• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.112-120
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• 2004

Purpose : Methicillin Resistant-Coagulase Negative Staphylococcus(MR-CNS) infection has become an increasingly important cause of morbidity in NICU infants. We investigated the c linical characteristics of MR-CNS sepsis. Methods : This study included 40 neonates with MR-CNS sepsis who were admitted to the neonatal intensive care unit of Kangnam Sacred Heart Hospital, Hallym University from January 1998 to July 2002. MR-CNS sepsis was defined as MR-CNS recovery from blood with clinical symptoms and signs of infection. Retrospective analyses of the medical records of patients with MR-CNS sepsis were performed. The analyses included demographic findings, clinical features, hospital courses, risk factors for infection including invasive procedures and mortality. Results : From 1998 to 2002, there were 40 cases of MR-CNS sepsis, comprising 17.7% of late onset infections in NICU of Kangnam Sacred Heart Hospital. The male/female ratio was 1.5 : 1. The mean gestational age of infected babies was $32.4{\pm}4.3$ weeks at birth. And the first positive MR-CNS culture was done in the day $10.6{\pm}9.3$ after birth. Clinical symptoms such as fever, dyspnea, cyanosis, grunting, bradycardia, vomiting and diarrhea were frequent in MR-CNS. Mechanical ventilation was applied in 12 cases and catheter was inserted in 11 cases. The mortality(12.5%) directly attributable to MR-CNS sepsis was similar to other late onset infections. Conclusion : MR-CNS is a pathogen responsible for most late onset and nosocomial infections. And it will be life-threatening in high-risk neonate. Awareness of increasing infections due to MR-CNS in NICU is important not only for infection control but also placing a great limit in use of antibiotics and invasive procedures, especially in premature infants.

• Journal of Genetic Medicine
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• v.8 no.1
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• pp.71-75
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• 2011

A male infant was diagnosed with obstetric brachial plexus injury, congenital muscular torticollis and cleft palate 17 days after birth. His mother presented with gestational diabetes and premature rupture of membranes. Although it is possible that these three disorders arose independently, it is very likely that all three have the same etiologic cause, and we propose that a possible mechanism for this concurrence is related to maternal gestational diabetes. Maternal hyperglycemia mostly affects fetal structures deriving from the neural crest, including the palatine bone, and may have caused the cleft palate observed in this case. Gestational diabetes is also associated with increased frequency of large for gestational age infants and, by extension, with increased risk of birth injuries such as obstetric brachial plexus injury or congenital muscular torticollis associated with large for gestational age infants. Since the children of mothers with gestational diabetes are at increased risk for congenital defects such as cleft palate as well as being large for gestational age, precautions indicated for each respective disorder must be taken during prenatal testing and during birth. However, further studies of more cases are required to evaluate whether the concurrence of obstetric brachial plexus injury, congenital muscular torticollis and cleft palate in this case are complications specifically associated with gestational diabetes or just a simple coincidence.

• Journal of Korean Academy of Nursing
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• v.13 no.1
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• pp.7-21
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• 1983

For the flexible and rational distribution of limited existing health resources based on measurements of individual risk, the socalled Risk Approach is being proposed by the World Health Organization as a managerial tool in maternal and child health care program. This approach, in principle, puts us under the necessity of developing a technique by which we will be able to measure the degree of risk or to discriminate the future outcomes of pregnancy on the basis of prior information obtainable at prenatal care delivery settings. Numerous recent studies have focussed on the identification of relevant risk factors as the Prior infer mation and on defining the adverse outcomes of pregnancy to be dicriminated, and also have tried on how to develope scoring system of risk factors for the quantitative assessment of the factors as the determinant of pregnancy outcomes. Once the scoring system is established the technique of classifying the patients into with normal and with adverse outcomes will be easily de veloped. The scoring system should be developed to meet the following four basic requirements. 1) Easy to construct 2) Easy to use 3) To be theoretically sound 4) To be valid In searching for a feasible methodology which will meet these requirements, the author has attempted to apply the“Likelihood Method”, one of the well known principles in statistical analysis, to develop such scoring system according to the process as follows. Step 1. Classify the patients into four groups: Group $A_1$: With adverse outcomes on fetal (neonatal) side only. Group $A_2$: With adverse outcomes on maternal side only. Group $A_3$: With adverse outcome on both maternal and fetal (neonatal) sides. Group B: With normal outcomes. Step 2. Construct the marginal tabulation on the distribution of risk factors for each group. Step 3. For the calculation of risk score, take logarithmic transformation of relative proport-ions of the distribution and round them off to integers. Step 4. Test the validity of the score chart. h total of 2, 282 maternity records registered during the period of January 1, 1982-December 31, 1982 at Ewha Womans University Hospital were used for this study and the“Questionnaire for Maternity Record for Prenatal and Intrapartum High Risk Screening”developed by the Korean Institute for Population and Health was used to rearrange the information on the records into an easy analytic form. The findings of the study are summarized as follows. 1) The risk score chart constructed on the basis of“Likelihood Method”ispresented in Table 4 in the main text. 2) From the analysis of the risk score chart it was observed that a total of 24 risk factors could be identified as having significant predicting power for the discrimination of pregnancy outcomes into four groups as defined above. They are: (1) age (2) marital status (3) age at first pregnancy (4) medical insurance (5) number of pregnancies (6) history of Cesarean sections (7). number of living child (8) history of premature infants (9) history of over weighted new born (10) history of congenital anomalies (11) history of multiple pregnancies (12) history of abnormal presentation (13) history of obstetric abnormalities (14) past illness (15) hemoglobin level (16) blood pressure (17) heart status (18) general appearance (19) edema status (20) result of abdominal examination (21) cervix status (22) pelvis status (23) chief complaints (24) Reasons for examination 3) The validity of the score chart turned out to be as follows: a) Sensitivity: Group $A_1$: 0.75 Group $A_2$: 0.78 Group $A_3$: 0.92 All combined : 0.85 b) Specificity : 0.68 4) The diagnosabilities of the“score chart”for a set of hypothetical prevalence of adverse outcomes were calculated as follows (the sensitivity“for all combined”was used). Hypothetidal Prevalence : 5％ 10％ 20％ 30％ 40％ 50％ 60％ Diagnosability : 12% 23% 40% 53% 64% 75% 80%.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.855-861
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• 2002

Purpose : Thymus size can be affected by several factors and perinatal diseases can be estimated by its size. The purpose of this study was to search for a relationship between cardiothymic/thoracic(CT/T) ratio and perinatal diseases such as neonatal respiratory distress syndrome(RDS) and intrauterine growth retardation(IUGR) by measuring the width of the cardiothymic shadow at the level of the carina and dividing it by the width of the thorax at the costophrenic angles. Methods : A clinical study was conducted on newborn infants with RDS(n=51), IUGR(n=27), and premature rupture of membranes(PROM, n=48), who were admitted at NICU of Catholic University of Daegu from June 2000 to Oct. 2001. CT/T ratio was measured within six hrs of age, at 2-3 days of age, and at 5-7 days of age. Results : CT/T ratios of RDS group, IUGR group, and PROM group were $0.46{\pm}0.07$, $0.32{\pm}0.04$. $0.36{\pm}0.06$, respectively. CT/T ratios of RDS group within 6hrs of age, at 2-3 days of age, and at 5-7 days of age were $0.43{\pm}0.07$, $0.34{\pm}0.06$, $0.25{\pm}0.04$, respectively. There were statistically significances among the RDS group, the IUGR group, and the PROM group and in the RDS group at different times. Regression for gestational age among three groups was not statistically significant but correlation for gestational age in the entire groups was statistically significant. CT/T ratio between normal spontaneous vaginal delivery and c-section among three groups was not statistically significant. CT/T ratios with dexamethasone-treated group and untreated group was not statistically significant. Conclusion : We concluded that thymus size differed significantly in the perinatal diseases such as RDS and IUGR, and so can be used as an early diagnostic tool for perinatal diseases.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.249-260
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• 1986

Recent reports have noted the increase of and questioned the justification for cesarean section rate in the past decade. This study was carried out retrospectively based on the clinical charts of 510 patients who had been performed cesarean section among 3,357 deliveries at Yeungnam University Hospital from May, 9, 1983 through Nov., 30, 1986. The results were as follows : 1. Overall incidence of cesarean section was 15.7% of total deliveries. Of these, 10.9% were by primary cesarean section and 4.7% by repeat operation. There has been a gradual increase in the cesarean section rate. 2. In the distribution of age, the 26-30 aged group was the most prevalent(60.2%). 3. The most common indications for cesarean section were previous cesarean section(30.2%), CPD (26.9%), Malpresentation(22.7%), and fetal distress(3.5%). In primipara, CPD was the most frequent and in multipara malpresentation. 4. A great proportion(31.6%) was done at 40th gestational week. 5. In the weight distribution of infants, the group of 3,000-3,499gm was the most prevalent(39.8%), premature baby was 9.1%, and giant baby was 5.6%. 6. In the type of operation, lower segment transverse cesarean section was the most(97.5%). 7. In the combined surgery, sterilization was the most prevalent and the next was ovarian cystectomy, hysterectomy, and myomectomy in order. 8. In the type of the anesthesia, general anesthesia was 83.5%. 9. Maternal morbidity was 14.7%. Among the causes of this morbidity, wound infection was the most and the next was urinary tract infection, fever of unknown origin, and atonic bleeding in order. 10. It was found that 18.4% was maternal morbidity in the patients below 10gm Hb. In this group, maternal morbidity was markedly increased as the level of Hb was decreased. 11. Maternal morbidity was increased as the duration of ruptured membrane was prolonged. In the group of over 24 hours after rupture of membrane, it was markedly increased(44.4%). 12. Maternal morbidity was increased as the duration of labor was prolonged. In the group of over 12 hours after the onset of labor, it was 24.6%. 13. Maternal morbity of lower segment transverse cesarean section was the least(14.1%). 14. Maternal morbidity of emergency cesarean section was about two times as much as elective cesarean section.

• Clinical and Experimental Pediatrics
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• v.49 no.4
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• pp.381-387
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• 2006

Purpose : Neonatal lupus is characterized by congenital complete heart block(CCHB), cutaneous rash, and laboratory abnormalities in infants born to mothers with systemic lupus erythematosus(SLE). This study aims to examine the incidence of CCHB and clinical outcome in neonates born to mothers with SLE. Methods : The study group consisted of 49 neonates, born from 57 pregnancies of 55 women with SLE, diagnosed at Hanyang University Hospital for the period between January 1997 and January 2005. Clinical and laboratory data were retrospectively identified from medical record. Results : There were 5(8.8 percent) spontaneous abortions and one(1.8 percent) still births among 57 pregnancies of 55 mothers. Of 49 live births, 15(26.3 percent) were premature and eight(12.3 percent) were small for their gestational age. There was one(1.8 percent) CCHB suspected during pregnancy on fetal echocardiograpy in a fetus of mother with systemic lupus erythematosus and the fetus was not born by artificial abortion because of mother. There was no CCHB among EKG findings of 49 newborns. Laboratory testing showed hematologic abnormalities among 25.6 percent(10/39) of the babies. 5.1 percent(2/39) and 7.7 percent(3/39) of them were diagnosed as neutropenia, and thrombocytopenia was seen respectively. Anti-SSA(Ro) and antiphospholipid antibodies were predictive factors for prematurity(P=0.003, P=0.049). Anticardiolipin antibodies were predictive factors for ventilatory care(P=0.018). Conclusion : The incidence of CCHB among neonates born to mothers with SLE, which was measured in this study, was lower than that in earlier studies. A high incidence of hematologic abnormalities was found in our study. It is suggested that careful examination should be made of skin for the diagnosis of neonatal lupus.

• Clinical and Experimental Pediatrics
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• v.52 no.10
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• pp.1140-1146
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• 2009

Purpose:The pathophysiology of magnesium, the second highest common compound in humans, is still unclear, especially in preterm babies. We accessed the association between total magnesium (tMg), ionized Mg (iMg), and gestational age (GA) and that between serum magnesium (sMg) and intraventricular hemorrhage (IVH) in preterm babies. Methods:In all, 119 inborn preterm infants admitted between July 2006 and February 2008 were divided into the IVH group (19) and the control group (100) and were prospectively analyzed. TMg, iMg, pH, total calcium (tCa), and ionized Ca (iCa) levels were determined immediately after delivery or within 3 hours after birth, and their correlation with GA were investigated. Results:TMg was not correlated with GA, tCa, iCa, and pH. IMg was correlated with tMg (r=0.288, P=0.002) and iCa (r=0.212, P=0.021); however, it was not correlated with GA and pH. Mean GA and birth weight were significantly lower (P=0.002) and smaller (P=0.030) in the IVH group. Mean sMg was higher in the IVH group ($2.5{\pm}0.9mg/dL$) than in the control group ($2.1{\pm}0.6mg/dL$) (P=0.021). SMg was a risk factor even after logistic regression analysis (OR, 2.798; 95% C.I., 1.265-6.192; P=0.011). Conclusion:In less than 37-week-old preterm babies, tMg and iMg were similar, regardless of GA. High sMg may be a risk factor for IVH in premature babies, regardless of their exposure to antenatal magnesium.

• Journal of the Korean Society of Food Science and Nutrition
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• v.40 no.1
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• pp.70-77
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• 2011

This study was conducted to evaluate the efficacy of human milk fortifier (HMF) on growth and nutritional status in growing rats fed infant formula supplemented with HMF. Three week-old male Sprague-Dawley rats were divided into three groups and fed regular formula (RF), premature formula (PF) and regular formula fortified with HMF (RF+HMF) diets for 3 weeks. There was no significant difference in weight gain among groups. However, a significant increase of food intake was observed in PF and RF+HMF groups compared with RF group. With increasing food intake, the intakes of carbohydrate and protein were significantly increased in PF and RF+HMF groups. The weight of perirenal fat was significantly increased in rats fed RF+HMF; however, the weights of liver, kidney and spleen were not significantly different among groups. Although total lipids, total cholesterol, HDL-cholesterol concentrations of serum were not significantly different among groups, triglyceride was significantly increased in PF group. The triglyceride and total-cholesterol of liver were significantly increased in rats fed regular formula fortified with HMF and PF compared with RF group. Glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), creatinine (Cre) and blood urea nitrogen (BUN) in serum showed no significant difference among groups. The concentration of growth hormone was significantly increased in PF group compared with other groups. The concentration of hemoglobin was significantly increased in rats fed PF and RF+HMF. These results suggest that the supplementation of human milk fortifier in growing rats may promote growth as increasing food intake and lipid contents in tissues and prevent the anemia of infants.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.44-49
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• 2009

Purpose : Early surfactant treatment and minimal ventilation, bronchopulmonary dysplasia needed prolonged oxygen supplement is a problem. This study aimed to report the effects of early surfactant treatment and minimal ventilation on the prevention of bronchopulmonary dysplasia in respiratory distress syndrome. Methods : We retrospectively studied 139 premature newborn infants (gestational age, 36 weeks; birth weight, 1,500 gm) admitted to the neonatal intensive care unit of Daegu Fatima Hospital between January 2001 and December 2006. We analyzed the occurrence of bronchopulmonary dysplasia with respect to ventilator care and surfactant treatment. Results : The incidence of bronchopulmonary dysplasia was significantly higher with prolonged ventilator care, moderate to severe respiratory distress syndrome, and low Apgar score (P<0.001). Despite early surfactant treatment and minimal ventilation, mild bronchopulmonary dysplasia occurs in a considerable number of patients with mild respiratory distress syndrome. The patient group with low Apgar scores required ventilator care for a prolonged period (P=0.020). Conclusion : Early surfactant treatment and minimal ventilation shortens the duration of ventilator care; however, the preventive effects on bronchopulmonary dysplasia are limited. Therefore, not only early surfactant treatment and minimal ventilation but also appropriate management in the delivery room is essential.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.155-166
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• 2006

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.