• Journal of Chest Surgery
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• 제30권6호
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• pp.585-590
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• 1997

미숙아에 있어서 동반되는 동맥관개존증은 향후 환아의 경과에 지대한 영향을 미친다. 본 연구는 미숙아 에 있어서 동맥관 개존증으로 진단되어 치료를 받은 례를 관찰 분석하여 그 성적을 살피고 향후 동맥관개 존증의 치료 방향을 설정하고자 하였다. 1994년 12월 부터 1996년 10월까지 신생아 중환자실에 입원하여 동맥관개존증으로 진단을 받은 환자 57 명중을 대상으로 하여 임상기록지를 관찰하였다. 인도메타진 등의 내과적 치료를 받은 환자(I 군)는 48명 (남자 29명, 여자 19명) 이었으며, 수술적 교정을 받은 환아(II 군)는 9명(남자 5명, 여자 4명)이었다. 각군에서의 환아의 평균 재태기간은 각각 29.6$\pm$3.1주, 28.1$\pm$1.6주0>0.05), 평균 출생시 체중은 각각 1,413$\pm$ 580gm, 1,098$\pm$235gm(p.0.05)이였다. 모든 환아에서 일차적으로 인도메타진 치료를 하였으며, 그중 인도메타 진 치료에도 불구하고 동맥관이 막히지 않고 패출혈, BUN의 상승, 소변량 감소 등으로 수술 대상이 되었 (9/57, 16%). 수술은 환자를 이동시키지 않고 신생아중환자실에서 결찰을 시행하였다. 2명의 환아들이 술 후 15일, 47일째 술전 부터 발생한 지속적인 패혈증및 기관지패 鎌紈봐塚막\ulcorner사망하였다. 수술과 직접적으 로 관련된 합병증 및 사망 례는 없었다. 인도메타진으로 내과적 치료만 한 환자 47명중 9명이 합병증(패혈 증, 기관패이형성증, 패내출혈, 신부전 등)으로 인하여 사망하여(19%) 내과적 치료의 실패는 520lo(18fsf였 다. 출생체중을 기준으로 보았을때 체중이 1500gm미만인 경우가 1500gm이상인 경우보다 그 실패율이 높았다(41% 15/38, 16% 3/19, p<0,05). 상기 결과로 부터 크기가 큰 동맥관 개존증, 체중이 적은 미숙아, 선천성 심기형을 동반한 경우 등 일부 미숙아에 있어서는 수술적 결찰술이 일차적 치료법으로 고려 되어야 할 것으로 사료된다. 또한 환아를 수 술장으로 이동하지 않고도 중환자실에서 안전하게 수술할 수 있었다.

• 대한간호학회지
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• 제25권2호
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• pp.330-340
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• 1995

This study was conducted to find out the degree of paternal attachment to neonate, and to identify factors affecting paternal attachment. The main purpose was to make the base data for nursing intervention to improve parternal attachment. The subjects of this study were 20 fathers whose partners have delivered premature neonate and 30 fathers whose partners have delivered normal neonate in 3 university hospitals in Seoul. Data were collected from Feb. 10 to Apr. 10 1994 by self report questionaires. The instrument for this study was based on 7 kinds of characteristics of paternal attachment by Greenberg St Morris(1974), and developed by re-searcher The statistical methods for data analysis were percentage, mean, standard deviation, 1-test, ANOVA with S.P.S.S. program. The conclusions are as follows. 1. Fathers had the high degree of paternal attachent to neonate, but were afraid of active touch. 2. The factors that affect paternal attachment were delivery odor, past experience about own father except delivery pattern, pregnancy plan, sex of nonate. 3. There were not significant correlations between paternal attachment and early visual contact frequency of father-neonate. 4. In the degree of paternal attachment, though normal neonate father showed somewhat higher result than premature neonate father, there was not statistically significant difference between two groups(t=-1.83, P=0.076). But in the character of tactail awarness there were significant differences between two groups, hence nursing interventions are needed to help the premature neonate's father bring early tactile con-tact. Pother research about factors affecting paternal attachment to neonate and high risk neonate as well as low birth weight neonate is reguired.

• Clinical and Experimental Pediatrics
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• 제58권11호
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• pp.415-420
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• 2015

Purpose: Bronchopulmonary dysplasia (BPD) is characterized by inflammation with proteolytic damage to the lung extracellular matrix. The results from previous studies are inconsistent regarding the role of proteinases and antiproteinases in the development of BPD. The aim of the present study was to investigate whether matrix metalloproteinase (MMP)-8, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-2, and TIMP-1 levels in the serum of preterm infants at birth are related to the development of BPD. Methods: Serum was collected from 62 preterm infants at birth and analyzed for MMP-8, MMP-9, TIMP-2, and TIMP-1 by using enzyme-linked immunosorbent assay. MMPs and TIMPs were compared in BPD (n=24) and no BPD groups (n=38). Clinical predictors of BPD (sex, birth weight, gestational age, etc.) were assessed for both groups. The association between predictors and outcome, BPD, was assessed by using multivariate logistic regression. Results: Sex, birth weight, and mean gestational age were similar between the groups. BPD preterm infants had significantly lower TIMP-2 levels at birth compared with no BPD preterm infants ($138.1{\pm}23.0ng/mL$ vs. $171.8{\pm}44.1ng/mL$, P=0.027). No significant difference was observed in MMP-8, MMP-9, and TIMP-1 levels between the two groups. Multivariate logistic regression analysis indicated that the TIMP-2 levels were predictive of BPD after adjusting for sex, birth weight, gestational age, proteinuric preeclampsia, and intraventricular hemorrhage (${\beta}=-0.063$, P=0.041). Conclusion: Low TIMP-2 serum levels at birth may be associated with the subsequent development of BPD in preterm infants.

• Journal of Preventive Medicine and Public Health
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• 제49권3호
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• pp.165-175
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• 2016

Objectives: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. Methods: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Results: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent's intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. Conclusions: Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries.

• Advances in pediatric surgery
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• 제1권1호
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• pp.8-17
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• 1995

The clinical experience of 2,340 inguinal hernia repaired by one pediatric surgeon on 2,079 children at Hanyang University Hospital from September 1979 to December 1993 was analyzed. Of 2,046 patients who had primary hernia repairs at Hanyang University Hospital, 1,636 were male and 410 female, and 55.5% of hernias occurred on the right side, 36.0% on the left, and 8.6% were bilateral. The patients presented hernia under the age of 12 months were 45.3% and those performed herniotomy under the age of 12 months were 25.5%. Birth weight was less than 2.5kg in 111 patients(8.7%) of 1,279 data available patients. Ninety(6.6%) of 1,354 data available patients were premature(<37wks gestation). The proportions of bilateral inguinal hernia and the onset age under 12 months of life in low birth weight babies and premature babies were higher than in full-term babies. Incarcerated inguinal hernia occurred in 327 patients(16.0%) of whom 8 patients were strangulated hernias. The occurrence of incarceration inversely related with age of patients. The subsequent contralateral inguinal hernia following unilateral hernia repairs occurred in 80 patients(4.3%) among which 72 were male and 8 were female. The incidence of contralateral inguinal hernia was more frequent in boys(4.8%) than girls (2.2%) and in cases after left herniotomy(6.4%) than after right herniotomy(2.9%). Sixty percent of contralateral inguinal hernia developed within 1 year after primary hernia repair. The recurrence of inguinal hernia occurred in 6 patients(0.27%) treated at our hospital primarily. There were one or more associated congenital anomalies in 83 patients of which congenital heart diseases were the most common. Sliding hernia occurred in 25 patients consisted of 5 boys and 20 girls. Family history was noted in 35 patients and there were 28 sets of monozygotic and 3 sets of dizygotic twins.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.472-483
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• 2020

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion: Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.

• 대한간호
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• 제30권3호
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• pp.49-65
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• 1991

This study was carried out to assess the problems with the pregnant women, and check out the risk-factors in the high-risk pregnancies, using a simplified antepartum risk-scoring system, which was revised from Edwards' scoring system to be suitable for Korean situaition. This instrument was included 4 categories, demographic, obstetric, medical and miscellaneous factors. This survey was based on the 1300 pregnant women who were admitted, $x^2$-test, F-test, Pearsons correation, using statistical package SAS in NAS computer system, KIST. The results of the study were as follows; 1. 1313 infants were deliveried of these 560 infants(42.7%) were born to mothers with risk-scores > 7, and 753 infants(57.3%) were born to mothers risk-scores <7. 2. Maternal age" parity, education level, of the demographic factors were significant relation statistically to identify the high risk pregnancies($X^2$=20.88, 42.87, 15.60 P < 0.01). 3. C-section, post term, incompetent cervix, uterine anomaly, polyhydramnios, congenital anomaly, sensitized RH negative, abortion, preeclampsia, excessive size infant, premature, low birth weight infanl, abnormal presentation, perinatal loss, multiple pregnancy, of the obstetric factors were significant relation statistically to identify the high risk-pregnancies. ($X^2$ = 175.96, 87.5, 16.28, 21.78, 9.46, 8. 10, 6.75, 22.9, 64.84, 6.93, 361.43, 185.55, 78.65, 45.52, P < 0.01). 4. Abnormal nutrition, anemia, UTI, other medicalcondition(pulmonary disease, severe influenza), heart disease, V.D., of the miscellaneous and medical factors, were significant relation statistically to identify the high risk-pregnancies. 5. Premature, low birth weight infant, contracted pelvis, abnormal presentation, of the risk factors were significantly related with Apgar score at 1 '||'&'||' 5 minute after birth and neonatal body weight. 6. Apgar score at 1 '||'&'||' 5 minute after, birth and neonatal body weight were significantly negative correlated with risk-score. 7. There were statistically significant difference between risk-score and Apgar score at 1 '||'&'||' 5 minute after birth, 3 group(0-3, 4-6, above 7), and neonatal body weight, 2 group(below 2.5kg, the other group) (F=104.65, 96.61, 284.92, P<0.01). 8. Apgar score at 1 '||'&'||' 5 minute after birth(below 7), and neonatal body weight(below 2.5kg), were significant relation statistically with risk score.($x^2$=65.99, 60.88, 177.07, P<0.01) were 60.8 %, 60% . 9. Correct classifications of morbid infants(l '||'&'||' 5 minute Apgar score < 7) were 77.8%, 83.8% and that of nonmorbid infants(l '||'&'||' 5 minute Apgar score > 7) were 60.8%, 60%. 10. There were statistically significant difference between dislribution of maternal risk-score among the morbid infants(l '||'&'||' 5 minute Apgar score < 7) and non morbid infants(l '||'&'||' 5 minute Apgar score> 7) ($x^2$=64.8, 58.8, P < 0.001). 11. There were statistically significant difference between distribution of morbid infants(l '||'&'||' 5 minute Apgar score < 7) and fetal death. 12. The predictivity for classifying high.risk cases was 12 % and for classifying low-risk cases was 98.3 % in 5 minute Apgar score. Suggestions for further studies are as follows; 1. Contineous prospective studies, using this newly revised scoring system are strongly recommended in the stetric service. 2. Besides risk facto~s used in this study, assessmenl of risks by factors in another scoring system and paralled studies related to perinatal outcome are strongly recommended.

• 대한유전성대사질환학회지
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• 제16권2호
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• pp.70-78
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• 2016

선천성 부신 과형성증 중 가장 흔한 21-hydroxy-lase deficiency (21-OHD)는 신생아 선별검사에서 17-hydroxyprogesterone (17-OHP)의 증가로 조기 진단이 가능하다. 17-OHP가 애매하게 증가되는 경우에는 ACTH 자극 검사가 필요하며, 이 검사는 nonclassical (NC형) 21-OHD 진단의 gold standard이다. 전형적인 임상 증상이 없는 경우, 예를 들어 남성화가 심하지 않은 여아, 경한 simple virilizing (SV)형 남아나 신생아 선별 검사에서 발견되지 않을 수 있는 NC형 환자의 경우, 분자유전학적 검사가 진단에 도움을 줄 수 있으며, 이는 예후 에측 및 유전 상담에도 도움이 된다. 미숙아와 저체중 출생아의 경우는 17-OHP가 위양성을 보이기 쉬우므로 출생 주수나 출생 체중에 따른 cutoff 값 설정이 필요하다. 높은 위양성률을 극복하기 위해 기존 RIA방법에 비해 최근 LC-MS/MS가 민감도와 특이도를 높이는 검사로 주목 받고 있다. 21-OHD 신생아 선별 검사의 효율성을 높이기 위해서는 SW형 남아를 조기에 발견하고, 여아에서 성별 결정을 조기에 올바르게 하고, NC형 환자를 찾아내고, 미숙아/저체중 출생아/아픈 신생아에서 위양성률을 낮추어서 불필요한 재검 및 경제적/심리적 부담을 최소화 하기 위한 노력이 필요하다. 무엇보다 21-OHD가 임상적으로 확실하게 의심되는 경우에는 확진 검사에 앞서 적절한 치료가 조기에 시작되어야 한다. 저자들은 본 종설에서 21-OHD의 신생아 선별 검사 후 진단 알고리즘에 대해 최신 문헌들에 근거하여 가이드라인을 제시하는 바이다.

• Clinical and Experimental Pediatrics
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• 제52권9호
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• pp.1053-1058
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• 2009

거대세포바이러스(CMV)는 신생아에서 가장 흔한 선천성 감염의 원인 중 하나이며, 모든 정상 출산아 중 약 0.3-2.4%에서 감염되어 있다. 혈청에서 거대세포바이러스 양성인 모체 중 40-96%에서 모유를 통한 바이러스의 배출이 증명되었으며, 거대세포바이러스에 감염된 모유를 통한 감염은 전체 영아 거대세포바이러스 감염의 약 1/3을 차지한다. 본 증례에서는 극소 저체중 출생아에서 모유를 통하여 발생한 거대세포바이러스 감염을 기술하였다. 환아는 생후 7일 경부터 모유 수유를 하였으며, 심한 혈소판감소증, 빈혈, 그리고 패혈증과 유사한 임상 양상에 대하여 반복되는 혈소판 수혈, 적혈구 수혈, 면역 글로불린 요법을 시행받았다. 거대세포바이러스 감염은 생후 2개월 경 혈청 CMV IgM 양성 및 소변 CMV 배양 검사 양성 소견을 통하여 진단하였다. 출생 당시 혈청 CMV IgM 및 소변 CMV 배양 검사가 음성이었으므로 선천성 감염은 배제할 수 있었다. 환아의 혈청과 모유의 핵산 배열 순서 분석을 통하여 동일한 바이러스에 의한 감염임을 증명하였다. 저자들은 국내에서 최초로 nucleotide sequencing 방법을 이용, 모유 수유를 통한 거대세포바이러스 감염이 발생한 극소 저체중 출생아의 예를 보고하는 바이다.

• Neonatal Medicine
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• 제28권2호
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• pp.83-88
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• 2021

Treatment guidelines for postnatal cytomegalovirus (pCMV) infection in preterm have not been established yet. Neutropenia, thrombocytopenia, hepatitis, colitis, and sepsis-like disease are among the clinical manifestations, which range from moderate to serious. We present a case of autopsy diagnosed as pCMV infection in a premature infant delivered at gestational age of 24 weeks and 5 days. On the 7th and 14th days of birth, urinary CMV polymerase chain reaction samples were negative, ruling out congenital CMV infection. However, autopsy examination revealed that the patient had disseminated pCMV infection. CMV inclusion bodies were found in the majority of tissues, including the lung, liver, pancreas, breast, kidney, and adrenal gland, but not the placenta. The thymus exhibited significant cortical atrophy and T-cell immunodeficiency, possibly induced by dexamethasone treatment for bronchopulmonary dysplasia or by pCMV infection itself. If dexamethasone treatment is extended or high doses are considered, it may be beneficial to test the CMV infection status to prevent aggravation of infection. This case demonstrates that, despite the low prevalence, pCMV infection should be considered a differential diagnosis in preterm if other conditions or etiology cannot justify clinical deterioration.