• 대한소아치과학회지
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• 제50권2호
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• pp.192-204
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• 2023

본 연구는 조산아 유치의 발육성 법랑질 결함을 정량화하는 평가 기준을 제시하고, 조산아의 재태기간, 출생 시 체중, 다양한 합병증 및 치료 이력에 따른 발육성 법랑질 결함의 심각도를 조사하고자 하였다. 조산아의 신생아집중치료실 입원 및 퇴원 기록을 후향적으로 평가하여 출생 정보, 합병증 진단 여부, 비경구 영양 및 기관내 삽관 기간을 조사하였다. 기존의 발육성 법랑질 결함 평가지표를 수정하여 Preterm Developmental Defects of Enamel (PDDE) index를 고안하였으며, 평가자는 기준에 맞추어 조산아 유치의 발육성 법랑질 결함을 법랑질 저광화와 저형성으로 구분하여 점수화하였다. 재태기간 28주 미만, 출산 시 체중 1000 g 미만인 군의 PDDE score는 유의하게 증가하였다. 기관지폐이형성증, 구루병, 뇌실내출혈, 괴사성 대장염 진단 이력이 있는 군, 기관내 삽관 일수가 50일 이상인군, 비경구영양 일수가 20일 이상인 군 역시 PDDE score를 유의하게 증가시켜 발육성 법랑질 결함의 위험인자임을 확인하였다. 본 연구는 조산아 발육성 법랑질 결함 위험인자를 파악하여 조산아의 구강 상태를 예측하고 설명하기 위한 기초 정보를 제공할 수 있을 것이다.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.316-323
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• 2023

Objective : Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. Methods : This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. Results : A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. Conclusion : In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

• Pediatric Infection and Vaccine
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• 제30권1호
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• pp.12-19
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• 2023

목적: 패혈증은 개발도상국에서 연간 사망률의 30-50%를 차지하는 신생아 사망의 가장 흔한 원인이다. 본 연구는 신생아 패혈증 사망률의 예후인자를 알아보고자 하였다. 방법: 2021년 4월부터 2021년 9월까지 R. Sosodoro Djatikoesoemo 주지사 병원 신생아 중환자실에서 패혈증을 진단받은 121명의 신생아를 대상으로 후향적 코호트 연구로 진행되었다. 연구대상자 선정기준은 신생아 중환자실에 입원하고 패혈증을 진단받은 생후 0-28일된신생아였다. 임상 기록이 불완전한 경우와 선천적 기형을 가진 경우는 제외하였다. 성별, 재태주령, 분만방식, 출생체중, APGAR 점수, 출생지, 혈액배양에 대해 카이제곱 검정을 시행하였고 백혈구, 림프구, 호중구, 혈소판, C반응단백 (C-reactive protein, CRP) 및 체류 기간에 대하여서는 정규성 검정을 한 후 Mann-Whitney 테스트로 분석하였다. 결과: 출생체중 (P=0.038), 임신주수 (P=0.009), 혈액배양 (P=0.014)은 신생아 패혈증 결과에 유의한 상관관계를 보였고, Mann-Whitney 검사는 혈소판 (P=0.018), CRP (P=0.002) 및 재원기간 (P<0.001)에서 유의한 차이를 보였다. 다변량 분석에서 신생아 패혈증 사망률과 관련된 세 가지 예후 인자는 미숙아 (오즈비 [odds ratio, OR], 3.906; 95% 신뢰구간 [confidence interval, CI], 1.344-11.356; P=0.012), 저체중 출생 (OR, 2.833; 95% CI, 1.030-7.790; P=0.044), 그람 음성 박테리아 (OR, 4.821; 95% CI, 1.018-22.842; P=0.047)인 것으로 나타났다. 결론: 미숙아, 저체중아, 그람 음성균 감염이 신생아 패혈증의 예후와 관련이 있었다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권2호
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• pp.133-141
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• 2001

위식도역류는 영아들에 있어서 흔하게 있다고 알려져 있고 특히 미숙아들에게 더 흔히 있다고 알려져 있지만 아직 이에 대한 연구는 부족하다. 목적: 건강하게 자라고 있는 미숙아들에게 위식도역류의 진단에 가장 예민하다고 알려져 있는 24시간 식도 pH 검사를 통하여 그 빈도 및 연관 인자를 찾고자 하였다. 방법: 특이 증상 없이 건강하게 자라고 있는 미숙아 21명(평균 재태기간: $30+{\pm}2+0$주, 출생시의 평균 체중은 $1,468{\pm}329$ g, 검사 당시의 평균 나이는 $29{\pm}8$일, 수태 후 나이(Postconceptional age: 재태기간+출생 후 나이)는 $34+6{\pm}1+4$주, 체중은 $1,750{\pm}329$ g, 남아 : 여아=15:6)을 대상으로 휴대용 레코더가 연결되어 있는 실리콘 재질의 마이크로 소식자를 Stobel의 공식($0.252{\times}$키+5 (cm))에 따라 코로 넣어 그 거리만큼 식도내강에 위치시킨 후 거리를 교정하여 24시간 동안 식도 pH 검사를 시행하였다. 결과: 네 가지 파라미터(number of acid reflux, number of long acid reflux (5 min), longest acid reflux minutes, RI)를 제시하였고 전체 대상환아의 57%에서 유의한 위식도역류가 있음을 보였다. 위식도역류와 number of acid reflux, RI의 두 파라미터가 통계적으로 의미있는 상관관계를 보였으며 이 두 파라미터와 Reflux index of the postprandial 120 min간에도 의미있는 상관관계가 있음을 알 수 있었다. 위식도역류가 있는 환아들을 출생체중, 재태기간, 검사 당시의 나이, 수태 후 나이, 체중, 성별 및 테오필린(theophylline) 투약 여부에 따라 각각 구분하여 그 차이를 살펴보았고 모두 통계학적으로 큰 차이는 없었다. 소식자의 거리는 Stobel의 공식에 의한 거리와 실제길이 사이에 차이가 있어 우리의 미숙아의 경우에는 $0.252{\times}$키+3.7 (cm)로 적용시킬 수 있었다. 결론: 위와 같은 결과로 미숙아들에게 있어서 무증상적, 유의한 위식도역류가 57%의 높은 빈도로 나타났고, 위식도역류증의 진단에 가장 중요한 파라미터는 number of acid reflux, RI와 Reflux index of the postprandial 120 min로 나타났다. 출생체중, 재태기간, 검사 당시의 나이, 수태 후 나이, 체중 및 성별, 테오필린 투약여부 등과 위식도역류와는 통계적으로 유의성이 없었다. 또한 1세 이하의 영아에게 소식자의 위치를 정하는데 사용되는 Strobel의 공식을 본 연구대상 미숙아들에게 적용해본 결과 소식자의 위치가 $0.252{\times}$키+3.7(cm)로 나타났다.

• Advances in pediatric surgery
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• 제10권1호
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• pp.17-21
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• 2004

Improvement in prenatal ultrasonography is leading to diagnose choledochal cyst before birth and before onset of classical symptom more frequently. But, there is a controversy about optimal timing for Cyst excision of prenatally diagnosed asymptomatic choledochal cyst. To identify the most appropriate timing for surgery in prenatally diagnosed choledochal Cysts, we analyzed 6 patients who had operation for choledochal cysts within 30days after birth at the division of Pediatric Surgery, Samsung Medical Center and Inha University School of Medicine, from June 1995 to June 2002. Males were four and females 2, the mean age at operation was 11.2 days, and the median age 8.0 days. The range of gestational ages of the antenatal diagnosis of bile duct dilatation was 24 weeks to 32 weeks, mean was 38.3 weeks, and mean birth weight was 3,298.3 g. After birth, abdominal ultrasonography, hepatobiliary scintigraphy, and magnetic resonance cholangiopancratography (MRCP) were performed. Mean age at operation was 11.2 days. All patients had the cyst excision and Rouxen-Y hepaticojejunostomy. Immediate postoperative complication was not found. During the median follow-up period of 41 months, one patient was admitted due to cholangitis, and the other due to variceal bleeding. Early operative treatment of asymptomatic newborn is safe and effective to prevent developing complications later in life.

• Clinical and Experimental Pediatrics
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• 제58권2호
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• pp.52-59
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• 2015

Purpose: This study aimed to investigate the relative weight gain at 2-week intervals up to 6 weeks after birth to predict retinopathy of prematurity (ROP) requiring treatment among very low birth weight infants. Methods: A total of 211 preterm infants with birth weights <1,500 g and gestational age <32 weeks were retrospectively reviewed. The main outcome was the development of ROP requiring treatment. Body weight measurements were recorded daily. Relative weight gains (g/kg/day) were calculated at the second, fourth, and sixth week after birth. Results: Of the 211 infants, 89 developed ROP, of which 41 spontaneously regressed and 48 with early treatment of ROP type I required laser treatment. The relative weight gain at 2, 4, and 6 weeks postnatal age was significantly lower in infants with ROP requiring treatment than in infants without ROP or those with spontaneous regression (P<0.001, P=0.005, and P=0.004, respectively). On logistic regression, poor relative weight gain in the first 2 weeks was found to be related to ROP requiring treatment (adjusted odds ratio, 0.809; 95% confidence interval, 0.695-0.941; P=0.006). Relative weight gain at 2 weeks postnatal age was significantly lower in infants with ROP requiring treatment compared to that in ROP requiring no treatment (P=0.012). Conclusion: Poor postnatal weight gain in the first 2 weeks of life is an important and independent risk factor for ROP requiring treatment. Postnatal weight gain can predict the development of severe ROP requiring treatment.

• Advances in pediatric surgery
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• 제5권2호
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• pp.103-110
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• 1999

To estimate the normal anal canal pressure in neonates, anal manometry was performed in 46 normal babies less than 6 days of age. Twenty-eight of the subjects were boys and 18 girls. All the subjects passed meconium within 24 hours after birth. Birth weights were above 2.4 kg. There were no sexual differences in birth weight, birth height, gestational age, postnatal age, or Apgar score (p<0.05). The mean manometry values were; anal sphincter length $18.6{\pm}3.9$ mm, high pressure zone (HPZ) $9.2{\pm}3.6$ mm, vector volume $2027.2{\pm}2440.7$ mmHg2cm, maximum pressure $42.3{\pm}17.4$ mmHg, and position of the maximum pressure $6.0{\pm}22.4$ mm. Only the HPZ of boys was longer than those of girls (p=0.005). In squeezing state, HPZ and the position of maximun pressure were not changed from resting state. HPZ, vector volume, and maximum pressure in boys were higher than those in girls. As the birth weight increased, the anal sphincter length (p=0.001) and the HPZ increased (p=0.047). The resting pressures of the anal canal were evaluated in three portions; /23 upper portion, $12.8{\pm}8.6$ mmHg, middle portion, $20.3{\pm}10.8$ mmHg, and lower portion, $26.1{\pm}12.9$ mmHg. These normal values may serve as guidelines for the evaluation, diagnosis and treatment of neonatal anal diseases.

• Advances in pediatric surgery
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• 제15권1호
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• pp.18-26
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• 2009

The survival of Very Low Birth Weight (VLBW) infants has been improved with the advancement of neonatal intensive care. However, the incidence of accompanying gastrointestinal complications such as necrotizing enterocolitis has also been increasing. In intestinal perforation of the newborn, enterostomy with or without intestinal resection is a common practice, but there is no clear indication when to close the enterostomy. To determine the proper timing of enterostomy closure, the medical records of 12 VLBW infants who underwent enterostomy due to intestinal perforation between Jan. 2004 and Jul. 2007 were reviewed retrospectively. Enterostomy was closed when patients were weaned from ventilator, incubator-out and gaining adequate body weight. Pre-operative distal loop contrast radiographs were obtained to confirm the distal passage and complete removal of the contrast media within 24-hours. Until patients reached oral intake, all patients received central-alimentation. The mean gestational age of patients was $26^{+2}$ wks ($24^{+1}{\sim}33^{+0}$ wks) and the mean birth weight was 827 g (490~1450 g). The mean age and the mean body weight at the time of enterostomy formation were 15days (6~38 days) and 888 g (590~1870 g). The mean body weight gain was 18 g/day (14~25 g/day) with enterostomy. Enterostomy closure was performed on the average of 90days (30~123 days) after enterostomy formation. The mean age and the mean body weight were 105 days (43~136 days) and 2487 g (2290~2970 g) at the time of enterostomy closure. The mean body weight gain was 22 g/day after enterostomy closure. Major complications were not observed. In conclusion, the growth in VLBW infants having enterostomy was possible while supporting nutrition with central-alimentation and the enterostomy can be closed safely when the patient's body weights is more than 2.3 kg.

• Clinical and Experimental Pediatrics
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• 제63권2호
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• pp.48-51
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• 2020

Background: The etiopathogenesis of late preterm (LPT) birth is undetermined. Placental histopathology, which reflects an adverse intrauterine environment and is reportedly associated with preterm labor and neonatal morbidities, has not been studied in LPT infants. Purpose: We investigated placental pathological lesion as markers of an adverse intrauterine environment during LPT labor. Methods: This retrospective case-control study compared placental histopathological and clinical variables between LPT and term neonates. Placental variables included chorioamnionitis, funisitis, hemorrhage, abruption, infarction, calcification, and syncytial knots. Maternal variables included age, substance abuse, pregnancyassociated diabetes mellitus and hypertension, duration of rupture of membrane, antibiotic use, and magnesium sulfate, whereas, those of neonates included gestational age, birth weight, race, sex, and Apgar scores. Standard statistical proedures were applied to analyze the data. Results: Chorioamnionitis (50% vs. 17.8%, P<0.001) and funisitis (20% vs. 4.4%, P=0.002) were more common in term infants. Placental infarction rate was insignificantly higher in LPT infants (25.6% vs. 14.3%, P=0.08). The mothers in the LPT group were older (30.4 years vs. 28.1 years, P=0.05; odds ratio [OR], 1.06; 95% confidence interval [CI], 0.998-1.12, P=0.056) and more often suffered from hypertension (28.9 vs. 12.9 %, P=0.02), and received magnesium sulfate (48.9 vs. 20%, P< 0.001; OR, 2.86; 95% CI, 1.12-7.29, P<0.05). Duration of rupture of membrane was higher in term infants (13.6 hours vs. 9.1 hours, P<0.001). Chorioamnionitis (OR, 0.33; 95% CI, 0.13-0.79; P<0.05) was associated with a lower risk of LPT delivery. Conclusion: Placental infection is not a risk factor for LPT births. There is a nonsignificant predominance of vascular anomalies in LPT placentas. Higher maternal age, magnesium sulfate therapy, and maternal hypertension are clinical risk factors for LPT labor.

• Child Health Nursing Research
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• 제3권2호
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• pp.117-130
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• 1997

This research was to examine the mother's responsiveness to infant cue in order to improve interaction between mother and infant. The subjects were 144 mothers who gave birth to at general hospital or a public health center in Kangnung. The gestational age of infants was more than 38weeks and birth weight was more than 2500g. A questionnaire was developed by applying the content about infant cue in Barnard's NCAST program. This questionnaire was revised through the examination of expertis in this field. The questions were classified into 3 categories : 10 questions about engagement cue, 11 questions about disengagement cue, and 9 questions about general cue and reflex behavior. Each item measured the mother's responsiveness to infant cue using 5 scales : 2 positive responsiveness, 1 negative responsiveness, and 1 meaningless, 1 for in case which mother can't recognize the meaning of reaction. The result presented that mothers showed positive reaction to engagement cue. However, most mothers still didn't recognize that their infants can lead a mother-infant interaction and show active response in interaction. Mothers tended to treat them as Just passive objects. In disengagement cue, mothers tended not to give proper responsiveness to their infants when the infants desired feeding or not and they did not desire mother -infant interaction. In general cue and reflex behavior, the mother's reaction was positive and they took it granted as a infant's behavior. When each item was analyzed by the general characteristics of the subject, there was significant differences according to the mottler's age, birth weight, average house income, birth order, feeding type, nature of infant, and infant's age.