• Title/Summary/Keyword: Pediatric Care Unit

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Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit (소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 예후 및 위험인자)

  • Kim, Bo Eun;Ha, Eun Ju;Bae, Keun Wook;Kim, Seon Guk;Im, Ho Joon;Seo, Jong Jin;Park, Seong Jong
    • Clinical and Experimental Pediatrics
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    • v.52 no.10
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    • pp.1153-1160
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    • 2009
  • Purpose:To evaluate the risk factors for mortality and prognostic factors in pediatric hemato-oncology patients admitted to the pediatric intensive care unit (PICU). Methods:We retrospectively reviewed the medical records of pediatric hemato-oncology patients admitted at the PICU of the Asan Medical Center between September 2005 and July 2008. Patients admitted at the PICU for perioperative or terminal care were excluded. Results:Total 88 patients were analyzed. Overall ICU mortality rate was 34.1%. Mean age at PICU admission was $7.0{\pm}5.7$ years and mean duration of PICU stay was $18.1{\pm}22.2$ days. Hematologic diseases contributed to 77.3% of all the primary diagnoses, and the primary cause of admission was respiratory failure (39.8%). The factors related to increased mortality were C-reactive protein level (P<0.01), ventilation or dialysis requirement (P<0.01), and hematopoietic stem cell transplantation (P<0.05). In all, 3 scoring systems were investigated [Number of Organ System Failures (OSF number), the Pediatric Risk of Mortality III (PRISM III) score, and the Sequential Organ Failure Assessment (SOFA) score]; higher score correlated with worse outcome (P<0.01). The Oncological Pediatric Risk of Mortality (O-PRISM) scores of the 21 patients who had received hematopoietic stem cell transplantation were higher among the non-survivors, but not statistically significant (P=0.203). Conclusion:The PRISM III and SOFA scores obtained within 24 hours of PICU admission were found to be useful as early mortality predictors. The highest OSF number during the PICU stay was closely related to poor outcome.

A Study on the Patient Care Standard (환자간호실무 표준에 관한 연구)

  • Yoon, Suck-Hee;Kang, Chai-Won;Jurn, Mee-Soo;Kim, Yong-Soon;Kim, Moung-Ock;Park, Sung-Ae;Kim, Hye-Ja;Lee, Byung-Sook;Jung, Myun-Sook;Jun, Myung-Hee
    • The Korean Nurse
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    • v.31 no.1
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    • pp.68-87
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    • 1992
  • The purpose of this study is to develop a patient care standard which is the basis of unit based quality assurance. The subjects were 570 nurses of 6 hospitals is Seoul. Patient Care Standards were developed from 3 times of clinical Nurses Association's workshop & the joint meeting of Clinical Nurses Association & the Korean Nurses Academic Socity of Nursing Administration. Respondents were instructed to rate of the 2 types of 5 - point Likert type questionnaire(one is the level of perceived importance, the other is the level of actual performance) Findings of this study were as follows 1. As a results of reliability analysis, each questionnaire ranged from $\alpha$=0.79 to 0.94

    2. The Correlations between the levels of perceived importance & actual performances were ranged from r=.40 to 0.72(P=.00) 3. There were significant differences in the level of percevied importance according to the several variables. $\circled1$ Chemotherapy unit; df=5, F=4.06, P=.000/hospital $\circled2$ Pediatric unit; df=5, F=2.8, P=.02/hospital $\circled3$ OBGY ; df=5, F=4.20, P=.00/hospital $\circled4$ ICU ; df=5, F=2.83, P=.02/hospital df=3, F=5.38, P=.00/age df=3, F=6.22, P=.00/total duration. $\circled5$ GS ; df=3, F=3.37, P=.02/total duration 4. There were significant difference in the level of actual performance according to the several variables. $\circled1$ Chemotherapy unit; df=5, F=2.89, P=.02/hospital df=3, F=3.07, P=.03/age df=3, F=3.61, P=.02/total duration $\circled2$ OBGY ; df=5, F=15.48, P=.00/hospilal df=3, F=7.83, p=.00/total duration $\circled3$ GS ; df=5, F=6.70, P=.00/hospital df=3, F=4.49, P=.01/age df=3, F=5.99, P=.00/total duration $\circled4$ ICU ; df=5, F=2.96, P=.02/hospital df=3, F=4.39, P=.0l/age df=3, F=5.20, P=.00/total duration

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  • A Survey of the Nursing Interventions Performed by Neonatal Nursing Unit Nurses Using the NIC (신생아 간호단위 간호중재 분석 - 3차 개정 Nursing Intervention Classification(NIC)을 적용하여 -)

    • Oh Won-Oak;Suk Min-Hyun;Yoon Young-Mi
      • Child Health Nursing Research
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      • v.7 no.2
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      • pp.161-178
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      • 2001
    • The purpose of this study was to identify nursing interventions performed by neonatal nursing unit nurses. For data collection this study used the taxonomy of Nursing Intervention Classification(NIC : 486 nursing intervention) which was modified by McCloskey & Bulecheck(2000). The new 58 nursing interventions was translated into Korean, and then modified by pannel group, which consist of clinical experts and nursing scholars and finally the 419 nursing interventions was selected. The data were collected from 112 nurses. 168 nursing interventions were performed at least monthly by 50% or more of the nurses. The high frequency of performed nursing interventions were Family domain. 37 nursing interventions were performed at least once a day. The nursing interventions receiving the highest item mean score were neonatal care, neonatal monitoring, photo-therapy; neonate, bottle feeding and temperature regulation. 56 nursing interventions were rarely performed by 90% or more of the nurses. Most of them were in the behavioral domain. The rarely used interventions were urinary bladder training, art therapy, religious addiction prevention, religious ritual enhancement and bladder irrigation. Therefore, neonatal nursing units nurses used interventions in the Physiological: basic domain most often on a daily basis and the interventions in the behavioral domain least often. These findings will help in building of a standardized language for the neonatal nursing units and enhance the quality of nursing care. Further study will be needed to classify each intervention class and nursing activity and validate NIC in pediatric care unit.

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    Utilizing Video vs Simulation Practice for Handoff Education of Nursing Students in Pediatric Nursing (간호대학생을 위한 시뮬레이션 기반의 아동간호 인수인계에 관한 동영상 실습교육과 시뮬레이션 실습교육의 효과)

    • Park, Sun-Nam;Im, Young Soon
      • Child Health Nursing Research
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      • v.24 no.1
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      • pp.27-36
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      • 2018
    • Purpose: The purpose of this study was to develop a model for handoff education for nursing students based on simulation using video and to identify educational effects of a simulated situation in pediatric care units. Methods: Data were collected from May 1 to 30, 2016. Participants were 84 senior nursing students in Seoul (video group: 43, simulation group: 41). Both groups were given a lecture and pre-briefing on handoff education. The simulation group had nursing practice on resolving health issues for respiratory distress using a high-fidelity baby simulator. The video group watched a video recording of a scenario based simulation, and used a summarized handoff situation to practice patient handoff to another student. Results: There was no significant difference between the two groups for handoff self-confidence, problem solving ability, handoff competence (self-assessment of students), or learning satisfaction. Self-confidence increased significantly in both groups. Handoff competency evaluated by the instructor was higher in the video group compared to the simulation group (t=2.33, p=.022). Conclusion: Nursing student education for handoff practice utilizing a video in the pediatric unit was more cost effective. Therefore, it could be a useful educational method for students in learning patient handoff practices and helpful for related research.

    Respiratory syncytial virus prevention in children with congenital heart disease: who and how?

    • Kim, Nam-Kyun;Choi, Jae-Young
      • Clinical and Experimental Pediatrics
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      • v.54 no.5
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      • pp.197-200
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      • 2011
    • Respiratory syncytial virus (RSV) is a major cause of respiratory infection in children. Most of the pediatric population have RSV infection before the age of 2, and recurrent infections are common even within one season. Chronic lung disease, prematurity, along with congenital heart disease (CHD) are major risk factors in severe lower respiratory infection. In hemo-dynamically significant CHD patients with RSV infection, hospitalization is usually needed and the possibility of treatment in intensive care unit and the use of mechanical ventilator support are known to increase. Therefore the prevention of RSV infection in CHD patients is mandatory. The current standard for RSV prevention is immunoprophylaxis by palivizumab. Immunoprophylaxis is recommended monthly in hemodynamically significant CHD patients, up to 5 months. Motabizumab, a second generation drug and newly developing RSV vaccines are also expected to play a key role in RSV prevention in the future. The prophylaxis of RSV infection in CHD patients is cost-effective in both the medical aspect of the patients as well as the socio-economic aspect. Therefore an effort to promote prevention should be made by not only the family of the patients but also by the government.

    Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa

    • Vandenplas, Yvan;Rakhecha, Aditya;Edris, Amira;Shaaban, Bassel;Tawfik, Eslam;Bashiri, Fahad A.;AlAql, Fahd;Alsabea, Hassan;Haddad, Joseph;Barbary, Mohammed El;Salah, Mohamed;Abouelyazid, Mohamed;Kumar, Mudit;Alsaad, Sulaiman
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • v.22 no.6
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      • pp.536-544
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      • 2019
    • Purpose: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. Methods: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. Results: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. Conclusion: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

    Copper Deficient Anemia in Severe Protein-Energy Malnutrition due to Child Abuse (아동학대로 인해 발생한 중증 단백-에너지 영양실조 환아에서 동반된 구리결핍증 빈혈 1예)

    • Byun, Sung-Hwan;Jeon, Je-Deok;Chang, Soo-Hee
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • v.10 no.1
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      • pp.60-65
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      • 2007
    • An unconscious 5-year-old girl was admitted to the Intensive Care Unit. She was neglected by her parents; she suffered from inadequate nutritional, medical and emotional care. The girl appeared to be emotionally detached, dehydrated and malnourished; she had edematous extremities, moderately bruised skin and brittle coarse hair. Laboratory testing showed electrolyte imbalance, anemia, pneumonia, copper deficiency, and liver dysfunction in addition to severe protein-energy malnutrition (PEM). Medical intervention was followed by improvement of most of the symptoms. During the rehabilitation phase, the patient showed a voracious appetite and gained weight too fast. The liver became enlarged and the patient developed a mild fever due to excessive nutrition. The microcytic anemia with severe PEM did not responded to iron supplementation possibly due to the copper deficiency. Addition of copper without zinc and iron helped to improve the anemia. The patient was discharged to a childcare center where she received cognitive and psychosocial therapy.

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    An 18-year experience of tracheoesophageal fistula and esophageal atresia

    • Seo, Ju-Hee;Kim, Do-Yeon;Kim, Ai-Rhan;Kim, Dae-Yeon;Kim, Seong-Chul;Kim, In-Koo;Kim, Ki-Soo;Yoon, Chong-Hyun;Pi, Soo-Young
      • Clinical and Experimental Pediatrics
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      • v.53 no.6
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      • pp.705-710
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      • 2010
    • Purpose: To determine the clinical manifestations and outcomes of patients with tracheoesophageal fistula (TEF) and esophageal atresia (EA) born at a single neonatal intensive care unit. Methods: A retrospective analysis was conducted for 97 patients with confirmed TEF and EA who were admitted to the neonatal intensive care unit between 1990 and 2007. Results: The rate of prenatal diagnosis was 12%. The average gestational age and birth weight were $37^{+2}$ weeks and $2.5{\pm}0.7kg$, respectively. Thirty-one infants were born prematurely (32%). Type C was the most common. The mean gap between the proximal and distal esophagus was 2 cm. Esophago-esophagostomy was performed in 72 patients at a mean age of 4 days after birth; gastrostomy or duodenostomy were performed in 8 patients. Forty patients exhibited vertebral, anorectal, cardiac, tracheoesophageal, renal, limb (VACTERL) association with at least 2 combined anomalies, and cardiac anomaly was the most common. The most common post-operative complications were esophageal stricture followed by gastroesophageal reflux. Balloon dilatation was performed for 1.3 times in 26 patients at a mean age of 3 months. The mortality and morbidity rates were 24% and 67%, respectively, and the most common cause of death was sepsis. The weight of approximately 40% patients was below the 10th percentile at 2 years of age. Conclusion: Mortality and morbidity rates of patients with TEF and EA are high as compared to those of infants with other neonatal surgical diseases. Further efforts must be taken to reduce mortality and morbidity and improve growth retardation.

    Influenza A Outbreak in a Neonatal Intensive Care Unit During the 2011-2012 Influenza Season in Korea (2011-2012년 인플루엔자 국내 유행시기에 신생아 중환자실에서 발생한 A형 인플루엔자 바이러스 집단발병)

    • Son, Ok Sung;Oh, Chi Eun;Kong, Seom Gim;Jung, Yu Jin;Hong, Yoo Rha
      • Pediatric Infection and Vaccine
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      • v.23 no.2
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      • pp.87-93
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      • 2016
    • Purpose: An outbreak of influenza virus is uncommon in neonatal intensive care unit (NICU). The clinical presentation of influenza virus infection in neonates is diverse. This study was aimed to report an outbreak of influenza A in a NICU and to investigate the clinical characteristics of influenza virus infection in neonates especially preterm infants during the 2011-2012 influenza season in Korea. Methods: We reviewed the medical records of 29 patients who were evaluated by respiratory virus multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) at NICU of Kosin University Gospel Hospital during the 2011-2012 seasonal influenza outbreak in Korea. Results: Eleven patients (37.9%) were influenza A virus RT-PCR positive during the survey periods. They were all preterm infants and three of them had no symptoms. Eight patients had symptoms and it was fever (18%, 2/11), respiratory difficulty (72.7%, 8/11) without symptoms of upper respiratory infection, and gastrointestinal symptoms (27.3%, 3/11). The median duration of symptom was 5 days. There were differences of duration of admission at the test of respiratory RT-PCR, Clinical Risk Index for Babies (CRIB) score, use of mechanical ventilation, and use of dexamethasone before infection between influenza A virus RT-PCR positive and negative group. All 11 patients with influenza A were discharged without any complications. Conclusions: The symptoms of influenza A virus infection in the preterm infants is nonspecific. Influenza A virus should be considered as a possible cause of infection in NICU during the influenza season in the community.

    Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit

    • Hay, William W. Jr.
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • v.21 no.4
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      • pp.234-247
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      • 2018
    • The goal of nutrition of the preterm infant is to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.


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