• Journal of Korean Academy of Fundamentals of Nursing
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• v.4 no.2
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• pp.229-243
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• 1997

Especially in NICU(Neonatal Intensive Care Unit), handwashing is an important factor in decresing nosocomial infections due to reduced immunity, prematurity and various invasive procedures. The purpose of this study was to investigate the basic characteristics related to handwashing by NICU nurses. It was composed of three parts ; questionnaire survey I (genoral characteristics of handwashing), questionnaire survey II(the awareness degree of handwashing importance) and actual performance. This study was performed from Oct. 8 to 14 in 1994. The results of this study were as follows ; 1. Frequency of handwashing were different by shift of working about 47.1% of the respondents. They were washing most frequently during day-shift about 75% of above. According to self evaluation to handwashing frequency, 64.7% of the respondents said their frequency of handwashing was inadequate, because of being too busy.(45.1%), bothering caused by detergent or disinfectant(17.6%), and too far from handwashing facilities(17.6%). 2. The most common handwashing agent was soap(88.2%), 52.9% of the subjects experienced adverse effects after handwashing ; rough hand(44.5%), dryness(33.3%) All subjects washed their hands with running water, and 70.6% of the subjects washed upto wrist. In duration of handwashing, 52.9% of subjects washed hands 5 to 10 seconds, 29.5% of them did 11 to 15 seconds. 3. 29.4% among subjects had participated to take in the handwashing educational program. About 60% responded they would like to take the course of handwashing if possible. 4. The important nursing activities that need handwashing were chaning of caring ostomy, suctioning, chaning IV dressing site. On the other hand, they responded handwashing was not essential before dealing with omitus, before and after transfering machine, before chaning diaper(stool) 5. Handwashing performance was 61.7%. Among seven nursing activities, suctioning(73.4%) was the highest, the next was dealing with discharge or sampling(71.1%), the lowest was bathing(34.6%). The performance was better after(70.2%) nursing activities that before(52.5%), and day(63.6%) or evening(68.3%) shift than night(56.7%)

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.1
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• pp.39-45
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• 2009

Purpose: Preterm infants are very susceptible to malnutrition because of a lack of storage of nutrients, immature digestion and metabolism, and accompanying diseases associated with prematurity. The purpose of this study was to evaluate the effects of nutritional support by the pediatric nutritional support team (pNST) on the clinical course of preterm infants in the neonatal intensive care unit (NICU). Methods: Between July 2003 and July 2006, 48 preterm infants who were admitted to the NICU at Seoul National University Bundang Hospital were included. The subjects were divided into the following two subgroups according to the presence of NST activity; pre-NST group (n=23) and NST group (n=25). Hospital records were reviewed retrospectively. Results: Forty-eight preterm babies were included (M：F=27：21; gestational age, 25~33 weeks). A dietician, pharmacists, or the pNST participated in the prescription of total parenteral nutrition (TPN) more rapidly in the NST group (p=0.000). The fasting periods and TPN administration periods were significantly decreased in the NST group compared to the pre-NST group (p=0.017 & p=0.001, respectively). The doses of calories, protein, and lipids administered via TPN were significantly increased in the NST group compared to the pre-NST group (p=0.016, p=0.000, and p=0.000, respectively). The total period on antibiotic therapy was significantly decreased in the NST group compared to the pre-NST group (p=0.007). Conclusion: Because nutritional support by the pNST is of benefit to the clinical course of preterm infants in the NICU, the pNST should recommend to improve the nutritional status and clinical outcome of preterm infants.

• Neonatal Medicine
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• v.25 no.3
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• pp.96-101
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• 2018

Purpose: We aimed to evaluate the respiratory illness-related hospital visits (out-patient clinics, emergency room, and re-admission) of preterm infants, and compare them according to corrected age and prematurity. Methods: We reviewed the medical records of preterm infants born at <37 weeks of gestation admitted to the neonatal intensive care unit (NICU) at Inha University Hospital between January 2012 and June 2015. Infant follow-up appointments in both neonatology and pulmonology out-patient clinics occurred for at least 2 years after NICU discharge. Results: The proportion of infants who visited the hospital due to any respiratory illness was as high as 50% until 12 months of corrected age, and subsequently decreased over time. Hospital admission was significantly higher in early preterm infants (<34 weeks of gestation) compared to late preterm infants (${\geq}34$ and <37 weeks of gestation). The proportion of infants who were re-admitted due to lower respiratory tract illness was significantly higher until 6 months of corrected age compared to the later, and did not differ between early and late preterm infants. Conclusion: The proportion of hospital visits of preterm infants due to respiratory disease was high until 12 months of corrected age. Most notably, the re-admission proportion from lower respiratory tract illness was high under 6 months in both early and late preterm infants. Preterm infants within this age that are visiting the hospital with respiratory symptoms should be carefully observed and followed up.

• Neonatal Medicine
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• v.16 no.2
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• pp.213-220
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• 2009

Purpose: Hearing loss is one of the common birth defects in humans, with a reported prevalence of 1-3 per 1000 newborns. We investigated the incidence of hearing loss and evaluated the use of neonatal hearing screening test in neonatal intensive care unit (NICU) graduates who are at greater risk for hearing loss than normal newborns. Methods: The neonates admitted to the NICU of Asan Medical Center from 1 March, 2003 to 30 March, 2008 who were available for follow-up were included. Those who failed the first auditory brainstem response prior to discharge were retested with the stapedial reflex test, auditory brainstem response and tympanometry in the Otolaryngology department. Results: Of 2,137 neonates, 2,000 (93.5%) neonates were tested prior to discharge. Sixty-seven neonates (3.4%) failed the first newborn hearing screening test. Of 67 infants, 52 infants were retested for a second hearing test. Excluding 10 infants (19.2%) who were lost during follow-up, 16 infants were confirmed to have hearing impairment of which 12 and 4 infants had unilateral and bilateral hearing loss, respectively. Of 16 infants, 5 did not meet the criteria set by the Korean National Health Insurance Corporation. Conclusion: The prevalence of hearing impairment in NICU graduates is about 0.8%, excluding those who were lost for follow up, necessitating a systemic and effective hearing assessment program among these high risk infants and more generous national insurance coverage.

• Child Health Nursing Research
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• v.8 no.3
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• pp.344-356
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• 2002

This study was conducted to analyse the current clinical education of pediatric nursing in baccalaurate nursing program, then to give basic data for enhancing the quality of future clinical education of pediatric nursing. Data were collected through self-reported questionnaire by mail from December 2001 to February 2002. The subjects were 29 schools of 50 baccalaurate nursing education programs. The data were analysed by double raters, researcher and assistant researcher. The results were summarized as follows: 1. Twenty-eight schools had the objectives of the clinical education of pediatric nursing, and 28 schools in pediatric ward, 23 schools in nursery, 22 schools in neonatal intensive care unit(NICU), 15 schools in objectives related to profession by clinical site. 2. Credits on clinical education of pediatric nursing were most 15 schools of 3 credits. 3. The clinical sites were mainly the hospital that sick children were admitted in. 4. The clinical teacher were 9 types including pediatric professor and field nurse. 5. On teacher's role, the professor instructed the case study and conference, and field nurse instructed the patient assignment and nursing procedures. 6. All of schools used explanation and conference as a method of clinical education, 1 or 2 schools used PBL or role play or field study. 7. On clinical education content, most of school included Apgar scoring system, physical examination in newborn assessment, respira- tion maintenance, temperature maintenance, infection prevention, nutrition, and bath in newborn care. 8. On clinical education content, most of school included care of incubator, phototheraty, infusion, gavage feeding and how to use the instruments in NICU. Eighteen schools included attachment promotion, and 20 schools case study. 9. On clinical education content, most of school included a checklist of nursing procedures, case study, assessment of growth and development in pediatric ward and other sites. 10.There were various evaluation types in scores, measuring items. In conclusion, the results of this study revealed that there were some discrepancy in the objectives and contents, clinical sites on hospital focused, teacher's role, and diversity of measurement items and ratings in clinical education of pediatric nursing. There is a need for a standardization of content, clinical site, and evaluation tool to improve a quality of clinical education of pediatric nursing based on this study.

• Pediatric Infection and Vaccine
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• v.30 no.1
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• pp.12-19
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• 2023

Purpose: Sepsis is the most common cause of neonatal death accounting for 30-50% of mortality annually in developing countries. This study was to determine the prognostic factors of neonatal sepsis mortality. Methods: A retrospective cohort was conducted in Dr. R. Sosodoro Djatikoesoemo Governor Hospital from April 2021 to September 2021 on 121 neonates in the neonatal intensive care unit (NICU) diagnosed with sepsis. The inclusion criteria were neonates aged 0-28 days, admitted to the NICU, and diagnosed with sepsis. The exclusion criteria were incomplete data and the presence of congenital abnormalities. A χ² test was performed on the sex, gestational age, mode of delivery, birth weight, APGAR score, birthplace, and blood culture. A normality test was performed on leukocytes, lymphocytes, neutrophils, platelets, C-reactive protein (CRP), and length of stay. Then performed a Mann-Whitney test. Results: Birth weight (P=0.038), gestational age (P=0.009), and blood culture (P=0.014) showed a significant relationship with the neonatal sepsis outcome while Mann-Whitney test showed significant differences in the platelets (P=0.018), CRP (P=0.002), and length of stay (P<0.001). Multivariate analysis showed that 3 prognostic factors associated with neonatal sepsis mortality were prematurity (odds ratio [OR], 3.906; 95% confidence interval [CI], 1.344-11.356; P=0.012), low birth weight (LBW, OR, 2.833; 95% CI, 1.030-7.790; P=0.044), and gram-negative bacteria (OR, 4.821; 95% CI, 1.018-22.842; P=0.047). Conclusions: Prematurity, LBW, and gram-negative bacteria were associated with the prognostic factors of neonatal sepsis.

• Neonatal Medicine
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• v.18 no.2
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• pp.265-271
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• 2011

Purpose: Extended spectrum $\beta$-lactamase (ESBL) producing organism is an important cause of infections in the neonatal intensive care unit (NICU) since 1990s. The aim of this study is to investigate the differences of clinical characteristics and hematologic studies between neonates with ESBL-positive organism and those with ESBL-negative organism. Methods: The subjects included 48 neonates admitted to NICU at Inje University Sanggye Paik Hospital from January 2005 to September 2010, from whom a total of 58 Escherichia coli or Klebsiella pneumonia were detected. The data were categorized in 2 groups, neonates with ESBL-positive and ESBL-negative. We compared clinical characteristics and hematologic studies between two groups. Results: Of 48 neonates and 53 isolates, ESBL-positive were 18 neonates and 20 isolates. Both ESBL-positive and ESBL-negative isolates were largely found in urine, each with 10 and 23. Of 20 ESBL-positive isolates, 13 (65%) and 7 (35%) were ESBL producing Escherichia coli and Klebsiella pneumonia, respectively. ESBL-positive neonates were associated with low 1 and 5 minutes Apgar scores (P=0.002 and P=0.001, respectively), more uses of oxygen (56% vs. 27%; P=0.005), longer duration of oxygen uses (15.8${\pm}$38.43 days vs. 4.3${\pm}$12.5 days; P=0.008) and more frequent anemia (33% vs. 7%; P=0.040). Conclusion: ESBL-positive neonates may have more anemia and lower Apgar score at birth. We can consider the use of cabapenem earlier if infant with previous antibiotics is confirmed to be infected with ESBL-positive organisms.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.133-143
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• 2021

Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.

• Pediatric Infection and Vaccine
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• v.9 no.2
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• pp.163-174
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• 2002

Background : To delineate the changes in the causative agents of neonatal sepsis and their antimicrobial susceptibilities in the neonatal intensive care unit and nursery of Hanyang University Hospital during the past 10 years. Methods : Hospital records of 15,144 patients hospitalized at the NICU and nursery of Hanyang University Hospital from 1989 to 1998 were reviewed and neonates diagnosed of neonatal sepsis were sorted and included in the study. The study period was divided into Period A(the first 5 years) and Period B(the second 5 years) to analyse causative agents and their antimicrobial susceptibilities. Results : Neonatal sepsis was diagnosed in 170 patients(1.1%{Period A 1.2%, Period B 1.0%}) among the total of 15,144 inpatients. Two hundred isolates(Period A 109 isolates, Period B 91 isolates) were identified in 186 blood cultures(Period A 99 cultures, Period B 87 cultures) from 170 patients(Period A 91 patients, Period B 79 patients). The average age at the onset of the disease, when the initial blood culture was drawn, was 12.3 days old(Period A 8.8 days, Period B 16.3 days), and the proportion of the early onset disease was 34.7% in Period A and 23.0% in Period B, indicating that neonatal sepsis developed earlier during Period A. Among the isolated organisms including Gram positive bacteria[132(66.0%)], Gram negative bacteria [60(30.0%)], and fungi[8(4.0%)], coagulase negative Staphylococcus(CNS) was the most common organism(69/34.5%), followed by Staphylococcus aureus(36/18.0%), Klebsiella pneumoniae(17/8.5%), Enterococcus(12/6.0%), Enterobacter cloacae(8/4.0%), Escherichia coli(6/3.0%), and Pseudomonas aeruginosae(5/2.5%). The isolated fungi were Candida parapsilosis, Candida albicans, and Trichosporon pullulans. CNS, S. aureus and Acinetobacter baumannii were isolated more frequently in Period A compared to Period B. Antimicrobial susceptibilities of CNS and S. aureus to methicillin and the first generation cephalo sporins were decreased in Period B compare to Period A, those to aminoglycosides were increased in Period B, and vancomycin resistant strains were not identified. K. pneumoniae, Enterococcus, E. coli, and P. aeruginosa were isolated less frequently in Period B, compared to Period A. For K. pneumoniae, antimicrobial susceptibilities to the first generation cephalosporins were low in both Periods A and B, those to tobramycin and gentamicin were increased in Period B, and those to amikacin, ceftriaxone, and trimethoprim-sulfamethoxazole were high in both Periods A and B. Antimicrobial susceptibilities of Enterococcous to ampicillin, penicillin, and the first generation cephalosporins were decreased in Period B, but vancomycin resistant strains were not identified. Conclusion : The occurrence rate of neonatal sepsis during the past 10 years in the NICU and nursery of the Hanyang University hospital was 1.1%, and the most common causitive agents were CNS and S. aureus, to which the antimicrobial susceptibilities to the first line drugs decreased in the later half of the study period with no vancomycin resistant isolates identified. Group B Streptococcus known to be the most common agent causing neonatal sepsis was not identified, and K. pneumoniae was isolated more commonly during the later half of the study period without decreased antimicrobial susceptibilities.

• Neonatal Medicine
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• v.16 no.2
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• pp.205-212
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• 2009

Purpose: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. Methods: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. Results: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score ($\leq3$) was lower in the immediate group than the delayed group. Conclusion: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.