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Patient Distribution and Hospital Admission Costs in Neonatal Intensive Care Units: Collective Study of 7 Hospitals in Korea during 2006 (2006년도 전국 7개 병원 신생아중환자실 입원 현황 및 입원비용 분석)

  • Bae, Chong-Woo;Kim, Ki-Soo;Kim, Byeong-Il;Shin, Son-Moon;Lee, Sang-Lak;Lim, Baek-Keun;Choi, Young-Youn
    • Neonatal Medicine
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    • v.16 no.1
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    • pp.25-35
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    • 2009
  • Purpose: The characteristics of hospitalized patients in neonatal intensive care units (NICUs), including hospitalization costs (HC) and National Health Insurance (NHI) status were studied. Methods: We gathered the following data from 7 hospitals in Korea during 2006: the distribution of patients according to birth weight (BW), and the duration of the hospital stay according to BW and He. Results: The patients who were admitted to the NICU consisted of high-risk neonates, including low birth weight or premature neonates, which comprised 50% of all neonates admitted to the NICU. The duration of hospitalization was 75-90 days for neonates with BW <1,000 g, 45-60 days for neonates with BW between 1,000 and 1,499 g, and approximately 15 days for neonates with BW between 2,000 and 2,499 g. The portion of the HC covered by the NHI was 77.1%, 22.9% of the total HC was not covered by the NHI (19.5% was included in the list, but not covered by the NHI and 3.4% was not listed, but covered by the NHI). The average total HC per person was 4,360,000 won, and the HC covered and not covered by the NHI were 3,677,000 won and 1,007,000 won, respectively. The mean HC were as follows; 35,000,000 won for a BW <500 g, 18,000,000 won for a BW between 500 and 999 g, 16,000,000 won for a BW between 1,000 and 1,499 g, and 4,200,000 won for a BW between 1,500 and 1,999 g. Conclusion: Not only premature, but also ill neonates were under the care of the NICU. The HC increased as the BW decreased and the hospitalization period increased. The proportion of the patient's financial burden is >25% of the total He. For this matter, additional NHI is needed.

A Comparison of Video-assisted Thoracic Surgery with Mid-axillary Thora- colomy in the Treatment of Spontaneous Pneumothorax Video-assisted Thoracic Surgery in the Treatment of Spontaneous Pneumothorax- (원발성 자연기흉의 폐기포 절제시 비디오 흉강경수술과 정중액와 개흘술의 비교 -폐기포 절제시 비디 오흉강경수술-)

  • 오성철;김대식
    • Journal of Chest Surgery
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    • v.29 no.7
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    • pp.728-733
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    • 1996
  • Since thoracoscopy was originally described by Jacobaeus in 1922, video-assisted thoracic surgery has been used to treat many thoracic diseases. From June 1994 to July 1995, 35 patients with spontaneous pneumothorax'underwent video-assisted thoracic sugery as experimental group, and same number of patien:s with blob resection through mid-axillary thoracotomy as co trol group in our hospital.'The authors compared the clinical results between each group. 1. The sex distributions were 28 males, 7 females in experimental group and 30 males, 5 females in control group. The mean age of experimental group was 28.5 $\pm$ 12.6 years of age and that of control group was 2).9 $\pm$ 6.3 years of age. 2. The operative times were 98.8$\pm$ )9.3 minutes in experimental group and 103.6$\pm$ )2.6 minutes in control group. ). The duration of chest tube indwelling at postoperative period was 2.60 $\pm$ 0.98 days in experimental group, 4.80 $\pm$ 2.08 days in control group (P< 0.01). The periods of postoperative hospitalization were 17 $\pm$ 1.22 days in experimental group and 6.69 $\pm$2.52 days in control group. The durations of post-oper- ative chest tube indwelling and hospital stay in experimental group were shorter than in control group (P< 0.01 respectively). 4. The injection of analgesics at postoperative period was less in experimental group than control group. At the operative day and postoperative 1 st and 2nd day, the number of injections were respectively 1. 57$\pm$0.74, 1.97 $\pm$0.70 and 1.00$\pm$0.68 times/person in experimental group, 2.23 $\pm$0.60, 2.60 $\pm$0.67 and 2. 17$\pm$0.76 times/person in control group(P<0.01 respectively). The mean duration and dose of postoperative analgesic injection were 2.48$\pm$ 1.01 days/person and 4.88 $\pm$3.70 ampules/person in experimetal group, 3.70$\pm$ 1.40 days/person and 8.94 $\pm$4.21 ampules/person respectively (P< 0.01, p<0. 01).

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Clinical Characteristics and Prognosis of Neonatal Seizures (신생아 경련의 임상적 양상 및 예후에 관한 고찰)

  • Kim, Chang Wu;Jang, Chang Hwan;Kim, Heng Mi;Choe, Byung Ho;Kwon, Soon Hak
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1253-1259
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    • 2003
  • Backgroud : Seizures in the neonate are relatively common and their clinical features are different from those in children and adults. The study aimed to provide the clinical profiles of neonatal seizure in our hospital. Methods : A total of 41 newborns with seizures were enrolled in this study over a period of three years. They were evaluated with special reference to risk factors, neurologic examinations, laboratory data, neuroimaging studies, EEG findings, seizure types, response to treatment, and prognosis, etc. Results : The average age at onset of seizures was $6.1{\pm}4.6days$ and the majority of patients(42%) had multifocal clonic seizure and 24% had subtle seizure. Factors that are known to increase risk of neonatal seizures include abnormal delivery history, birth asphyxia, and electrolyte imbalance, etc. However, they remain obscure in about 20% of cases. More than 50 percent showed abnormal lesions on neuroimaging studies such as brain hemorrhage, periventricular leukomalacia, brain infarction, cortical dysplasia, hydrocephalus, etc. and 17 out of 32 patients showed abnormal electroencephalographic patterns. Phenobarbital was tried as a first line antiepileptic drug and phenytoin was added if it failed to control seizures. The treatments were terminated in the majority of patients during the hospital stay. The overall prognosis was relatively good except for those with abnormal EEG background or congenital central nervous system malformations. Conclusion : Neonatal seizures may permanently disrupt brain development. Better understanding of their clinical profiles and appropriate management may lead to a reduction in neurological disability in later childhood.

Clinical review of Typhoid Fever Patients (장티브스에 관한 임상적 관찰)

  • 최정신
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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Underlying Etiologic Factor of Recurrent Pneumothorax after Bullectomy (원발성 기흉환자에서 재수술의 원인)

  • 윤용한;이두연;김해균;홍윤주
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.556-560
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    • 1999
  • Background: The cause of spontaneous pneumothorax is not yet but it is certain that intrathoracic air comes from ruptured bulla. Video-assisted thoracoscopic surgery(VATS) or open thoracotomy is recommended for thoracic incision in recurrent pneumothorax. However, recurrent rate after bullectomy with the VATS is very high compared to mini-thoracotomy, 3% to 20% and below 2%, respectively. Material and Method: This retrospective analysis was performed on 16 re-operated cases among 446 surgically treated pneumothorax of the 737 cases of spontaneous pneumothorax diagnosed at Yongdong Severance Hospital from Nov. 1992 to June 1997. Result: Among the 446 surgically-treated patients in 737 case of spontaneous pneumothorax, 16 patients underwent re-operation, showing a 3.5% re-operation rate. Male-to-female ratio was 15 to 1 and mean age at initial attack was 20.2 years(ranging from 15 to 50). Mean hospital stay was 6.34 days(ranging from 2 to 20 days) and mean chest tube indwelling period was 4.2 days(ranging from 1-10 days). Median follow-up was 46 months(range 10-66 months). Three different surgical methods were applied : video-assisted thoracoscopic surgery(VAST) in 281 cases, of whom 2 underwent local anesthesia; subaxillary mini-thoracotomy in 159 cases and limited lateral thoracotomy in the remaining 6 cases. Three different re-operative surgical methods were applied ; video-assisted thoracoscopic surgery (VAST) in 6 cases, subaxillary mini-thoracotomy in 9 cases, and limited lateral thoracotomy in the remaining 1 case. The underlying etiological factors of the recurrent pneumothorax after bullectomy were o erlooking type(9) and new growing type(7). Mean recurrent period from previous operation was 1 month for overlooking type and 18 months for new growing type. Conclusion: The underlying etiological factors of recurrent pneumothorax lead to re-operation were new-growing and over-looking type. We need additional treatments besides resecting blebs of prevent the recurrence rate and more gentle handling with forceps due to less damage to the pleura.

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The Significance of Prophylactic Gastrojejunostomy for Patients with Unresectable Stage IV Gastric Cancer (절제 불가능한 4기 위암에서 예방적 위 공장 우회술의 의의)

  • Kim, Hwan-Soo;Kim, Chong-Suk;Kim, Jong-Han;Mok, Young-Jae;Park, Sung-Soo;Park, Seong-Heum;Jang, You-Jin;Kim, Seung-Joo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.231-237
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    • 2009
  • Purpose: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. Materials and Methods: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. Results: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. Conclusion: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.

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Recent Trends in the Prevalence of Mycoplasma pneumoniae Pneumonia According to Age (연령에 따른 Mycoplasma pneumoniae 폐렴 발병의 최근 경향)

  • Lee, Hyo Sang;Choi, Kyong Min
    • Pediatric Infection and Vaccine
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    • v.15 no.2
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    • pp.162-166
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    • 2008
  • Purpose : It has been previously reported that for patients with Mycoplasma pneumoniae pneumonia was previously recognized that overt illness is unusual under the age of three and the peak incidence of illness occurs in school-aged children. However, a higher incidence of this illness in younger children has been recently noted. Thus we investigated the incidence of M. pneumoniae pneumonia. Methods : The study subjects were 414 children who were diagnosed with M. pneumoniae pneumonia from January 2004 to December 2006 at Myong Ji Hospital were enrolled. The diagnostic criteria consisted of an anti-mycoplasma antibody (AMA) titer greater than 1: 320 or a four-fold rise in the titer at follow up. Results : The age distribution was as follows: before 2 years of age: 58 patients (14%), 2-4 years of age 157 patients (37.9%) and 5-15 years of age 199 patients (48.1%). The yearly incidence for the children before 5 years of age was 52 (44%), 49 (44.6%) and 114 (61.3%), respectively. The distribution according to the antibody titer was as follows; 1: 320 in 130 patients, 1:640 in 63 patients and greater than 1:1,280 in 221 patients. The hospital stay according to the antibody titer was not significant according to either age or the AMA titers. Conclusion : M. pneumoniae pneumonia showed a peak incidence in preschool children with a higher prevalence in children under the age of three than was previously recognized. The emergence of M. pneumoniae pneumonia as a cause of community acquired pneumonia in younger children calls for an epidemiologic study to investigate the changes of the pathogens in this age group and to recommend the proper treatment.

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Three Cases of Menopausal Hot Flush and Sweating Treated by Ascending Kidney Water and Descending Heart Fire (AKDH) Pharmacopuncture Treatment (약침을 이용한 수화조절법으로 호전된 갱년기 상열감 및 발한과다 환자 치험 3례)

  • Jo, Na-Young;Roh, Jeong-Du
    • The Journal of Korean Obstetrics and Gynecology
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    • v.28 no.2
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    • pp.193-203
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    • 2015
  • Objectives : The purpose of this study is to evaluate the clinical effects of ascending kidney water and descending heart fire pharmacopuncture treatment for hot flush and sweating. Methods : Ascending kidney water and descending heart fire pharmacopuncture is achieved by injecting pharmacopuncture on a specific acupoint to change from the state of water-fire disharmony to harmonious state. Hwangryunhaedok-tang (黃連解毒湯) pharmacopuncture is injected on both side Gyeonjeong (GB 21 ), Pungji (GB 20 ). Total 0.4 cc was injected by 0.1 cc each point. BUM (Bear’s gall bladder, ox bezoar and musk) pharmacopuncture is injected on both side Jeonjung (CV 17 ), Jungwan (CV 12 ), Gihae (CV 6 ). Total 0.15 cc was injected by 0.05 cc each point. Treatment was done daily. The method of evaluation are Hot Flush Score (HFS), VAS and sweating areas. Results : In case 1, after treatment hot flush score was reduced from 24 to 4 points. VAS scale was reduced from 7 to 2. It took about two weeks for the symptoms to decrease by half. Associated symptoms almost did not stay at discharge. In case 2, after treatment hot flush score was reduced from 28 to 2 points. VAS scale was reduced from 10 to 3. And emotional symptoms were reduced about 70%. In case 3, after treatment hot flush score was reduced from 8 to 1 points. VAS scale was reduced from 6 to 1. And headache and chest discomfort symptoms have disappeared. Conclusions : Ascending kidney water and descending heart fire pharmacopuncture treatment is effective for improve ascending kidney water and descending heart fire energy. Therefore, it will be used to alleviate hot flush and sweating.

Initial Experience of Robotic Cardiac Surgery (수술로봇을 이용한 심장수술 첫 체험)

  • Cho Sung Woo;Chung Cheol Hyun;Kim Kyoung Sun;Choo Suk Jung;Song Hyung;Song Meong Gun;Lee Jae Won
    • Journal of Chest Surgery
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    • v.38 no.5 s.250
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    • pp.366-370
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    • 2005
  • Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.

Early postoperative arrhythmias after open heart surgery of pediatric congenital heart disease (소아 선천성 심장병 개심술 후 발생한 조기 부정맥)

  • Choi, Hee-Joung;Kim, Yeo-Hyang;Cho, Joon-Yong;Hyun, Myung-Chul;Lee, Sang-Bum;Kim, Kyu-Tae
    • Clinical and Experimental Pediatrics
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    • v.53 no.4
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    • pp.532-537
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    • 2010
  • Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.