• Child Health Nursing Research
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• v.11 no.1
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• pp.125-131
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• 2005

Purpose: This study was done to evaluate the effects of massage on the level of stress hormone in the urine in preterm infants. Method: The design was a nonequivalent control group pretest-posttest design quasi experimental study. Fifty-eight preterm infants were assigned to the experimental(31) or control group(27). The data were collected from March 2002 to August 2003. The massage stimulation was provided to infants in the experimental group for 15-minutes twice a day for 10 days. On day 1 and day 10 of the study, a 24 hour-urine sample was collected for norepinephrine, epinephrine, and cortisol assays. In data analysis, SPSSWIN 10.0 program was utilized for descriptive statistics, ANOVA and t-test. Results: General characteristics of the two groups showed no significant differences, thus the two groups were found to be homogenous. The 24 hour-urine cortisol of the massage group (t=4.61, p=.000) was significantly reduced compared to the control group after 10 days. Conclusions: The results suggest that the massage stimulation can be used to reduce 24 hour-urine cortisol in preterm infants. Therefore, massage provided in the incubator is recommended for reduction of stress in preterm infants who are hospitalized in neonatal intensive care units.

• Child Health Nursing Research
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• v.13 no.2
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• pp.136-146
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• 2007

Purpose: The purpose of this study was to develop a tool to assess the severity of illness in high risk newborns. Method: The research design was a methodological study. The tool was developed in 4 stages: first, preliminary items were developed based on a questionnaire about the severity of illness index that was given to 8 health professionals in Neonatal Intensity Care Units (NICU) second, a panel of specialists reduced the preliminary items using 3 validity tests; third, final items were selected from the results of a pre-test. Finally, from July 2005 to May 2006, reliability and validity were tested with a sample of 160 high risk newborns admitted to the NICU. Results: The final tool to identify the severity of illness index in high risk newborns consisted 39 items and Cronbach's alpha coefficient for internal consistency was .922. Using factor analysis, 4 factors were extracted and these factors explained 54.451% of the total variance. Conclusion: The instrument for assessing the severity of illness in high risk newborns developed in this study was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for assessing and implementing care for high risk newborns.

• Korean Parent-Child Health Journal
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• v.4 no.1
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• pp.35-55
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• 2001

Recently attention has been focused on the effects of early intervention, or its lack, on both normal and preterm infants. Particularly numerous studies suggest that premature infants are not necessarily understimulated but instead are subjected to inappropriate stimulation. Developmental support and sensory stimulation have become clinical opportunities in which nursing practice can impact on the neurobehavioral outcome of premature infants. Developmental care has been widely accepted and implemented in neonatal intensive care units across the country. Increasingly, attention and concern in caring for low-birth-weight infants and premature infants has led clinicians in the field to explore the effects of a complex of interventions designed to create and maintain a developmentally supportive environment; to provide age-appropriate sensory input; and to protect the infant from inappropriate, excessive and stressful stimulation. The components of developmental care include modifications of the macro-environment to reduce NICU light and sound levels, care clustering, nonnutritive sucking, and containment strategies, such as flexed positioning or swaddling. Sensory stimulation of the premature infants is presented to standardize the modification of a developmental intervention based on physiologic and behavioral cues. The most appropriate type of stimuli are those that are sensitive to infant cues. Evaluation of infant physiological and behavioral responds to specific intervention stimuli may help to identify more appropriate interventions based on infants' cues. A critical question confronting the clinician is that of determining when the evidence supporting a change in practice is sufficient to justify making that change. There are acknowledged limitations in the current studies. Many of the studies examined had small sample sizes; used nonprobability sampling; and used a phase lag design, which introduces the possibility of threats to internal validity and limits the generalizability of the results. Although many issues regarding the effects of developmental interventions remain unresolved, the available research base documents significant benefits of developmental care for LBW infants in consistent outcomes, without significant adverse effects. Particularly, although the individual studies vary somewhat in the definition of specific outcomes measured, instrumentation used, time and method of data collection, and preparaion of the care providers, in all studies, infants receiving the full protocol of individualized developmentally supportive care had improvements in some aspect of four areas of infant functioning: level of respiratory or oxygen support, the establishment of oral feeding; length of hospital stay, and infant behavioral regulation. In summary, based on the available literature, individualized developmental intervention should be incorporated into standard practice in neonatal intensive care. And this implementation needs to be coupled with ongoing research to evaluate the impact of an individualized developmental care programs on the short- and long-tenn health outcomes of LBW infants.

• Perspectives in Nursing Science
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• v.15 no.2
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• pp.49-69
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• 2018

Purpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or ${\geq}4$) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended ${\geq}4$ ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as "low" quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as "low" quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.11 no.2
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• pp.203-212
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• 2004

Purpose: This study was done to determine whether providing auditory and vestibular stimulation to preform infants would have an effect on stress hormones. Methods: The design was a nonequivalent control group protest-posttest design in a quasi-experimental study Seventy-nine preform infants were assigned either one of two experimental groups or to a control group: 27 in the auditory stimulation group, 25 in the vestibular stimulation group and 27 in the control group. The criteria for inclusion in this study were 1) gestational age of less than 37 weeks, 2) birth weight of less than 2,500g, 3) the absence of congenital anomalies or specific diseases, 4) recovering physiological weight loss, and 5) weaned from ventilatory assistance or oxygen. The data were collected from March 2002 to May 2003. The auditory stimulation, a music audiotape, was provided 20 minutes twice a day for 10 days and the vestibular stimulation, an infant waterbed, was provided for 10 days. On day 1 and day 10 of the study, 24 hour urine sample was collected for norepinephrine, epinephrine, and cortisol assays. In the data analysis SPSSWIN 10.0 program was utilized for descriptive statistics, ANOVA and t-test. Results: General characteristics of the three groups showed no significant differences, thus three groups were found to be homogenous. The 24 hour urine cortisol for the auditory (t=3.489, p=.001) and for the vestibular (t=2.638, p=.013) stimulation group were significantly reduced compared to the control group after 10 days. Conclusions: The results suggest that auditory and vestibular stimulation can be used to reduce 24 hour urine cortisol in preform infants. Therefore, music audiotapes and waterbeds provided in incubator are be recommended for reduction of the stress in preform infants who are hospitalized in neonatal intensive care units.

• Child Health Nursing Research
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• v.1 no.1
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• pp.5-15
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• 1995

The quality of mother-infant interaction during early postpartum period has a significant influence on the child growth and development in many aspects. The mother's initial perception of the newborns might have the lasting influence on the development of the mother-infant attachment and mother-infant relationship. Therefore the proper mother-infant interaction should be developed after infant birth. However, it is acknowledged that the high risk infants influence on the mothers' perception because of their abnormalities or disorders of physical condition and the restricted maternal contacts and interactions. The object of this study is to identify the difference of mother's perception of their normal and high-risk newborn during the early postpartum period. The ultimate goal is to contribute to use this basic data to develop nursing intervention toward the promotion of healthy mother-infant relationship and the helping of growth and development of children. The data were collected for this study from Sep. 21, 1990 to Oct. 1. 1991 at E University Hospital. The sample was 83 of mothers who had normal newborns and 73 mothers who had high risk newborns .The instrument was Neonatal Perception Inventory(NPI) designed by the Broussard for the measurement of mothers' perception of newborns about Average Baby and Your Baby. The data were analysed by using an SPSS Program and include percentage mean, SD, t-test, ANOVA. The results of this study are as follows : 1. The normal newborn mothers' perception is more positive than the high-risk newborn mothers(t=7.94, p=0.000). 2. Mothers' perception of the newborns is not related significantly to mothers' general characteristics. In conclusion, in order to promote positive, healthy mother-infant relationship, the nurse need to support, give information, and educate high-risk newborn mothers through early nursing assessment.

• Clinical and Experimental Pediatrics
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• v.58 no.8
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• pp.288-293
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• 2015

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was $4.4{\pm}1.7days$ of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

• Journal of Veterinary Clinics
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• v.25 no.4
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• pp.227-230
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• 2008

To determine the distribution of feline blood types and then to estimate the risk of neonatal isoerythrolysis (NI) in non-pedigree cats, we typed blood of 482 cats of both genders and various breeds (336 domestic shorthair cat and 146 pedigree) from August 2005 through July 2007. Blood samples from Seoul and Kangwon province were typed within 5 days after collection by the simple tube method. High-titer anti-A antiserum and anti-B reagent, prepared with Triticum vulgaris lectin, were used to determine type A and type B blood, respectively. The majority of cats were type A (n = 465, 96.5%) and only 3.5% (n = 17) were type B. No type AB blood were detected. Blood type distributions among the non-pedigree and pedigree cats were similar: for non-pedigree cats, 96.4% were type A and 3.6% were type B, whereas for pedigree cats, 96.6% were type A and 3.4% were type B. All type B cats had a very strong agglutination reaction to anti-A antiserum: 8 sample for 3+ and 9 for 4+. Assuming 19% of estimated frequency for the type-B allele in domestic cats, the calculated proportion of random mating from this population at risk for developing NI was 3.4%. Based on this finding, it is strongly recommended that blood typing be performed prior to any blood transfusion or breeding to minimize blood type incompatibilities. Further comprehensive studies on the titer of naturally occurring antibodies in cat populations in Korea and the prevalence of possible NI in practice are clearly required.

• Journal of Korean Academy of Nursing
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• v.42 no.4
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• pp.517-524
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• 2012

Purpose: To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy. Methods: A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital. Results: There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of ${\geq}25$ was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group. Conclusion: The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.

• Child Health Nursing Research
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• v.4 no.2
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• pp.159-176
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• 1998

In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U.S. Purpose : The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants. Methods : A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preform infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or other genetic anomalies, major congenital infections, or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation)of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas : the demograghic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics. Results : 1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Mean birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of dischage from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurses for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specific aids to self regulation on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical envronment and the stress responses of the infants in NICU. 8. There were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feed ing was 31/sup +5/ weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need. Conclusion : It, thus, appears that to minimize the sensorymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preform infant as the infants grow older in NICU.