• Clinical and Experimental Pediatrics
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• 제64권4호
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• pp.180-187
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• 2021

Background: Severe perinatal asphyxia results in multiple organ involvement, neonate hospitalization, and eventual death. Purpose: This study aimed to investigate the predictive factors of death in newborns with hypoxic-ischemic encephalopathy (HIE) receiving selective head cooling. Methods: This cross-sectional descriptive-retrospective study was conducted from 2013 to 2018 in Fatemieh Hospital of Hamadan and included 51 newborns who were admitted to the neonatal intensive care unit with a diagnosis of HIE. Selective head cooling for patients with moderate to severe HIE began within 6 hours of birth and continued for 72 hours. The required data for the predictive factors of death were extracted from the patients' medical files, recorded on a premade form, and analyzed using SPSS ver. 16. Results: Of the 51 neonates with moderate to severe HIE who were treated with selective head cooling, 16 (31%) died. There were significant relationships between death and the need for advanced neonatal resuscitation (P=0.002), need for mechanical ventilation (P=0.016), 1-minute Apgar score (P=0.040), and severely abnormal amplitude-integrated electroencephalography (a-EEG) (P=0.047). Multiple regression of variables or data showed that the need for advanced neonatal resuscitation was an independent predictive factor of death (P=0.0075) and severely abnormal a-EEG was an independent predictive factor of asphyxia severity (P=0.0001). Conclusion: All cases of neonatal death in our study were severe HIE (stage 3). Advanced neonatal resuscitation was an independent predictor of death, while a severely abnormal a-EEG was an independent predictor of asphyxia severity in infants with HIE.

• Child Health Nursing Research
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• 제18권4호
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• pp.170-176
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• 2012

Purpose: The purpose of this study was to identify the current status and needs in neonatal emergency training for nursing students in Korea and to obtain preliminary information to develop a simulation based educational program on neonatal emergency care for nursing students. Methods: Structured questionnaires were distributed to five hospitals and ten nursing schools during April and May, 2012. Data were collected from 59 nurses who worked in the nursery or Neonatal Intensive Care Units and 13 nursing educators who had specialized in pediatric nursing. Results: Most nurses (86.4%) reported that they had experienced an emergency situation with newborns. Most nursing educators (84.6%) claimed that more intensive training with newborns is needed for nursing students. In particular, training in neonatal resuscitation (72.2%), respiratory distress (59.7%), and neonatal seizures (18.1%) were highly recommended as simulation based training for nursing students. Conclusion: A significant need for neonatal emergency educational programs was found. More efforts should be made to provide nursing students with knowledge and skills for working with neonates. The findings of this survey will ultimately provide a basis for developing a simulation based educational program on neonatal emergency care for nursing students.

• Child Health Nursing Research
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• 제21권2호
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• pp.98-106
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• 2015

Purpose: This study was done to develop and evaluate an algorithm-based simulation scenario for emergency measures for high-risk newborns presenting with apnea. Methods: A one shot case study design was used to evaluate the algorithm-based simulation scenario. Effects of the developed simulation scenario were evaluated using the Simulation Effectiveness Tool (SET) and the Lasater Clinical Judgement Rubric (LCJR). From March to November 137 senior nursing students completed the simulation using this scenario. Results: The eight-frame simulation scenario was developed based on the Neonatal Resuscitation Program (NRP) and the nursing clinical judgment process. After use of the scenario, overall scores for SET and LCJR were 21.0 out of 26.0 and 32.4 out of 44.0 respectively. There were no significant differences in scores according to general characteristics. Positive correlation coefficients were identified among overall and subcategories of SET and LCJR. In addition, students provided positive feedback on the simulation experience. Conclusion: Considering that nursing students have limited access to high-risk newborns during their clinical experience and that newborns presenting apnea are common in the neonatal intensive care unit, the simulation scenario developed in this study is expected to provide nursing students with more opportunities to practice emergency measures for high-risk newborns.

• The Korean Journal of Physiology and Pharmacology
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• 제3권2호
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• pp.231-236
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• 1999

This study was performed to examine 1) Whether hypothermic cardiac arrest produces myocardial HSP72 expression; 2) And if, whether it serves to protect the heart against the subsequent hypothermic arrest. In the present study, neonatal rats were placed in an icebath to induce hypothermia. To determine whether hypothermic cardiac arrest produces myocardial HSP72, experimental animals were subjected to 10-min hypothermic insult before the extraction of the heart. The intervals between the insult and extraction were 1 (1 HR), 4 (4 HR), 8 (8 HR), 24 (24 HR) or 72 (72HR) hours. A minimal amount of HSP72 was detected in control, 1 HR and 72 HR groups. In contrast, 8 HR and 24 HR groups showed a significant level of HSP72 expressions. To assess the cardioprotective effect of HSP72 against hypothermic cardiac arrest, we compared the proportion of recovery from the arrest between control and preconditioned (PREC) animals. Control animals were subjected to 20-min hypothermic insult, while PREC group was preconditioned by 10-min hypothermic insult 8 hours before the 20-min test hypothermic insult. Resuscitation rate from cardiac arrest induced by the 20-min hypothermic insult in PREC group was significantly higher than that in controls. These results suggest that the cardioprotective effect of hypothermic preconditioning is associated with an increase in HSP72 expression.

• Neonatal Medicine
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• 제28권2호
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• pp.77-82
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• 2021

We present the case of a healthy 28-day-old female full-term neonate who was admitted to the neonatal intensive care unit for severe metabolic acidosis, hypoglycemia, and an initial sinus rhythm. The first diagnostic hypothesis was hypovolemic shock, and fluid resuscitation was started immediately. During fluid therapy, cardiovascular collapse occurred with supraventricular tachycardia. The latter was successfully treated with adenosine and beta-blockers. After 8 days, electrocardiography showed ventricular pre-excitation, and Wolff-Parkinson-White syndrome was diagnosed. A novel variant of the MYL2 gene that is related to hypertrophic cardiomyopathy and conduction defect was found after discharge. Cardiogenic shock should be considered, despite being a rare cause of shock in neonates.

• International Journal of Advanced Culture Technology
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• 제10권4호
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• pp.110-116
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• 2022

The purpose of this study was to examine the effectiveness of gamification in nursing practice for undergraduate students, as well as to explore the use of gamification in nursing education. This study is a systematic review of RCTs evaluating the effectiveness of gamification in nursing practice for undergraduate students. A total of 7 articles were identified in a search of PubMed, Cochrane Library, and Embase, and the additional databases were CINAHL (in English) and RISS (in Korean) between September 28, 2022 to October 5, 2022. Themes related to the environment and personal behaviors between 2002 and 2021 were extracted. The intervention themes were blood transfusion, postoperative pediatric nursing, postoperative hemorrhage and brain trauma nursing, basic and advanced life support, disaster nursing, and neonatal resuscitation. The primary outcomes were knowledge in five studies, satisfaction in one study, and competency in one study. The secondary outcomes were satisfaction in three studies, confidence in two studies, performance in two studies, skills in two studies, and self-efficacy, motivation, professional attitude, cognition, gameful experience, and affective response in one study each. Therefore, gamification interventions can be utilized in nursing practice education instead of traditional teaching methods such as lectures and face-to-face clinical practice.

• Advances in pediatric surgery
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• 제12권2호
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• pp.192-201
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• 2006

1989년 3월부터 2005년 5월까지 울산대학교 의과대학 서울아산병원 소아외과에서 치료받은 신생아 Bochdalek 탈장 67예를 대상으로 하였다. 1989년 3월부터 1999년 말까지 조기수술, 과호흡, 수술시 흉관의 삽입을 시행한 I기(33예)와, 2000년 1월부터 2005년 5월까지 지연 수술, 최소한의 호흡 요법과 고빈도 환기 요법, 일산화질소 흡입 요법을 병행하고, 수술시 흉관의 삽입을 제한한 II기(34예)로 나누어 생존율을 비교하였다. I기의 경우 33예 중 20예가 생존하여 60.6 %, II기의 경우 34예 중 25예가 생존하여 73.5 %의 신생아기 생존율을 보였으나 통계학적 유의성은 없었다. 하지만 II기에서 생존율이 향상된 경향을 보임으로, II기에 불필요한 수술은 피할 수 있었던 것으로 생각되며, 나쁜 예후 인자를 갖는 예에서 치료 원칙의 변화가 의미 있는 역할을 했을 것으로 생각된다. 지연수술, 호흡요법, 일산화질소 흡입요법 각각의 영향에 대한 조사를 할 수 없었던 것은 이번 연구의 한계이다. 그러나 수술 전에 충분하게 제반 상태가 안정된 후에 시행하는 지연 수술이 바람직하다고 생각되며, 수술시 흉관 삽입은 피하는 것이 좋겠다. 수술 전후의 고빈도 환기 요법과 에 대해서는 좀 더 연구가 필요할 것으로 보인다.

• Clinical and Experimental Pediatrics
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• 제58권4호
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• pp.154-157
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• 2015

Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1221-1227
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• 2009

목 적:신생아 집중치료술이 발달함에 따라 미숙아 및 극소 저체중 출생아 등의 고위험 신생아의 생존율이 크게 향상되었다. 따라서 이러한 고위험 신생아의 생존율 향상과 더불어 생존 환아에서 발육 지연, 뇌성마비, 청력 저하 등 신경학적 발달 이상을 보이는 환아의 수도 증가하여 이들 환아들의 이상을 보다 조기에 발견하기 위해 추적 관찰의 필요성이 증대되고 있다. 저자들은 신생아 집중 치료실에서 치료 후 퇴원한 환아 중 위험한 주산기 인자들로 인하여 발달 이상의 위험도가 상대적으로 높아 고위험 신생아로 추적 관리를 받고 있는 환아에서 Bayley 발달 검사를 이용하여 발달 이상의 위험 인자를 확인하기 위하여 연구를 시행하였다. 방 법:2002년 1월부터 2005년 11월까지 인제대학교 의과대학 상계백병원 신생아 집중 치료실에 입원하였던 신생아 중에서 퇴원 후 외래에서 추적 관리하였던 환아 중 Bayley 발달 검사를 시행한 94례를 대상으로 하였다. 연구 대상은 32주 미만의 재태 연령, 극소 저체중 출생아, 5점 이하의 Apgar 점수, 뇌 초음파 및 자기 공명 검사상 뇌실 내 출혈 혹은 뇌실주위 백색질 연화증 등의 이상, 신생아 소생술을 시행한 경우, 신생아 경련 또는 선천성 감염 중 한 가지 이상의 요인이 있었던 환아이다. 대상 환아들의 발달 검사로 Bayley 발달 검사(Bayley Scales of Infant Development II)를 임상심리치료사가 시행하였고, MDI와 PDI를 분석에 이용하였다. 결 과:뇌 초음파 및 자기 공명 검사는 MDI, PDI와 각각 통계적인 연관성을 보였으며(P<0.05, P<0.001), 뇌실주위 백색질 연화증의 경우 MDI는 $70.10{\pm}28.68$, PDI는 $69.70{\pm}24.91$로 의미 있게 낮은 점수를 보였다. MDI보다 PDI가 뇌의 영상학적 검사 소견과 상관관계가 더 큰 것으로 나타났다. PDI는 1분 Apgar 점수 및 극소 저체중 출생아와도 유의한 상관관계가 있었다(P<0.05, P<0.05). Bayley 발달 검사 결과는 성별, 재태 연령, 신생아 소생술 여부, 신생아 경련과 유의한 연관성이 없었다. 결 론:신생아 집중 치료실에서 치료받은 고위험 신생아를 추적 관찰하며 Bayley 발달 검사를 시행하였을 때, 검사 결과에 독립적으로 영향을 미치는 위험 인자는 뇌의 영상학적 검사 소견, 1분 Apgar 점수 및 극소 저체중 출생아였다. 그 중 뇌의 영상학적 검사 소견상 이상이 있는 경우 발달 장애의 가능성이 가장 높고, 그 외의 위험 요인에 대해서도 주기적인 추적 관찰이 중요할 것으로 생각된다.

• Neonatal Medicine
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• 제18권2호
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• pp.257-264
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• 2011

목적: 신생아기에 기흉 발생과 관련된 호발 요인 및 각 원인에 따른 임상 양상을 조사하여 조기 진단 및 치료 효과 향상을 도모하기 위해 본 연구를 시행하였다. 방법: 2001년부터 2010년까지 순천향대학교 부천병원 신생아 집중치료실에서 기흉으로 진단받은 환아를 대상으로 후향적으로 조사하였다. 만삭아에서 발생한 원발성 기흉군과 이차성 기흉군으로 분류하였고, 이차성 기흉군에서 만삭아군과 미숙아군으로 분류하여 비교 분석하였다. 결과: 총 입원 환자 4,414명 중 57명(1.3%)이 기흉으로 진단받았고 만삭아 이차성 기흉 28명(80%), 만삭아 원발성 기흉 7명(20%)이었다. 두 군간의 성별, 출생 체중, 심폐소생술의 종류, 입원기간에 의미있는 통계학적 차이는 없었다. 흉강 삽관술 시행한 환자(20명, 57%)에서 호전까지의 기간은 원발성 기흉군에서 의미있게 길었다(5.4${\pm}$2.9일 vs. 2.7${\pm}$2.0일). 만삭아 이차성 기흉군에서 신생아 호흡곤란 증후군 선행 환자에서 폐표면활성제 투여 후 22.8시간에 기흉이 발생하였고, 태변 흡입 증후군, 폐렴, 신생아 일과성 빈호흡 환자에서는 16.6시간 후에 기흉이 발생하였다. 이차성 기흉군에서 신생아 호흡곤란 증후군(19명, 38%), 태변 흡입 증후군(11명, 22%), 신생아 일과성 빈호흡(7명, 14%), 폐렴(6명, 12%)이 선행되었다. 이차성 기흉군의 만삭아군에서 환자의 42.9%가 100% 산소 치료만으로 호전되었다. 미숙아군에서는 환자의 72.6%에서 흉강삽관술 및 27.3%에서 인공 기계 환기 치료를 필요로 했다. 결론: 신생아 시기에 폐질환이 존재시 기흉이 호발하였다. 따라서 기흉 속발 여부를 주의 깊게 관찰하고 증상에 맞는 적절한치료가 필요할 것으로 사료된다.