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Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants

  • Lee, Eui Young;Kim, Sung Shin;Park, Ga Young;Lee, Sun Hyang
    • Clinical and Experimental Pediatrics
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    • v.63 no.2
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    • pp.56-62
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    • 2020
  • Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.

Open Heart Surgery in Infants Weighing Less than 3kg (체중 3kg 이하 소아에서의 개심술)

  • 이창하
    • Journal of Chest Surgery
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    • v.33 no.8
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    • pp.630-637
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    • 2000
  • Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

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Development of a Coverall Design for Infant Body Shapes (유유아 체형에 적합한 커버롤 디자인 개발)

  • Lee, Yoon-Kyung;Kim, Min-Ja;Nam, Yun-Ja
    • Journal of the Korean Society of Clothing and Textiles
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    • v.34 no.2
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    • pp.189-199
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    • 2010
  • This study develops a coverall design for the body shape and movement of infants. This research analyzed these processes: 1. The current coverall styles preferred for infants. 2. The appropriate products for the real size, body shape, movement, and fit of infants. 3. The observations of the 6 months to 9 months movement and development of infants. 4. The design and creation of a new coverall base in this study, and to check the suitable test the developed coverall design for the infant. The result of this study are: A coverall for infants that lie or crawl on the floor must avoid opening in the center front and a gore has to be added at the crotch of the pants for the better movement of infants. These ways provide infants a neat appearance and easy movement. The test of developed designs shows that the developed coverall design covers the size gap of the trunk loop according to the growth of the infant and the movement of the legs; in addition it provides a positive aesthetic effect. The waistline in the developed coverall (a waistline that should exist lower than the body waistline of the infant) can reduce seam stress because the pressure of the seam line can be absorbed in a dipper. It is one of the suitable design points for infants lying prone all day long in this study.

A Study on Sizes Specifications of Infants' Apparels (유아복(乳兒服)브랜드 치수규격(値數規格) 실태(實態) 조사(調査) 연구(硏究) II)

  • Kim, Jin;Sohn, Hee-Soon
    • Journal of Fashion Business
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    • v.3 no.4
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    • pp.31-39
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    • 1999
  • The purpose of this study is to survey and analyze the general conditions of infants' apparel brands in Korea, review the sizes and specifications of each brand, analyze the differences and correlations among brands, and thereby, present the reasonable sizes and specifications for infants' apparels in consideration of domestic and foreign specifications and infants' health conditions. for this purpose, 13 brands manufacturing the apparels for the infants aged from 0 to 4 were sampled, and their design directors and outside pattern suppliers were surveyed through direct interviews. The collected data were processed for frequencies, mean, median and mode. The results of this study can be summarized as follows; 1. The sample infants' apparel brands were mostly launched as national brands in 1990's, while their target ages were diverse : 0 $\sim$ 72 months, 0 $\sim$ 36 months, 0 $\sim$ 48 months, 0 $\sim$ 60 months, 12 $\sim$ 24 months, etc. 2. More brands were restructuring the pattern suppliers' sizes and specifications rather than developing them directly, which suggests that most of infants' brands depend much on pattern suppliers. 3. Infants' apparel brands were presenting the 'space suites' sized from #60 to #90 because consumers prefer those space suites distinct in their upper and lower parts and convenient for their toddlers aged 36 months or older. The brands were setting the sizes for 6 parts: total length, breast, sleeve length, hip, hip height, leg. 4. The sizes for infants' one-pieces were #70, #75, #80, #85, #90, #95, #100, #110 and #120, while their subsizes were determined for 4 parts: total length, breast, sleeve length, hip.

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Growth and Development of Infants Fed Soy- Based Formulas over 3 Months (액상 대두 유아식을 3개월 이상 섭취한 영유아의 성장과 발달)

  • 조상운;신해철;손헌수;정재원;남희정;박혜련
    • Korean Journal of Community Nutrition
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    • v.9 no.5
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    • pp.555-565
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    • 2004
  • The objective of this study was conducted to investigate growth and development status of infants fed soy-based formulas over 3 months. The height and weight were measured and Z-scores were calculated by using standard of the same age groups. Their mothers were interviewed using questionnaires including general and environmental characteristics, total food intakes, soy based formula intakes and Ewha infant development screening test. Main results were as follows: 1) Nutrient intake levels of subjects were similar to or more than the level of Korean Recommended Dietary Allowances except for intakes of vitamin E (79.89% RDA), and the average status of nutrient intakes of infants were fairly good. 2) Z-scores of height for age (HAZ) and Z-scores of weight for age (WAZ), Kaup index, WLI and Ewha Infant Developmental Screening Test score of subjects were in the normal growth range. 3) There were no significant differences among soy based formula intake percentile groups in HAZ, WAZ, Kaup index, WLI and Ewha Infant Developmental Screening Test score. 4) Total energy intake was positively correlated with HAZ (p < 0.00, WAZ (p <0.00, and WLI (p < 0.05) in infants less than 12 month. Also, soy based formula energy intake was positively correlated with HAZ (p < 0.05) in infants less than 12 month. However, energy and soy based formula intake levels of infants over 12 month were not significant among variables. Considering results of this study, infants fed soy-based formulas over 3 months showed normal growth and development status. Further studies are needed to evaluate longterm growth and development in infants fed soy based formulas.

Comparison of breast feeding practice rates and mothers' breast feeding empowerment in preterm, late preterm and early term infants (미숙아, 후기 미숙아와 조기 만삭아의 모유수유 실태 및 모유수유 임파워먼트 비교)

  • Kim, Taeim;Jang, Gunja
    • Journal of the Korean Data and Information Science Society
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    • v.24 no.4
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    • pp.713-721
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    • 2013
  • The purpose of this study was to compare the breast feeding practice rates and mothers' breast feeding empowerment in preterm (gestation age [GA]<34), late preterm ($34{\leq}$GA<37), early term infants ($37{\leq}$GA<39). We surveyed 33 preterm, 22 late preterm, and 30 early term infants at a 'Baby-Friendly Hospital' in D city. The data were collected from October 1st, 2008 to February 28th, 2010 through the medical records of the infants and their mothers. We also checked the mothers' breast feeding empowerment at discharge day. The rate of breast feeding in the late preterm and preterm infants was significantly lower than that of the early term infants. The score of mothers' breast feeding empowerment in the late preterm and preterm infants was also significantly lower than that of the early term infants. The breast feeding education program is required for the mothers who have preterm and late preterm infants considering the low rate of breast feeding.

Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department

  • Lee, Tae Gyoung;Yu, Seung Taek;So, Cheol Hwan
    • Journal of Yeungnam Medical Science
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    • v.37 no.2
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    • pp.106-111
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    • 2020
  • Background: Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants. Methods: We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed. Results: In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701-0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360-0.550) and that for ANC was 0.453 (95% CI, 0.359-0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis. Conclusion: CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

Survey on Parent's Recognition for Necessity of Health Examinations for Infants and Children by Korean Medicine (한방 영유아 건강검진 필요성에 대한 일반인 대상 설문 - 환아의 부모를 대상으로)

  • Choi, Jung Yoon;Min, Sang Yeon;Kim, Eun Jin
    • The Journal of Pediatrics of Korean Medicine
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    • v.35 no.3
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    • pp.100-117
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    • 2021
  • Objectives The purpose of this study is to investigate the satisfaction and improvement points of the current health checkup in infants and children, and recognition of parents about introduction of health examinations for infants and children by Korean medicine. Methods We conducted an online survey through the website of Dongguk University Bundang Korean medicine hospital for the parent of infants and children between 4 and 71 months age who received at least one health checkup. Statistical processing was performed using the SPSS Version 23.0 program. Results As a result of correlation analysis between the degree of necessary improvement point of current health checkup for infants and children and the degree of strength of health examinations for infants and children by Korean medicine, there was a statistically significant positive correlation (r=0.957). With the participation of Korean medical doctors, it can be expected that the number of health examinations centers for infants and children will be expanded, screening services will be increased, and oriental medicine childcare and education to prevention of major pediatrics disease can be provided. Conclusions These results show that health examinations for infants and children by Korean medicine can increase the satisfaction of the parent and the inspection rate.

Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up

  • Kono, Yumi
    • Clinical and Experimental Pediatrics
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    • v.64 no.7
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    • pp.313-321
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    • 2021
  • Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without follow-up data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without follow-up data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.

Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea

  • Choi, Eui Kyung;Shin, Jeong Hee;Jang, Gi Young;Choi, Byung Min
    • Neonatal Medicine
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    • v.25 no.4
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    • pp.137-143
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    • 2018
  • Purpose: This study was performed to determine the clinical features of full-term infants with hypoxemia detected by pulse oximetry and to establish the diagnosis of critical congenital heart disease (CCHD). Methods: We retrospectively reviewed the medical records of neonates who had been admitted to the neonatal intensive care unit within 2 weeks of birth at Korea University Ansan Hospital between January 2013 and October 2017 (n=450). We classified these neonates based on the presence of hypoxemia at admission and investigated neonatal characteristics, initial symptoms, echocardiographic findings, and final diagnosis associated with hypoxemic diseases. Results: Of 450 term infants, 265 infants (58.9%) were identified hypoxemia by pulse oximetry at admission. The most common symptoms of them were cyanosis and tachypnea. Among them, 80.1% of infants (214/265) were diagnosed with respiratory tract disease and 8.3% of infants (22/265) had congenital heart disease. Thirteen infants (13/265, 4.9%) had CCHD and were treated with urgent surgery or transcatheter intervention within 28 days of birth. Majority of infants with respiratory tract disorder were transferred from hospital immediately after birth, but 46.1% of infants (6/13) with CCHD remained asymptomatic after birth and were admitted after 48 hours after birth. In addition, other hypoxemic illnesses were identified as neonatal infectious and neurological diseases. Conclusion: This study showed the importance of assessment in neonates with hypoxemia, including those diagnosed with CCHD. The possibility of CCHD should be considered in the differential diagnosis in neonates demonstrating hypoxemia after 48 hours of birth. A larger prospective study is needed to assess the effectiveness and outcomes of pulse oximetry for neonatal screening in Korea.