• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.143-147
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• 2005

Purpose : The aim of the this study was to evaluate the effect of various perinatal conditions on TSH and thyroid hormone levels in cord blood. Methods : Cord blood samples were collected from 130 neonates immediately after birth. TSH, $T_3$, and free $T_4$ levels were measured by the radioimmunoassay(RIA) method. The effects of gestational age, sex, birth weight, delivery method, perinatal asphyxia, maternal diabetes mellitus(DM), and preeclampsia on TSH and thyroid hormone levels were assessed by ANOVA test, Student t-test, and multiple regression analysis. Results : Birth weight and sex did not affect TSH and thyroid hormone levels. TSH level increased according to gestational age(P<0.05). TSH level was $4.42{\pm}0.66{\mu}IU/mL$ in infants born vaginally, which was higher than that of cesarian section delivery($3.31{\pm}0.33{\mu}IU/mL$)(P<0.05). TSH level was $5.18{\pm}0.93{\mu}IU/mL$ in asphyxiated newborns and $2.97{\pm}0.84{\mu}IU/mL$ in non-asphyxiated newborns(P<0.05). TSH level in infants with maternal DM($8.911{\pm}1.25{\mu}IU/mL$) was higher than that of infants without maternal DM($4.32{\pm}0.42{\mu}IU/mL$)(P<0.05). TSH level was $5.28{\pm}0.42{\mu}IU/mL$ in infants with maternal preeclampsia and $3.65{\pm}0.46{\mu}IU/mL$ in infants without maternal preeclampsia(P<0.05). Thyroid hormones were lower in infants with perinatal asphyxia(P<0.05). In asphyxiated infants, $T_3$ level was $75.33{\pm}55.65ng/mL$ and free $T_4$ was $0.54{\pm}0.21ng/mL$. $T_3$ and free $T_4$ level was $109.85{\pm}41.77ng/mL$ and $0.76{\pm}0.22ng/mL$ each in infants without perinatal asphyxia. Among the perinatal factors, gestational age, 1 min Apgar score and maternal DM influenced TSH level independently. Conclusion : In our study, cord blood TSH and thyroid hormone levels were affected by perinatal stress events.

• Neonatal Medicine
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• v.16 no.2
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• pp.197-204
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• 2009

Purpose: The objective of this study was to describe the frequency of hepatobiliary dysfunction (HD) at our hospital and determine the possible risk factors and complications associated with the development of HD in very low birth weight infants (VLBWI) treated with parenteral nutrition (PN). Methods: A retrospective study of VLBWI (n=92) that required PN between 2004 and 2008 in the NICU at the Bucheon St. Marys Hospital of Catholic University was performed. HD was defined by a direct bilirubin (DB) >2 mg and a transaminase of 60 IU/L defined cholestasis and liver injury. Groups I, II, and III were limited to cases of cholestasis, liver injury without cholestasis, and no abnormalities, respectively. The VLBWI were compared to each other. Results: Thirty-six subjects (39.1%) had cholestasis and 51 (55.4%) had liver injury. In addition, 36 (39.1%), 19 (20.7%), and 37 (40.2%) subjects were classified as groups I, II, and III, respectively. The three groups showed significant differences in gestational age, 1- and 5-minute Apgar scores, use of surfactant, duration of parenteral nutrition, frequency of RBC transfusions, bronchopulmonary dysplasia (BPD), and patent ductus arteriosus (PDA) (P<0.05). The multiple regression analysis with cholestasis as the dependent variable, showed a significant correlation with gestational age, use of surfactant, frequency of RBC transfusions, and PDA. Conclusion: Various factors, such as birth weight, gestational age, 1- and 5-minute Apgar scores, use of surfactant for respiratory distress syndrome (RDS), frequency of RBC transfusions, BPD, and PDA may be related to hepatobiliary dysfunction in VLBWI treated with PN.

• Neonatal Medicine
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• v.17 no.1
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• pp.53-63
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• 2010

Purpose : Extrauterine growth restriction (EUGR) in preterm infants is a major problem in neonatal intensive care units (NICUs) and it has been related to long-term growth deficit and neurodevelopmental issues. The aim of this study was to investigate the frequency of and risk factors for EUGR. Methods : The study subjects consisted of very low birth weight (VLBW) infants with a gestational age $\leq$32 weeks that were born at the Seoul National University Children's Hospital between November 2005 and April 2009. EUGR was defined as weight for gestation, lower than the 10th percentile on discharge. Results : The frequency of EUGR was 67% (n=111/166). By multiple logistic regression, the presence of small for gestational age (SGA) was the greatest predictor of EUGR, birth weight and daily weight gain during the first 28 days were independent predictors of EUGR. Risk factors for EUGR in non-SGA infants were evaluated because 56% (64/114) of non-SGA infants developed EUGR at discharge. Daily weight gain in the first 28 days was also decreased in EUGR group and independently predicted the risk of EUGR in the non-SGA group. Conclusion : EUGR was a common problem in the NICU. SGA was the most significant predictive factor of the EUGR. Half of the non-SGA infants also developed EUGR, revealing poor weight gain in the early days was as an important predictor. These results support the importance of early nutritional intervention for weight gain which have lagged behind other modern therapeutic interventions when the infant is clinically unstable.

• Women's Health Nursing
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• v.6 no.1
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• pp.153-165
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• 2000

The antenatal self-care, one of antenatal management, was almost done by a pregnant woman herself. But It's especially difficult for primigravidas to cope with the change of being pregnant, and they also had insufficient knowledge of pregnancy, The purpose of this study was to serve as a basis for antenatal management, by grasping how much primigravidas performed antenatal self-care, how much they had maternity-related knowledge, and what factors affected those two factors. The subjects of this study were the primigravidas, selected from among visitors to a general hospital and a hospital for obstetrics and gynecology located in the city of K. A questionnaire survey was carried out over them from July 16 to August 19, 1998, to collect data. The test instrument used in this study for antenatal self-care behavior was one that modified the measurement instrument employed in studies by Kim Hae Won(1996), Lee Mi La(1984), and Yoon Young Mi(1994). Another one for maternity-related knowledge was Kim, Hae Won(1996)'s instrument. The collected data were statistically analyzed by SAS PC+. Frequency and percentage were calculated to find out the primigravidas' general characteristics, and the mean and standard deviation, rank were estimated to determine the degrees of antenatal self-care behavior and maternity-related knowledge, t-test and ANOVA were carried out to identify the general characteristic that affected antenatal self-care and maternity-related knowledge. and the relationship of antenatal self-care behavior to maternity-related knowledge was tested by Pearson correlation coefficient. The findings of this study were as follows; First, the age of the subjects ranged from 18 to 37, and their mean age was 26.43. Their mean gestational period was 24.87 weeks. 45% of the subjects were in the third-term pregnancy. Second, their total mean score in antenatal self-care behavior ranged from 94, the highest, to 36, the lowest. Its average score was 63.81(SD 9.98). The total mean score in maternity-related knowledge ranged from 20, the highest, to 1, the lowest, and its average score was 10.91(SD 4.59, 54.55 percent). Third, the general characteristics that gave impact on the primigravidas' antenatal self-care behavior were age, educational background, gestational period, experience of natural miscarriage, and experience of infertility test. A higher score in antenatal self-care behavior was gained by the primigravida group who had better educational background(F=3.29, p=.02), who was in the late stage of pregnancy(F=4.31, p=.01), who experienced a natural miscarriage(t=2.06, p=.04), and who went through a infertility test(t=-2.19, p=.04). Fourth, the general characteristics that had an influence on maternity-related knowledge were identified as the religion, the term of marriage, and the gestational period. A higher score in maternity-related knowledge was got by the primigravida group who had a religion(t=-2.02, p=.04), and who was in the late stage of pregnancy(F=5.77, p=.003). The term of marriage also made a significant difference(F=3.46, p=.02). Fifth, the relationship of the total mean score between antenatal self-care behavior and maternity-related knowledge was found to be at r=.37(p=.0001). In this study, an attempt was made to affirm the subjects' characteristics, the degree of their antenatal self-care behavior, and the extent of their maternity-related knowledge, to confirm what characteristics affected significantly primigravida's antenatal self-care behavior and maternity-related knowledge, and to verify that there was a relationship between the two variables. The meaning of this study might be backed up by the fact that its findings would serve as a basis for primigravida's efficient antenatal management in the future.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.183-187
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• 2003

Purpose : Long-term stress to the fetus causes alterations in adrenal steroidogenesis. The purpose of this study was to analyze the association of cord blood cortisol with stress during delivery. Methods : Cord blood samples were collected from 58 neonates at once to labor. Cortisol was measured by RIA method(DPC, USA). Cortisol level according to gestational age(<34, 34-37, >38 wks) and method of delivery(Cesarean section vs. vaginal delivery), Apgar score and uterine contraction, were compared to know stress during labor. Results : Cortisol of cord blood had considerable differences between each group, according to gestational age(P<0.001). It was statistically higher in the cases of vaginal delivery than cessarian delivery(P<0.001). The concentration of cortisol was significantly higher according to duration of labor (P<0.05). There was a significant relationship between cortisol level and uterine contraction(P<0.05). The concentration of cortisol was significantly low when Apgar score at 1 min was low(P<0.05). Conclusion : Cord cortisol has close association with stress during labor. And so do with post birth prognosis of neonate.

• Neonatal Medicine
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• v.18 no.2
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• pp.293-300
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• 2011

Purpose: The aim of the study was to investigate the change in usage and clinical outcomes of using a humidified high flow nasal cannula (HHFNC) in preterm infants. Methods: A retrospective review of patients with gestational age <32 weeks born at our neonatal intensive care unit from January 2008 to March 2011 was performed. First, data were compared between Era 1 (January 2008 to February 2009) and Era 2 (March 2009 to March 2011) to describe the increased usage of HHFNC. Second, the patients (gestational age 25-30 weeks) were divided into two groups to compare clinical outcomes. nasal continuous positive airway pressure (NCPAP) and HHFNC groups who received either NCPAP or HHFNC as a respiratory support within 14 days of birth. Results: Compared to Era 1, HHFNC usage increased from 10 to 55% in Era 2, whereas NCPAP usage decreased from 40 to 5%. No difference in pulmonary or adverse outcomes including the incidence of reintubation and bronchopulmonary dysplasia (BPD), days on oxygen and a ventilator, and other outcomes was observed between the HHFNC and NCPAP groups. Days to reach full feed (32.2${\pm}$16.7 vs. 24.7${\pm}$10.2, P=0.05) and regain birth weight (20.9${\pm}$16.9 vs. 17.2${\pm}$4.3, P=0.04) decreased in the HHFNC group. Conclusion: HHFNC was feasible and did not differ in respiratory and other outcomes, but days to reach full feed and regain birth weight decreased in the HHFNC, when compared with the NCPAP. An additional prospective multicenter designed study is needed to better define safety and efficacy of HHFNC.

• Neonatal Medicine
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• v.18 no.2
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• pp.280-287
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• 2011

Purpose: The purpose of the present study was to determine the association of positive Ureaplasma urealyticum in gastric fluid with clinical features and outcomes in preterm infants. Methods: Gastric fluid from the preterm infants was first aspirated within 30 minutes and cultured within 24 hours after birth to check for U. urealyticum. Infants were divided into two groups on the basis of the presence/absence of U. urealyticum. Results: U. urealyticum in gastric fluid was identified in 17 of 91 (19%) preterm infants. Compared with the negative U. urealyticum group, there were significantly higher percentage of infants with gestational age ${\leq}$30 weeks (P=0.020), higher Apgar score at 1 minute and 5 minutes (P=0.017 and P=0.048, respectively), and higher rate of vaginal delivery (P=0.000) in the positive U. urealyticum group. Although the incidence rate of bronchopulmonary dysplasia between the two groups was not different, the frequency of bronchopulmonary dysplasia without previous respiratory distress syndrome was significantly higher in the positive group (11%) than that in the negative group (1%) (P=0.030). Conclusion: The detection of U. urealyticum in gastric fluid is more frequent in infants with gestational age ${\leq}$30 weeks. It can be helpful to predict the development of bronchopulmonary dysplasia without previous respiratory distress syndrome in preterm infants.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.7
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• pp.3029-3034
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• 2015

Background: While the perinatal outcomes of active maternal smoking are well documented, results of the effects of environmental tobacco smoke (ETS) exposure during pregnancy are inconsistent. We aimed to examine the effect of ETS exposure, assessed by maternal hair nicotine levels at $35^{th}$ week of gestation, on birth weight and the risk of small for gestational age (SGA) and low birth weight (LBW). Materials and Methods: A total of 871 non-smoking healthy pregnant women were recruited by one Korean hospital between 1 October 2006 and 31 July 2007. Hair samples were collected and anthropometric questionnaires administered at $35^{th}$ week of gestation. The primary outcome was birth weight and secondary outcomes were the risk of babies being SGA and LBW. Results: Log-transformed hair nicotine concentrations were inversely related with birth weight after adjusting for confounding variables (${\beta}=-0.077$, p=0.037). After stratifying hair nicotine levels by tertiles (T1, low [0.0-0.28 ng/mg]; T2, medium [0.29-0.62 ng/mg]; and T3, high [0.63-5.99 ng/mg]), the mean birth weight in each groups were 3,342g (T1) 3,296g (T2) and 3,290 g (T3), respectively. However the difference between groups was not statistically significant by analysis of co-variance (ANCOVA) adjusting for covariates (p=0.062). In logistic regression analysis, the risk of SGA was higher in the T3 (OR=1.59, 95%CI 1.05-2.42) than in the reference group (T1), after controlling for confounding variables. The risk of low birth weight (<2,500g, LBW) was not significantly higher (OR=1.44, 95%CI 0.95-2.19), but the risk of babies being below 3,000g birth weight was increased in the T3 group (OR=1.53, 95%CI 1.00-2.36) compared with that in the T1 group. Conclusions: Maternal ETS exposure during pregnancy was inversely related with birth weight. The risk of SGA increased in the highest ETS exposure group compared with in the low exposure group. To prevent ETS exposure during pregnancy, more comprehensive tobacco control policies are needed.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.56-60
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• 2009

Purpose : This study aimed to test whether rotavirus-associated necrotizing enterocolitis (RV+NEC) produced different clinical findings or outcomes from those of non-rotavirus necrotizing enterocolitis (RV-NEC). Methods : Eight patients from the RV+NEC group and 22 patients from the RV-NEC group diagnosed with modified Bell stage II or higher NEC were selected for this study. Fecal specimens from all infants were tested for rotavirus infection using a monoclonal antibody-based enzyme immunoassay (EIA). Clinical, radiographic, and clinical outcome data were analyzed retrospectively. Results : RV+NEC infants had a significantly higher birth weight and were born at a significantly higher gestational age ($33.5{\pm}3.3$ weeks vs. $29.3{\pm}4.4$ weeks; P=0.01). There were no differences in the occurrence of thrombocytopenia, mural gas, and pneumoperitoneum between the 2 groups. However, portal vein gas was more common in the RV+NEC group (88% vs. 9%; P<0.01). Neither the incidence of Bell stage III (or higher) NEC nor surgical intervention differed between the two groups. The number of complications and mortality rates were also similar. Conclusion : Rotavirus-associated NEC occurs in infants with a higher birth weight and those born at a greater gestational age. However, the severity of the condition and the resulting outcomes did not differ from those for infants affected by non-rotavirus NEC.

• Journal of Preventive Medicine and Public Health
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• v.23 no.4 s.32
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• pp.436-450
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• 1990

This study was designed to investigate the mar factors affecting selection of delivery facilities by pregnant women. Five hundred women hospitalized at 23 Seoul-area delivery facilities, such as university hospitals, general hospitals, hospitals, and clinics were selected and given questionnaires from April 24 to May 7, 1990. A total of 350 questionnaires were collected and analysed for the study. The results are as follows ; 1. In general, variables which significantly affected the choice of delivery facilities included the age of women, their educational level, the educational level of their husbands, monthly average incomes and residential areas. 2. In analyzing the obstetrical characteristics of the women, those variables significantly affecting the choice of delivery facilities were the gestational period, the facilities for prenatal care, the frequency of prenatal care, the type of delivery, the frequency of miscarriage, previous delivery experiences and the awareness on prenatal care. 3. In comparing the motivation factors for selecting the delivery facilities, all the factors except convenience and need for hospitalization differed significantly among delivery facilities. 4. The factor analysis was assessed for twenty possible factors motivating the choice of delivery facilities. Six factors including personal service, scale of the facility, reputation, urgency, convenience, and experience were noted explaining by 57.7%. 5. In the discriminant analysis used to clarify the major factors affecting the selection of delivery facilities, the 16 significant variables were regarded as independent variables, and the type of delivery facilities was considered a dependent variable. The stepwise method was applied to the analysis. Detected discriminant variables were the facilities for prenatal care, scale factor, personal service factor, urgency factor, convenience factor, reputation factor, experience factor, gestational period, types of delivery, frequency of miscarriage, age and income. These 12 discriminant variables were tested, with reference to discriminant prediction, on their importance in the choice of the delivery facility, by the discriminant functional formula. The test showed a hit-rate of 67.7%. The results suggest that general characteristics, obstetrical characteristics, and motivations for selecting the delivery facilities differ significantly according to the types of the delivery facilities. This study implies that all types of delivery facilities should attempt to acommodate characteristics and motivations of pregnant women. The facilities should be prepared to increase their patients satisfaction with required medical conditions by improving service and responding to the pregnant women's preferences.