상자를 임의표출하여 비동등성 대조군 전후설계로 총 48명의 영아중 실험군 24명, 대조군 24명을 대상으로 하여 본 연구를 수행하였다. 결과 어머니의 노래 들려주기 중재를 제공받은 저출생체중아는 활력징후의 생리적 반응인 심박동수, 호흡수와 산소포화도에서 실험군과 대조군 사이에 통계적으로 유의한 차이가 없었다. 행동상태 점수는 두 집단 간 통계적으로 유의한 차이가 검증되었다. 즉, 노래 들려주기 중재를 제공받은 저출생체중아는 행동상태가 안정되는 결과를 보였다. 결론 본 연구를 통해 신생아중환자실에서 오랜 기간 치료를 받아야 하는 저출생체중아를 위한 긍정적인 청각자극으로서 어머니의 노래 들려주기 중재를 활용할 수 있는 객관적인 근거자료를 마련하였다는 데 의의가 있다. 또한 이러한 중재를 통해 재원기간 동안 저출생체중아의 돌봄에 어머니의 참여를 독려할 수 있을 뿐만 아니라 영아와 부모 사이의 이른 상호작용을 증진시키는 기회를 제공할 수 있다는 점에서 아동간호실무의 발전에 기여할 수 있을 것이다.

• Neonatal Medicine
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• 제16권2호
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• pp.101-109
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• 2009

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.

• Clinical and Experimental Pediatrics
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• 제54권9호
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• pp.363-367
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• 2011

Central venous catheters (CVCs) are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI) remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs) include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI) with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci, and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.

• 대한간호학회지
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• 제40권4호
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• pp.561-570
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• 2010

Purpose: This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea. Methods: After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records. Results: Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (${\pm}3.50$) weeks and the mean birth weight was 1,842 (${\pm}728.6$) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status. Conclusion: Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.

• The Korean journal of internal medicine
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• 제33권6호
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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.

• Neonatal Medicine
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• 제25권4호
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• pp.153-160
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• 2018

Purpose: The aim of this study is to examine the tolerability and effect of early high-dose amino acid administration in extremely low birth weight infants (ELBWIs). Methods: This retrospective cohort study included ELBWI (birth weight <1,000 g, n=142). Biochemical, nutritional, and neurodevelopmental data were compared between infants who received conventional low amino acid (LAA; 1.5 g/kg/day) and those who received high amino acid (HAA; 3 g/kg/day) within the first 48 hours after birth. Neurodevelopmental data included weight, height, and head circumference at discharge, 12 to 14 and 18 to 24 months of corrected age and the Korean Bayley Scale of Infant Development II (K-BSID-II) score at 18 to 24 months of corrected age. Results: The HAA group demonstrated higher peak plasma albumin ($3.0{\pm}0.4$ vs. $3.2{\pm}0.5$, P<0.05) and lower serum creatinine ($1.7{\pm}0.9$ vs. $1.4{\pm}0.8$, P<0.05) during the first 14 days than the LAA group. Full enteral feeding was achieved significantly earlier in infants in the HAA group than in infants in the LAA group ($46.2{\pm}23.0days$ vs. $34.3{\pm}21days$, P<0.01). There was no difference between the two groups in the z score changes in all growth indicators from birth to discharge and at 12 to 14 and 18 to 24 months of corrected age, as well as in the K-BSID-II score at 18 to 24 months of corrected age. Conclusion: Aggressive administration of amino acids during the first 2 days of life in ELBWI was well tolerated and correlated with earlier full enteral feeding, but did not improve growth and neurodevelopment.

• 한국간호교육학회지
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• 제17권2호
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• pp.257-266
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• 2011

Purpose: The aim of this study was to elucidate the themes involved in a nursing experience of caring for extremely low birth weight infants (ELBWIs) in a neonatal intensive care unit (NICU). Methods: Interviews with 6 nurses in various positions and observations in a level III NICU were conducted. The transcribed interview contents and observational notes were reviewed to analyze the data and conceptualize major themes. Results: Three major themes were identified: the fears expressed by the nurses regarding taking care of ELBWIs, reasons for persistent fears, and overcoming fears and gaining intuition. Nurses were afraid of the following factors: the physical fragility of the infants; the possibility of developing disabilities in the future; and the rapid changes in infants' physical condition. These fears were reduced when nurses had developed intuition and confidence in taking care of ELBWIs through various situational experiences. Conclusion: NICU nurses may benefit from obtaining more opportunities to participate in various learning experiences with simulated nursing situations in a variety of patient groups. Applying knowledge and skills into various nursing situations in an integrative way may contribute to enhancing nurses' confidence in nursing practice.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1132-1138
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• 1995

From 1991 to 1994, we experienced 24 cases of neonatal pneumothorax who were admitted to the Neonatal Intensive Care Unit[NICU , Chosun University Hospital. The Following results were obtained.1 The incidence of neonatal pneumothorax was 0.70%, and there were 8 spontaneous pneumothoraces and 16 secondary pneumothoraces. 2 The clinical manifestation of neonatal pneumothorax was as followed. Male infant was dominant[M:F=2:1 , the onset was within 24 hours in the majority[83% , and the right side[62% was more frequent than the left side. The gestation duration and birth weight show no correlation with underlying neonatal pneumothorax. The pulmonary diseases were meconium aspiration syndrome and hyaline membrane disease, and the incidence of those was 58%. Meconium aspiration syndrome occurred earlier than hyaline membrane disease. Symptoms and signs were tachypnea[46% , cyanosis[21% , irritability[13% , chest retraction[8% and apnea[8% .3 The treatments performed were oxygen therapy[17% , thoracentesis[4% and closed thoracostomy with underwater seal drainage[79% . The Mean duration of air leakage was 11.7 hours, and the mean drainage time was 4.35$\pm$1.3day. 4 The overall hospital mortality was 33%, and the rate of complication was 46%. The complications were metabolic acidosis, atelectasis, pleural effusion, pulmonary hemorrhage and pneumonia. We concluded that the prognosis was related to the underlying pulmonary disease.