• Neonatal Medicine
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• v.25 no.1
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• pp.16-22
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• 2018

Purpose: This study investigated predictive factors for severe neonatal thrombocytopenia, which greatly increases the need for intensive care and is associated with a high mortality rate in premature infants. Factors adopted for prompt identification of at-risk newborns include blood test results and birth history. This study analyzed the relationship between the presence of severe neonatal thrombocytopenia and the mortality rate. The causes of thrombocytopenia in premature infants were also examined. Methods: This retrospective study evaluated 625 premature infants admitted to the neonatal intensive care unit (NICU) at Chung-Ang University Medical Center. The neonates were classified into 3 groups according to the severity of thrombocytopenia: mild ($100{\times}10^9/L{\leq}platelet<150{\times}10^9/L$), moderate ($50{\times}10^9/L{\leq}platelet<100{\times}10^9/L$), or severe (platelet<$50{\times}10^9/L$). Analysis of blood samples obtained at the onset of thrombocytopenia included platelet count, white blood cell (WBC) count, hemoglobin level, hematocrit level, absolute neutrophil count, and high-sensitivity C-reactive protein level. Results: Of the 625 premature infants admitted to our NICU, 214 were detected with thrombocytopenia. The mortality rate in thrombocytopenic neonates was 18.2% (39/214), whereas a mortality rate of only 1.0% was observed in non-thrombocytopenic neonates. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants. Severe thrombocytopenia was noted more frequently in premature infants with higher WBC counts and in those with a younger gestational age. Conclusion: Platelet count, WBC count, and gestational age are reliable predictors for severe neonatal thrombocytopenia. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants.

• Neonatal Medicine
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• v.25 no.3
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• pp.118-125
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• 2018

Purpose: The pre-pregnancy body mass index (BMI) is associated with adverse neonatal outcomes. However, studies on very low birth weight (VLBW) infants are rare. This study aimed to investigate the effect of maternal pre-pregnancy BMI on VLBW infants. Methods: This retrospective study evaluated singleton VLBW infants born at the CHA Gangnam Medical Center from 2006 to 2016. The neonates were classified into three groups according to the maternal pre-pregnancy BMI: underweight (<$18.5kg/m^2$), normal weight (${\geq}18.5$ to <$23kg/m^2$), and overweight or obese (${\geq}23kg/m^2$). Clinical characteristics and morbidities of mothers and infants were analyzed. Results: A total of 181 infants belonging to underweight (16.6%), normal weight (58.6%), and overweight or obese (24.8%) groups were enrolled. The pre-pregnancy BMI had a significant negative correlation with gestational age (r=-0.198, P=0.001) and a significant positive correlation with the z-score of the birth weight (r=0.078, P=0.001) and body length (r=0.067, P=0.008). The number of extremely preterm infants was significantly higher in the overweight or obese group. The proportion of risk of small for gestational age infants was higher in the underweight group (adjusted odds ratio [OR], 2.958; 95% confidence interval [CI], 1.113 to 7.864), whereas that of infants with severe retinopathy of prematurity was higher in the overweight or obese group (adjusted OR, 9.546; 95% CI, 1.230 to 74.109). Conclusion: In our population of VLBW infants, the pre-pregnancy BMI was associated with gestational age, intrauterine growth, and adverse neonatal outcomes. Therefore, proper weight control before pregnancy is important.

• Journal of Korean Academy of Nursing
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• v.17 no.1
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• pp.52-63
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• 1987

Il-primigravidas who visited antenatal clinic and their husbands were taught lamaze childbirth education by the investigator in the third trimester of pregnancy. Lamaze childbirth educational course consisted of six weekly class totaling twelve hours of instruction. A questionnaire was adminstered to subjects for the evaluation of Lamaze educational Program. 21-questions were rated on a Likert-type scale containing five responses and subjects described the advantages, the disadvantage, and the difficulties of lamaze childbirth education course. The results of the study were as follows; 1. The core contents of lamaze childbirth educational Program were Process of labor, anatomy and physiology of the female body, the care of newborn, maternal-infant attachment, breathing patterns to be used at the appropriate stage of labor, techniques for conscious relaxation of muscles during labor and delivery, and exercise to limber and prepare the body for the work of labor and delivery. All couples understood the above core contents very well and there were not significant differences between the understanding scores of wives and those of husbands (p>0.05). 2. 81.8% of couples Practiced breathing pattern to be used at the appropriate stages of labor one or three times a day and 72.7% of couples practiced conscious relaxation of muscles one or three times a day. 3. The contents of Lamaze childbirth educational program were easy for the couples to understand, and the total length, the amounts and the structures of 6-classes were appropriate. 4. Lamaze childbirth educational program was very useful, necessary, interesting, and successful to achieve the couples' objectives. 5. The couples expressed that they had positive attitude and high self-esteem, and reduced their anxiety on the pregnancy and labor.

• Clinical and Experimental Pediatrics
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• v.60 no.1
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• pp.10-16
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• 2017

Purpose: Although procalcitonin (PCT) level is useful for the diagnosis of neonatal sepsis, PCT reliability is inconsistent because of the varied conditions encountered in neonatal intensive care units. This study aimed to investigate PCT levels and factors influencing increased PCT levelin newborns without bacterial infection during the first week of life. Methods: In newborns hospitalized between March 2013 and October 2015, PCT levels were measured on the first, third, and seventh days after birth. Newborns with proven bacterial (blood culture positive for bacteria) or suspicious infection (presence of C-reactive protein expression or leukocytosis/leukopenia) were excluded. Various neonatal conditions were analyzed to identify the factors influencing increased PCT level. Results: Among 292 newborns with a gestational age of $35.2{\pm}3.0$ weeks and a birth weight of $2,428{\pm}643g$, preterm newborns (n=212) had higher PCT levels than term newborns (n=80). Of the newborns, 7.9% had increased PCT level (23 of 292) on the firstday; 28.3% (81 of 286), on the third day; and 3.3% (7 of 121), on the seventh day after birth. The increased PCT level was significantly associated with prenatal disuse of antibiotics (P=0.004) and surfactant administration (P<0.001) on the first day after birth, postnatal use of antibiotics (P=0.001) and ventilator application (P=0.001) on the third day after birth, and very low birth weight (P=0.042) on the seventh day after birth. Conclusion: In newborns without bacterial infection, increased PCT level was significantly associated with lower gestational age and respiratory difficulty during the first week of life. Further studies are needed for clinical applications.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.557-560
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• 2005

Congenital laryngeal atresia is a rare cause of airway obstruction that is almost always lethal within a few minutes after birth. Therefore congenital laryngeal atresia should be diagnosed in the prenatal period. If not, it should be considered in newborn infant with life-threatening symptoms at birth such as cyanosis and dyspnea that need emergent procedures like a tracheotomy. We report a case of congenital laryngeal atresia with single umbilical artery diagnosed in a one-day-old neonate who required a tracheotomy and ventilator care after intubation failure.

• Clinical and Experimental Pediatrics
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• v.56 no.3
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• pp.139-142
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• 2013

X-linked recessive myotubular myopathy (XLMTM) is a severe congenital muscle disorder caused by mutations in the MTM1 gene and characterized by severe hypotonia and generalized muscle weakness in affected males. It is generally a fatal disorder during the neonatal period and early infancy. The diagnosis is based on typical histopathological findings on muscle biopsy, combined with suggestive clinical features. We experienced a case of a newborn who required intubation and ventilator care because of profound hypotonia and respiratory difficulty. The preliminary diagnosis at the time of request for retrieval was hypoxic ischemic encephalopathy, but the infant was clinically reevaluated for generalized weakness and muscle atrophy. Muscle biopsies showed variability in fiber size and centrally located nuclei in nearly all the fibers. We detected an MTM1 gene mutation of c.1261-1C>A in the intron 10 region, and diagnosed the neonate with myotubular myopathy. The same mutation was detected in his mother.

• Journal of Microbiology and Biotechnology
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• v.30 no.7
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• pp.1067-1071
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• 2020

To understand the formation of initial gut microbiota, three initial fecal samples were collected from two groups of two breast milk-fed (BM1) and seven formula milk-fed (FM1) infants, and the compositional changes in gut microbiota were determined using metagenomics. Compositional change analysis during week one showed that Bifidobacterium increased from the first to the third fecal samples in the BM1 group (1.3% to 35.1%), while Klebsiella and Serratia were detected in the third fecal sample of the FM1 group (4.4% and 34.2%, respectively), suggesting the beneficial effect of breast milk intake. To further understand the compositional changes during progression from infancy to childhood (i.e., from three weeks to five years of age), additional fecal samples were collected from four groups of two breast milk-fed infants (BM2), one formula milk-fed toddler (FM2), three weaning food-fed toddlers (WF), and three solid food-fed children (SF). Subsequent compositional change analysis and principal coordinates analysis (PCoA) revealed that the composition of the gut microbiota changed from an infant-like composition to an adult-like one in conjunction with dietary changes. Interestingly, overall gut microbiota composition analyses during the period of progression from infancy to childhood suggested increasing complexity of gut microbiota as well as emergence of a new species of bacteria capable of digesting complex carbohydrates in WF and SF groups, substantiating that diet type is a key factor in determining the composition of gut microbiota. Consequently, this study may be useful as a guide to understanding the development of initial gut microbiota based on diet.

• Clinical and Experimental Pediatrics
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• v.59 no.1
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• pp.30-34
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• 2016

Purpose: Although Bednar's aphthae are common and regress spontaneously, these lesions may lead to feeding intolerance and are often misdiagnosed, rendering examinations useless. This study sheds new light on the clinical features of Bednar's aphthae. Methods: Sixteen neonates and infants were newly diagnosed with Bednar's aphthae via routine health check-ups in an outpatient clinic. Medical records were retrospectively reviewed, and the following parameters were analyzed; sex, gestational age, birth weight, mode of delivery, and perinatal problems. A physical examination was carried out during the next outpatient visit to examine the healing process and check for the existence of scars or complications. Results: Initial presentation included changes in feeding habits (n=10), longer feeding time, reduced intake, and increased irritability. In 6 patients, Bednar's aphthae were discovered incidentally, without prior symptoms. Feeding posture and method of feeding are important causes of Bednar's aphthae. Eleven patients were fed in a horizontal position, whereas 5 patients were fed in a semiseated position. Fifteen patients were bottle-fed, whereas 1 patient was exclusively breastfed. After correcting the feeding position, the ulcerative lesions disappeared within 1 month of diagnosis. During the follow-up period, lesions did not recur in any of the patients. Conclusion: This study suggests that Bednar's aphthae are caused by mechanical pressure. A diagnosis of Bednar's aphthae should be considered when lesions are found on the palate of infants and when symptoms seem to be feeding related. Proper education of parents can both treat Bednar's aphthae and easily prevent its recurrence.

• Perspectives in Nursing Science
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• v.17 no.2
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• pp.90-98
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• 2020

Purpose: This study examined the effects of breastfeeding education among preterm mothers. Methods: A nonequivalent control group, repeated measure, quasi-experimental study design was used. The participants comprised 46 preterm mothers recruited from the neonatal intensive care unit of a university hospital who were divided into two groups: 23 in the control group and 22 in the experimental group. The breastfeeding education program intervention to promote preterm mothers' self-efficacy used was devised based on the self-efficacy theory. The intervention program consisted of individual breastfeeding education with demonstrations and discharge education, and telephone follow-up education within one week after being discharged. The participants were surveyed before and after the intervention, and four weeks after being discharged from the newborn intensive care unit. Results: The intervention group showed a significant increase in breastfeeding self-efficacy compared with the control group (F=6.92, p=.003) and showed a significant increase in their breastfeeding attitude score (F=3.49, p=.039). Four weeks after discharge, the breastmilk volume of the intervention group increased significantly (t=-2.87, p=.006), and the same group continued to breastfeed more compared with the control group (χ²=4.50, p=.049). Conclusion: This study suggests that the preterm breastfeeding program had a positive effect on breastfeeding self-efficacy, breastfeeding attitude, and extending the breastfeeding period among preterm mothers.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.26-31
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• 2000

Background: This study was aimed at analyzing the preoperative conditions post-operative results indication and methods of surgical closure of patent ducturs arterio년 in prematures low birth weight infants and neonates. Patients and Methods: We retro-spectively studied two groups of patients (prematures group and neonates group) who underwent surgical closure of the patent ductus arteriosus between March 1995 and June 1998. Results: The premature group consisted of 9 patients(3 males and 6 females) Their mean gestational period was 30.7 weeks(ranging from 26 weeks to 33 weeks) mean age 27.8 days(11 days to 55 days) and mean body weight 1.56 kg. Prominent preoperative symptoms were dependency on mechanical ventilation generalized edema and hepatomegaly. We performed PDA ligation via thoracotomy in all premature patients. The neonate group consisted of 16 patients and their mean body weight was 3.75 kg. Major symptoms of this group was tachypnea and intercostal retraction resistant to medical treatment. We performed video-assisted PDA clipping to them all. There were no postoperative complications or operation-related mortality in both groups. Comparing the ratio of size of PDA(mm)/body weight(kg) the ratio of premature group (ligation through thoracotomy) was higher than that of neonate group ( video-assisted clipping) that is 3,89:1.21(p=0.03) Conclusion : We conclude that the surgical closure of PDA can be a safe method of treatment for prematures low birth weight infants and neonates with compromised general conditions. Choice of surgical technique depends on the surgeon's preference but there was a tend-ency to choose the ligation method through thoracotomy for patients with small body weight and large PDA.