• Clinical and Experimental Pediatrics
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• 제58권6호
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• pp.224-229
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• 2015

Purpose: Thyroid dysfunction is common in preterm infants. Congenital hypothyroidism causes neurodevelopmental impairment, which is preventable if properly treated. This study was conducted to describe the characteristics of thyroid dysfunction in very low birth weight infants (VLBWIs), evaluate risk factors of hypothyroidism, and suggest the reassessment of thyroid function with an initially normal thyroid-stimulating hormone (TSH) as part of a newborn screening test. Methods: VLBWIs (January 2010 to December 2012) were divided into two groups according to dysfunction-specific thyroid hormone replacement therapy, and associated factors were evaluated. Results: Of VLBWIs, 246 survivors were enrolled. Only 12.2% (30/246) of enrolled subjects exhibited thyroid dysfunction requiring thyroid hormone replacement. Moreover, only one out of 30 subjects who required thyroid hormone treatment had abnormal thyroid function in the newborn screening test with measured TSH. Most of the subjects in the treatment group (22/30) exhibited delayed TSH elevation. Gestational age, Apgar score, antenatal steroids therapy, respiratory distress syndrome, patent ductus arteriosus, sepsis, intraventricular hemorrhage, postnatal steroids therapy, and duration of mechanical ventilation did not differ between the two groups. Birth weight was smaller and infants with small for gestational age were more frequent in the treatment group. Conclusion: Physicians should not rule out suggested hypothyroidism, even when thyroid function of a newborn screening test is normal. We suggest retesting TSH and free thyroxine in high risk preterm infants with an initially normal TSH level using a newborn screening test.

• Journal of Chest Surgery
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• 제48권6호
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• pp.411-414
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• 2015

Interrupted aortic arch with an aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality, especially in premature low-birth-weight infants, and the proper timing of surgical correction remains a matter of debate. We present the case of a premature infant weighing 1.6 kg who successfully underwent one stage surgical repair to treat interrupted aortic arch with an aortopulmonary window. The therapeutic management of this patient is described below, and a review of the literature is presented.

• Neonatal Medicine
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• 제25권1호
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• pp.1-6
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• 2018

Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure--the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.

• Child Health Nursing Research
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• 제9권1호
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• pp.96-106
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• 2003

Advances in neonatal care system and research have resulted in an increased survival rate among low birth weight infants in the industrialized countries. Recent Korean neonatal mortality and morbidity statistics, and current status of Korean neonatal intensive care facilities were reviewed here for the sake of future improvement and research. Morbidity statistics revealed that perinatal diseases accounted for 80％ of the death of premature infants implying the possibility of its reduction by the vigorous prenatal care service in future.On the basis of extensive studies of nutritional support and growth rate of premature infants, commercial formulas for premature infants have been developed and various aspects of feeding techniques are standardized. However, problem of growth deficit of premature infants remains unsolved as medical problem. NICU specialists are challenged with the tasks of prenatal education or provision of care that minimizes the neurodevelopmental problems seen in preterm infants, various short-term outcome researches have been reported and those are reviewed here to promote research interest in the field of neonatal nursing. Systemic long-term outcome studies are also awaited in Korea for the formulation of welfare policy in future. Nursing science has to embrace all these interdisciplinary studies as their own research field in collaboration with neonatologist, nutritionist, rehabilitation therapist, social workers and teachers.

• Child Health Nursing Research
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• 제7권2호
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• pp.236-244
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• 2001

We studied the effects of nonnutritive sucking(NNS) on lingual lipase activity and body weight under bottle feeding with 17 premature infants hospitalized. NNS was applied to nine infants and other eight infants comprised the control group. Pacifiers were applied to the experimental group for 5 minutes before and after bottle feeding. The treatment took approximately 20-25 minutes each time including bottle feeding time and was applied 7 times a day at intervals of 3 hours and for consecutive ten days. Lingual lipase activity and body weight were measured on the first, third, seventh and tenth day. Results and Conclusion : 1. Lingual lipase activity was low at 30 minutes after feeding and then began to increase reaching its highest level at 120 and 180 minutes after the feeding in both group. 2. Lingual lipase activity in the experimental group was not higher than that of the control group on the third, seventh and tenth day. 3. Body weight increased in experimental and control groups as days passed, while it was not significantly different between groups. These results lead to conclusion that among premature infants under bottle feeding, NNS is not effective in increasing the lingual lipase for fat digestion and NNS is not also effective for increasing body weight. The application of NNS to premature infants under bottle feeding needs considerable judgement for promoting well-being of nursing goals.

• Clinical and Experimental Pediatrics
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• 제51권7호
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• pp.704-712
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• 2008

목 적 : 최근 모유수유의 장점이 부각되고 있으나 모유가 미숙아 전용분유에 비해 열량을 포함한 영양소들이 미숙아들의 적절한 성장을 유도하기에는 낮아 이를 극복하기 위한 모유강화제가 개발되었다. 본원에서는 극소저체중출생아들을 대상으로 모유강화제를 첨가한 모유를 수유한 경우와 미숙아 전용분유를 수유한 경우를 비교하여 성장에 어떠한 효과를 미치는지 알아보기로 했다. 방 법 : 2005년 10월부터 2006년 12월까지 동아대학교의료원에서 출생하여 신생아 집중치료실에 입원한 출생체중 1,500 g 이하, 재태주령 33주 미만인 극소저체중출생아들을 대상으로 강화된 모유수유군과 미숙아 전용분유 수유군으로 나누어 전반적인 특징, 영양상태, 성장 추이 및 합병증의 발생 등을 전향적으로 비교 조사하였다. 대상 환자들 중 본원에서 추적관찰이 가능했던 환자들의 경우 외래에서 1, 3, 6개월에 걸쳐 체중, 신장, 두위를 측정하여 비교하였다. 결 과 : 두 군의 평균 재태주령 및 출생체중은 각각 $30^{+1}{\pm}2^{+1}$주과 $29^{+4}{\pm}2^{+1}$주, $1,281.30{\pm}178g$과 $1,234.32{\pm}193g$으로 통계학적으로 차이가 없었으며(P=0.26, P=0.38), 성비, 괴사성 대장염, 패혈증, 신생아호흡곤란증후군, 동맥관개존증, 뇌 내출혈 및 뇌실 내 출혈 등의 합병증의 비율, 평균 재원 기간에서도 유의한 차이는 없었다. 수유 시작 시기는 강화된 모유수유군과 미숙아 전용분유 수유군에서 각각 생후 $8.00{\pm}3.27$일 및 $8.86{\pm}5.37$일(P=0.99), 완전수유 도달 시기는 각각 수유시작 후 $41.78{\pm}20.47$일 및 $36.86{\pm}20.63$일로(P=0.55) 통계적으로 유의한 차이가 없었으며, 총정맥영양 기간 및 수유 곤란증상 횟수에도 유의한 차이는 없었다. 수유시작 시점부터의 체중, 신장, 두위의 성장 속도 및 절대치도 두 군 간에 유의한 차이가 없었으나 각 시점의 평균치를 비교하였을 때 수유 시작 후 7주째 체중은 강화된 모유수유군에서 더 빨리 증가하였다(P=0.03). 환자들의 초기 체중 감소 후 출생체중까지 회복되는데 걸리는 기간도 각각 $22.3{\pm}6.92$일 및 $24.32{\pm}10.68$일로 통계학적 차이는 없었으며(P=0.41), 체중 회복 후부터 퇴원까지의 체중 및 두위, 신장의 증가속도는 두 군에서 유의한 차이는 없었다. 퇴원 후 외래 추적 관찰을 한 각 군의 환자들의 체중, 신장, 두위의 평균치에도 유의한 차이는 없었다. 결 론 : 극소저체중출생아에서 모유강화제를 포함한 모유수유군과 미숙아 전용분유 수유군 간의 전반적인 성장 상태, 생화학적 검사 수치 및 합병증 발생에는 유의한 차이가 없어 모유 강화제는 고열량 수유를 필요로 하는 극소저체중출생아에서 부가적인 선택 사항이라고 하겠다.

• Clinical and Experimental Pediatrics
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• 제56권3호
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• pp.112-115
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• 2013

Purpose: To investigate the association between necrotizing enterocolitis (NEC) and red blood cell transfusions in very low birth weight (VLBW) preterm infants. Methods: We studied were 180 VLBW preterm infants who were admitted to the neonatal intensive care unit of CHA Gangnam Hospital from January of 2006 to December of 2009. The subjects were divided into 2 groups: an NEC group (greater than stage II on the modified Bell's criteria) and a control group (less than stage II on the modified Bell's critieria). We defined red blood cell transfusion before NEC diagnosis as the frequency of transfusion until NEC diagnosis (mean day at NEC diagnosis, day 18) in the NEC group and the frequency of transfusion until 18 days after birth in the control group. Results: Of the 180 subjects, 18 (10%) belonged to the NEC group, and 14 (78%) of these 18 patients had a history of transfusion before NEC diagnosis. The NEC group received $3.1{\pm}2.9$ transfusions, and the control group received $1.0{\pm}1.1$ transfusions before the NEC diagnosis (P=0.005). In a multivariate logistic regression corrected for gestational age, Apgar score at 1 minute, the presence of respiratory distress syndrome, patent ductus arteriosus, premature rupture of membrane, disseminated intravascular coagulopathy and death were confounding factors. The risk of NEC increased 1.63 times (95% confidence interval, 1.145 to 2.305; P=0.007) with transfusion before the NEC diagnosis. Conclusion: The risk for NEC increased significantly with increased transfusion frequency before the NEC diagnosis.

• Parasites, Hosts and Diseases
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• 제52권6호
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• pp.639-644
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• 2014

Congenital malaria is assumed to be a risk factor for infant morbidity and mortality in endemic areas like Maumere, Indonesia. Infected infants are susceptible to its impact such as premature labor, low birth weight, anemia, and other unspecified symptoms. The aim of this study was to investigate the prevalence of congenital malaria and the influence of mother-infant paired parasite densities on the clinical outcome of the newborns at TC Hillers Hospital, Maumere. An analytical cross sectional study was carried out in newborns which showed criteria associated with congenital malaria. A thick and thin blood smear confirmed by nested PCR was performed in both mothers and infants. The association of congenital malaria with the newborn's health status was then assessed. From 112 mother-infant pairs included in this study, 92 were evaluated further. Thirty-nine infants (42.4%) were found to be infected and half of them were asymptomatic. Infected newborns had a 4.7 times higher risk in developing anemia compared to uninfected newborns (95% CI, 1.3-17.1). The hemoglobin level, erythrocyte amount, and hematocrit level were affected by the infants' parasite densities (P<0.05). Focusing on newborns at risk of congenital malaria, the prevalence is almost 3 times higher than in an unselected collective. Low birth weight, anemia, and pre-term birth were the most common features. Anemia seems to be significantly influenced by infant parasite densities but not by maternal parasitemia.

• Clinical and Experimental Pediatrics
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• 제63권8호
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• pp.284-290
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• 2020

Korea currently has the world's lowest birth rate but a rapidly inreasing number of preterm infants. The Korean Neonatal Network (KNN), launched by the Korean Society of Neonatology under the support of Korea Centers for Disease Control, has collected population-based data for very low birth weight infants (VLBWIs) born in Korea since 2013. In terms of the short-term outcomes of VLBWIs born from 2013 to 2016 registered in the KNN, the survival rate of all VLBWIs was 86%. Respiratory distress syndrome and bronchopulmonary dysplasia were observed in 78% and 30% of all VLBWIs, respectively. Necrotizing enterocolitis occurred in 7%, while 8% of the VLBWIs needed therapy for retinopathy of prematurity in the neonatal intensive care unit (NICU). Sepsis occurred in 21% during their NICU stay. Intraventricular hemorrhage (grade ≥III) was diagnosed in 10%. In terms of the long-term outcomes for VLBWIs born from 2013 to 2014 registered in the KNN, the post-discharge mortality rate was approximately 1.2%-1.5%, mainly owing to their underlying illness. Nearly half of the VLBWIs were readmitted to the hospital at least once in their first 1-2 years of life, mostly as a result of respiratory diseases. The overall prevalence of cerebral palsy was 6.2%-6.6% in Korea. Bilateral blindness was reported in 0.2%-0.3% of VLBWIs, while bilateral hearing loss was found in 0.8%-1.9%. Since its establishment, the KNN has published annual reports and papers that facilitate the improvement of VLBWI outcome and the formulation of essential healthcare policies in Korea.

• Journal of Nutrition and Health
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• 제55권5호
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• pp.572-586
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• 2022

본 연구는 미숙아의 체중을 추적 조사하여 성장곡선 체중 z-score 값으로 성장 상태를 확인하고 관련 요인을 탐색하기 위한 종단적 연구이다. 출생 체중, 재태연령, 출생 시 NICU에서의 의료적 처치 (CPR, 산소치료, 위장관 삽관), NICU 입원 기간 및 퇴원연령, 수유 문제, 일일 추정 수유량이 체중 성장에 유의하게 영향을 가지는 것이 확인되었다. 출생 체중과 연령이 적은 그룹이 유의하게 초기 성장 정도가 더 낮았으나 교정연령 3개월 이후부터 12개월까지의 체중에 차이가 없었다. 하지만 재태연령 40주 이후의 연령-체중 z-score가 평균 이하인 그룹이 출생 체중이 유의하게 낮은 것으로 보아 장기적인 성장에 출생체중이 영향을 미치는 것으로 보인다. 또한 NICU에서 의료적 처치를 받고 NICU 입원 기간이 긴 경우 성장곡선의 50 백분율 이하로 성장에 유의한 차이가 있었고, 퇴원 후 2개월간 수유과정 중 문제가 없으며 더 많은 양을 섭취한 그룹이 성장곡선에서 더 상위에 있었으며 더 잘 자랐다. 또한 NICU 퇴원 후 가정에서 자녀가 초기보다 하향 성장을 하고 있을 때, 외부의 도움 및 커뮤니티 케어를 필요로 하므로 미숙아 성장 지원을 위하여 커뮤니티 케어 도입의 필요성을 시사하였다. 본 연구 결과를 통하여 미숙아의 출생 체중 및 연령, NICU에서의 처치는 초기의 체중 성장에 영향을 끼치며, 재태연령 40주 이후의 성장 증진과 성장지연 위험을 감소시키기 위해서 올바른 섭취를 통한 원활한 영양공급이 중요함을 알 수 있다. 미숙아 성장 추적은 NICU 퇴원 후에도 지속되어야 하며 성장 증진 관련 변수, 특히 영양 지원에 적극적인 개입과 지지가 필요하다.