• Clinical and Experimental Pediatrics
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• v.54 no.6
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• pp.246-252
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• 2011

Purpose: The outcomes of small for gestational age (SGA) infants especially in extremely low birth weight infants (ELBWIs) are controversial. This study evaluated the mortality and morbidity of ELBWIs, focusing on whether or not they were also SGA. Methods: The medical records of 415 ELBWIs (birth weight<1,000 g), who were inborn and admitted to the Samsung Medical Center neonatal intensive care unit from January 2000 to December 2008, were reviewed retrospectively. Mortality and morbidities were compared by body size groups: very SGA (VSGA), birth weight ${\leq}$3rd percentile; SGA, 3rd to 10th percentile; and appropriate for gestational age (AGA) infants, >10th percentile for gestational age. For gestational subgroup analysis, groups were divided into infants with gestational age ${\leq}24^{+6}$ weeks (subgroup I), $25^{+0}$ to $26^{+6}$ weeks (subgroup II), and ${\geq}27^{+0}$ weeks (subgroup III) Results: Gestational age was $29^{+2}{\pm}2^{+6}$ weeks in the VSGA infants (n=49), $27^{+5}{\pm}2^{+2}$weeks in the SGA infants (n=45), and $25^{+4}{\pm}1^{+4}$ weeks in AGA infants (n=321). Birth weight was $692{\pm}186.6$ g, $768{\pm}132.9$ g, and $780{\pm}142.5$ g in the VSGA, SGA, and AGA groups, respectively. Cesarean section rate and maternal pregnancy-induced hypertension were more common in the VSGA and SGA than in AGA pregnancies. However, chorioamnionitis was more common in the AGA group. The mortalities of the lowest gestational group (subgroup I), and also of the lower gestational group (subgroup I+II) were significantly higher in the VSGA group than the SGA or AGA groups (P=0.020 and P=0.012, respectively). VSGA and SGA infants showed lower incidence in respiratory distress syndrome, ductal ligation, bronchopulmonary dysplasia, intraventricular hemorrhage than AGA group did. However, by multiple logistic regression analysis of each gestational subgroup, the differences were not significant. Conclusion: Of ELBWIs, extremely SGA in the lower gestational subgroups, had an impact on mortality, which may provide information useful for prenatal counseling.

• Child Health Nursing Research
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• v.6 no.1
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• pp.32-50
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• 2000

A descriptive exploratory design was used in this study to evaluate the effects of sponge bathing on physiological(heart rate, heart period, vagal tone, oxygen saturation, respiration) and behavioral responses in newly born 40 preterm infants from intensive care unit of S University Hospital in Seoul. Data has been collected from October, 1997 to March, 1999. The infants were between 27-33 weeks gestational age at birth, and were free of congenital defects. The subjects entered the protocol when they were medically stable (determined by initiation of feeding and discontinuation of all respiratory support) but still receiving neonatal intensive care. The infants' physiologic parameters were recorded a 10 - minute before, during, and after bathing. Continuous heart rate data were recorded on a notebook computer from the infant's EKG monitor. The data were digitized off-line on software(developed by Lee and Chang in Wavelet program) which detected the peak of the R wave for each heart beat and quantified sequential R-R intervals in msec(i.e. heart periods). Heart period data were edited to remove movement artifact. Heart period data were quantified as : 1) mean heart period; 2) vagal tone. Vagal tone was quantitfied with a noninvasive measure developed by Porges(1985) in Mxedit software. To determine behavioral status, tools were developed by Scafidi et al(1990) were used. Collected data were analyzed with the SPSS program using paried t-test, ANOVA, and Pearson correlation. The result were as follow. 1. The results of the ANOVAs indicated that vagal tone were signifcantly lower during bathing than baseline and post-bathing. There were significant differences in heart period and heart rate levels across the bathing. But the mean oxygen saturations and respirations were no differences. Also, there were no significant differences on behavioral sign, motor activity, behavioral distress, weight changes, morbidity, and hospitalization period. 2. To evaluate the relation between vagal tone and subsequent parameters, the two groups (the high group had 19 subjects and low group had 21subjects) were divided by the mean baseline vagal tone. Vagal tone measured prior to bathing were significantly associated with respiration before bathing, vagal tone during bathing, and the magnitude of change in both vagal tone. But, other subsequent reactivities were no differences in two groups. 3. Correlations were also calculated between vagal tone and the subsequent physiological reactivities from baseline through after- bathing. Correlations were significant between baseline vagal tone and baseline heart rate, between baseline vagal tone and baseline heart period, between baseline vagal tone and oxygen saturation after bathing. In summary, the bathing in this study showed a stressful stimulus on premature infants through there was significance in the physiological parameters. In addition, our study represents the documentation that vagal tone reactivity in response to clearly defined external stimulation provides an index of infant's status.

• Child Health Nursing Research
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• v.21 no.1
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• pp.37-45
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• 2015

Purpose: In this study, a comparison was done of the extent of health-related quality of life (HRQoL) for preterm and fullterm children during early childhood, and factors affecting HRQoL in the early childhood of premature children were analyzed. Methods: Eighty mothers of children born prematurely and 83 mothers of children born at fullterm listed on two Internet cafes were sampled for this study. The major instrument used for the study was the TNO-AZL Preschool Quality Of Life (TAPQOL) questionnaire. Results: Total score for HRQoL in the premature group was 80.5 (${\pm}9.9$) and for the full term group, 85.0 (${\pm}8.3$), on a 100-point scale. A comparison of the premature group and full term group showed that the domains which scored relatively lower with respect to HRQoL included the stomach, motor function, anxiety, liveliness and communication. Among the factors that have an impact on HRQoL were 'length of stay in neonatal intensive care unit (${\geq}7$ days)' and 'birth weight (<1,000 gm)'. The explanation power of the model was 17%, which was statistically significant. Conclusion: These findings indicate that a differentiated premature infant follow-up program for children who are hospitalized over 7 days in NICU or weighed under 1,000g at birth is urgently needed.

• Child Health Nursing Research
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• v.20 no.1
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• pp.20-29
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• 2014

Purpose: The purpose of this study was to develop a feeding protocol for premature infants and to evaluate the effects of protocol. Methods: The feeding protocol was developed through a literature review and discussions of an expert group. The developed feeding protocol was tested with 85 preterm infants in one neonatal intensive care unit in B city. A non-equivalent control group non-synchronized design was used. Data were collected from January 1 to April 30, 2013 for the control group and from June 1 to September 30, 2013 for the experimental group. The experimental group (n=38) received the feeding protocol, whereas the control group (n=47) had routine feeding care. Collected data were analyzed by t-test and -test using SPSS/WIN version 18.0. Results: First feeding time (t=2.22, p=.029) and full enteral feeding time (t=2.28, p=.026) were significantly decreased in the experimental group compared to the control group. There was no difference in incidence of complications (p>.05). Also no significant differences in weight reduction rate between the two groups were observed at the 7th postnatal day (t=-1.23, p=.222). Conclusion: The results indicate that the feeding protocol for preterm infants is effective in decreasing first feeding time and full enteral feeding time.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.585-590
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• 1997

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational alee(29.6$\pm$ 3.1weeks vs. 28.1 $\pm$ 1.6weeks) and birth weight(1,413 $\pm$ 580gm, ,098 $\pm$ 235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical libation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22% , 219). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in s ead of moving the patient to the operating room.

• Pediatric Infection and Vaccine
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• v.25 no.1
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• pp.17-25
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• 2018

Purpose: Blood culture is an essential diagnostic tool and requires clear indications, proper techniques, and quality control. We aimed to investigate whether blood cultures in children are appropriate for indications, are performed correctly, and receive proper quality control. Methods: We conducted an online survey targeting pediatric infectious diseases (ID) specialists working in general hospitals and neonatologists (Neo) working at hospitals operating a neonatal intensive care unit in Korea. Results: Approximately 81.1% (30/37) of pediatric ID specialists and 72.2% (52/72) of Neo responded to the survey. Some of the respondents (33.3% of ID and 59.6% of Neo) performed blood culture as a regular test irrespective of the indication. Approximately 40% of ID and 65.4% of Neo ordered only one set of blood culture in patients suspected with bacteremia. The most commonly used disinfectant for skin preparation was povidone-iodine, while the skin preparation method varied by institution. Approximately two-thirds of the institutions were monitoring the blood culture contamination rate, whereas relatively few provided staff with feedback on that rate. In addition, less than half of the institutions were providing regular staff training on blood culture (40% of ID and 28.8% of Neo). Conclusions: The indication and methods of blood culture for children varied according to institution, and few hospitals exert effort in improving the quality of blood culture. Institutions have to strive constantly toward improvement of blood culture quality and evidence-based recommendations for pediatric blood cultures should be standardized.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.147-153
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• 2015

Purpose: This study was aimed to investigate the contamination rates of blood culture in a neonatal intensive care unit (NICU) and to examine the clinical characteristics related to the contamination. Methods: Eight hundred thirty cases of blood culture performed from March 2013 to February 2014 were analyzed. We evaluated the contamination rates of blood culture by blood sampling sites and compared the clinical characteristics such as real name system and body weights of the contaminated cases and those of non-contaminated ones. The clinical characteristics were retrospectively reviewed by medical records. Results: The overall contamination rate was 3.6% (30/830). The contamination rates by blood sampling sites were as follows: peripheral vein 15.6% (10/64), peripheral artery 2.6% (20/759), and umbilical arterial catheter 0% (0/7). There was no difference in the contamination rates between cases with and without real name system (P=0.484). However, there were significant differences in the contamination rates by the physicians who performed the culture (P=0.038) and body weight (<1,000 g vs. ${\geq}1,000g$) at the time of blood culture (P<0.001). Conclusions: These results suggest that neonates with a body weight less than 1,000 g have more risks of the contamination of blood culture. Furthermore, there is a necessity to provide blood culture performers with active feedbacks and individualized education plans that can help diminish blood culture contamination rates. Prospective studies in a systematic manner that can be applied in actual clinical settings are needed in order to figure out factors that can diminish the contamination rates of blood culture in NICU.

• Journal of Yeungnam Medical Science
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• v.22 no.2
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• pp.183-190
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• 2005

Background: This study was performed to evaluate the incidence and clinical characteristics of symptomatic pneumothorax in the full-term neonate. Materials and Methods: We retrospectively reviewed the medical records of 32 symptomatic pneumothorax patients in the full term neonates who admitted to the neonatal intensive care unit in Ulsan Dong Kang General Hospital from January, 2000 to December, 2004. The subjects were divided into two groups according to underlying causes; spontaneous pneumothorax group and secondary pneumothorax group, then each clinical characteristics were assessed. Results: Spontaneous pneumothorax patients were 10(31%) and secondary pneumothorax patients were 22(69%). Overall incidence of spontaneous pneumothorax was 0.4%. Most common cause of secondary pneumothorax was pneumonia. Twelve cases(54.5%) among secondary pneumothorax patients were associated with mechanical ventilator care. Clinical characteristics, courses and managements were similar between two groups, but more shorter duration of admission and chest-tube insertion in spontaneous pneumothorax group Conclusion: The patient with symptomatic pneumothorax needs careful observation and proper management with or without underlying respiratory diseases.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.276-279
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• 2018

Klinefelter syndrome a genetic disorder with various clinical manifestations. Neurological symptoms, such as seizures, are rarely reported with Klinefelter syndrome, and it response well to anti-epileptic drugs. A 5-month-old boy visited the Inha university hospital due to jerking movements and hiccups. The patient had been diagnosed with Klinefelter syndrome at birth and had a medical history of admission to the neonatal intensive care unit due to opisthotonus and ocular deviation at 26 days of age. The patient's serum testosterone level was decreased and his anti-$M{\ddot{u}}llerian$ hormone level was increased. The brain image examination was normal and the electoencephalography and other blood test results showed no specific findings. However, after admission, the patient recurred generalized tonic-clonic-seizures recurred intermittently even after the administration of antiepileptic drugs. This paper reports a case of non-febrile seizures in a child with Klinefelter syndrome who presented with a refractory course.

• Journal of Nutrition and Health
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• v.55 no.5
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• pp.572-586
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• 2022

Purpose: This study examined the factors that may affect the growth status of preterm infants. Methods: This study included 91 preterm infants born at <37 weeks of gestation (22.9-36.9 weeks of gestation), including 48 (52.7%) males and 43 (47.3%) females. Diet-related data were collected through parental questionnaires, and growth-related data, such as height and weight, were collected through the hospital medical records. Results: No significant difference in weight and growth was observed between early and late preterm infants. On the other hand, smaller averages of all weight z-score (recent weight at 40 weeks of gestation) included lower birth weight, height, and head circumference. On the other hand, infants' birth weight, height, and head circumference in the weight z-score of <0 (<50% in the age-weight growth chart) was smaller than those in the weight z-score of ≥0. Furthermore, neonatal intensive care unit (NICU) hospitalization period and NICU discharge were shorter with growth cessation age in weight z-score of <0. The weight growth velocity was associated with gestational age, birth weight, and medical treatment in the NICU. Thus, parents of preterm infants with low growth rates prefer more community care services for their children. Conclusion: Birth weight, age of preterm infants, and medical treatment in the NICU were factors related to early birth weight growth. Following NICU discharge, poor intake and intake issues were associated with poor growth after 40 weeks of gestation. Therefore, monitoring the growth of preterm infants requires continuous active involvement and supports for growth-promoting factors after NICU discharge.