• Journal of Dental Anesthesia and Pain Medicine
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• 제19권5호
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• pp.253-260
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• 2019

Background: Sometimes general anesthesia is required for dental surgery in pregnant women. Facial bone fractures or neck abscess should be treated immediately. Dental surgery, however, creates a stressful situation that can cause inflammation. Inflammatory responses are a well-known major cause of preterm labor and preterm birth. Here we demonstrate the effects of remifentanil on the factors related to preterm labor and its mechanism of action on amniotic-derived epithelial cells (WISH cells). Methods: WISH cells were exposed to lipopolysaccharide (LPS) for 24 h and co-treated with various concentrations of remifentanil. MTT assays were performed to measure cell viability. To explain the effects of remifentanil on the factors related to inflammation in WISH cells, activation of nuclear factor kappa B ($NF-{\kappa}B$) and p38 and the expression of interleukin $(IL)-1{\beta}$, tumor necrosis factor $(TNF)-{\alpha}$, cyclooxygenase (COX)2, and prostaglandin E $(PGE)_2$ were quantified using western blotting and RT-PCR, respectively. Results: Remifentanil did not affect WISH cell viability. In western blot analysis, co-treatment with remifentanil resulted in decreased phosphorylation of $NF-{\kappa}B$, and expression of COX2 and $PGE_2$ in LPS-induced inflammation, but the results were statistically significant only at low concentrations. Reduction of $IL-1{\beta}$ and $TNF-{\alpha}$ expression was also observed with RT-PCR. Conclusion: Co-treatment with remifentanil does not affect the viability of WISH cells, but reduces the expression of the factors related to inflammation, which can induce uterine contraction and preterm labor. These findings provide evidence that remifentanil may inhibit uterine contraction and preterm labor in clinical settings.

• Journal of Preventive Medicine and Public Health
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• 제54권3호
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• pp.182-189
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• 2021

Objectives: This study investigated the relationship between sleep quality during pregnancy and preterm birth. Methods: This longitudinal study was conducted between August 2018 and May 2019. The participants were 150 pregnant women who had been referred to 7 healthcare centers in the city of Qazvin, Iran and met the inclusion criteria. The Petersburg Sleep Quality Index, the Epworth Sleepiness Scale, and 2 questions about daytime sleep status and a demographic questionnaire were administered at 14-18 weeks and 28-32 weeks of gestation. Data were analyzed using the Mann-Whitney test, the Fisher exact test, and univariate and multivariable logistic regression. Results: In the present study, poor sleep quality affected 84.7% of the participants at 14-18 weeks and 93.3% at 28-32 weeks of gestation. The final model for preterm birth prediction incorporated age and the Petersburg Sleep Quality Index score in the second and third trimesters. Preterm birth increased by 14% with each unit increase in age. With each unit increase in the Petersburg Sleep Quality Index score in the second and third trimesters, preterm birth increased by 42% and 28%, respectively, but the p-values of these factors were not significant. Conclusions: Although a significant percentage of pregnant women had poor sleep quality, no significant relationship was found between sleep quality during pregnancy and preterm birth.

• Perinatology
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• 제29권4호
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• pp.147-152
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• 2018

Objective: This study examines whether maternal group B Streptococcus (Streptococcus agalactiae, GBS) infection was associated with preterm births and premature neonatal outcomes. Methods: Maternal and neonatal outcomes were examined among singleton pregnant women with preterm birth (from $24^{+0}weeks$ to $36^{+6}weeks$) who were tested for GBS (n=203) during the pregnancy. Data were collected retrospectively from the medical records of women who delivered at our hospital from January 2015 to February 2017. We compared obstetrical factors (causes of preterm birth) and neonatal (gestational age at delivery, birth weight, Apgar score 1 min/5 min, hospitalization period, duration of mechanical ventilation, neonatal C-reactive protein within three days, and other complication [respiratory distress syndrome, neonatal deaths]) outcomes between GBS-infected and non-infected pregnant women. Results: There were 203 singleton pregnant women included in the study, 25 of whom were confirmed to have a GBS infection during the pregnancy. There was no difference in neonatal outcomes by GBS status. Preterm premature rupture of membranes (pPROM), as an obstetric factor, was associated with GBS infection (P=0.022). GBS infection raised the risk of pPROM by 3.6 times (odds ratio 3.648, 95% confidence interval 1.476-9.016, P=0.005). Conclusion: GBS infection in preterm birth was associated with pPROM but did not result in adverse neonatal outcomes. Continuous attention and evaluation of GBS infection, a major cause of neonatal sepsis and pneumonia, are needed.

• Clinical and Experimental Pediatrics
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• 제65권4호
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• pp.188-193
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• 2022

Background: Respiratory distress syndrome (RDS) is a common cause of hospitalization and death in preterm infants who require surfactant treatment and respiratory support. Purpose: This study aimed to compare the clinical outcomes of minimally invasive surfactant therapy (MIST) and the INtubation, SURfactant administration, and Extubation (INSURE) technique in preterm infants with RDS. Methods: In this clinical trial, 112 preterm infants born at 28-36 weeks of gestation and diagnosed with RDS randomly received 200-mg/kg surfactant by MIST or the INSURE method. In the MIST group, surfactant was administered using a thin catheter (5F feeding tube); in the INSURE group, surfactant was administered after intubation using a feeding tube and the tracheal tube was removed after positive pressure ventilation was started. Nasal continuous positive airway pressure was applied in both groups for respiratory support and the postprocedure clinical outcomes were compared. Results: The mean hospitalization time was shorter for infants in the MIST group than for those in the INSURE group (9.19±1.72 days vs. 10.21±2.15 days, P=0.006). Patent ductus arteriosus was less frequent in the MIST group (14.3% vs. 30.4%, P=0.041). Desaturation during surfactant administration occurred less commonly in the MIST group (19.6% vs. 39.3%, P=0.023). There were no significant intergroup differences in other early or late complications. Conclusion: These results suggest that surfactant administration using MIST could be a good replacement for INSURE in preterm infants with RDS since its use reduced the hospitalization time and the number of side effects.

• Clinical and Experimental Pediatrics
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• 제65권5호
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• pp.262-268
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• 2022

Background: The delayed diagnosis of developmental dysplasia of the hip (DDH) requires complex treatment and sometimes progresses to hip osteoarthritis. Purpose: This study aimed to evaluate the risk factors and screening time for DDH in preterm infants. Methods: A total of 155 preterm infants with a gestational age <32 weeks screened for DDH with ultrasonography were enrolled in this retrospective chart review. Results: The incidence of DDH was 6.45% (10 of 155). Gestational age, birth weight, sex ratio, and breech presentation did not differ significantly between infants treated for DDH (n=10) and nontreated infants (n=145) (gestational age, 29.2±1.4 weeks vs. 29.6±2.0 weeks, P=0.583; birth weight, 1,240±237 g vs. 1,295±335 g, P=0.607; female sex, 7 of 10 (70.0%) vs. 77 of 145 (53.1%), P=0.346; and breech presentation, 5 of 10 (50.0%) vs. 43 of 145 (29.7%), P=0.286, respectively). Performing the first ultrasonography earlier than 38 weeks of postmenstrual age (PMA) increased the risk of an abnormal finding by 3.76 times compared to performing it at ≥38 weeks of PMA. These abnormal findings on ultrasonography resolved spontaneously. Breech presentation increased the risk of minor abnormal findings on the first ultrasonography by 3.11 times versus nonbreech presentation and resolved spontaneously. DDH in preterm infants did not occur predominantly on the left side or in infants born with breech presentation. Conclusion: Performing ultrasonography screening earlier than 38 weeks of PMA caused unnecessary subsequent ultrasonography and overtreatment. Breech presentation was not a risk factor for DDH in preterm infants. However, breech presentation could increase the risk of minor abnormal findings at the 1st ultrasonography compared to nonbreech presentation, which resolved spontaneously. The etiology and risk factors for DDH in preterm infants are somewhat different from those for DDH in term infants.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권3호
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• pp.146-155
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• 2023

Purpose: The starting time for probiotic supplementation in preterm infants after birth varies widely. This study aimed to investigate the optimal time for initiating probiotics to reduce adverse outcomes in preterm or very low birth weight (VLBW) infants. Methods: Medical records of preterm infants born at a gestational age (GA) of <32 weeks or VLBW infants in 2011-2020 were reviewed respectively. The infants who received Saccharomyces boulardii probiotics within 7 days of birth were grouped into an early introduction (EI) group, and those who received supplemented probiotics after 7 days of birth were part of the late introduction (LI) group. Clinical characteristics were compared between the two groups and analyzed statistically. Results: A total of 370 infants were included. The mean GA (29.1 weeks vs. 31.2 weeks, p<0.001) and birth weight (1,235.9 g vs. 1491.4 g, p<0.001) were lower in the LI group (n=223) than in the EI group. The multivariate analysis indicated that factors affecting the LI of probiotics were GA at birth (odds ratio [OR], 1.52; p<0.001) and the enteral nutrition start day (OR, 1.47; p<0.001). The late probiotic introduction was associated with a risk of late-onset sepsis (OR, 2.85; p=0.020), delayed full enteral nutrition (OR, 5.44; p<0.001), and extrauterine growth restriction (OR, 1.67; p=0.033) on multivariate analyses after adjusting for GA. Conclusion: Early supplementation of probiotics within a week after birth may reduce adverse outcomes among preterm or VLBW infants.

• Clinical and Experimental Pediatrics
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• 제50권8호
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• pp.746-752
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• 2007

목 적 : 미숙아에서 발생하는 뇌실주변부 백질연화증, 뇌실내 출혈, 기관지폐 이형성증, 미숙아 망막증, 괴사성 장염 등의 합병증이 활성 산소에 의한 세포 및 조직 손상과 연관성이 있다는 보고들이 있어 왔다. 이에 저자들은, 활성 산소와 세포 내 분자들이 반응할 때 생성되는 활성 산화물의 농도를 측정하여, 미숙아와 정상 만삭아의 혈중 활성 산화물의 농도를 비교하고, 활성 산화물의 농도와 미숙아 합병증과의 연관성을 알아보고자 본 연구를 시행하였다. 방 법 : 2005년 7월부터 2006년 4월 사이에 포천중문의대 분당차병원 신생아 집중치료실에 입원한 36주 이하의 미숙아 39명과 37주 이상의 정상 만삭아 24명을 대상으로 하였다. 정상 만삭아군에서 출생일 혈청 total hydroperoxide(TH) 농도를 측정하였고, 미숙아군에서는 출생일과 생후 7일 째 혈청 TH 농도를 측정하였다. 만삭아군과 미숙아군의 출생일 혈청 TH 농도를 비교하였고, 미숙아군의 분만력 상의 특징, 혈액검사 소견, 뇌 초음파 및 뇌 자기 공명영상 소견, 임상경과 및 예후를 후향적으로 조사하여, 미숙아 합병증이 발생한 군과 합병증이 없었던 군으로 나누어 출생일과 생후 7일째 혈청 TH 농도를 비교 분석하였다. 결 과 : 미숙아군과 만삭아군의 출생일 TH 농도를 비교한 결과, 미숙아군은 평균 $186{\pm}42U.carr/L$, 만삭아군은 $157{\pm}36U.carr/L$로 미숙아군에서 유의하게 높았다. 미숙아군에서, 합병증이 발생한 군과 발생하지 않은 대조군의 출생일과 생후 7일 혈청 TH 농도를 비교한 결과, 출생일에는 합병증군 $211{\pm}37U.carr/L$, 비합병증군 $168{\pm}36U.carr/L$로 합병증군에서 유의하게 높았으나, 생후 7일에는 합병증군 $205{\pm}64U.carr/L$, 비합병증군 $188{\pm}32U.carr/L$로 합병증군이 다소 높았으나 통계적으로 유의한 차이는 보이지 않았다. 그러나 합병증이 발생하지 않은 미숙아군과 정상 만삭아군의 출생일 혈청 TH 농도에는 통계적으로 유의한 차이가 없었다. 합병증 발생의 위험 인자인 재태주령, 5분 Apgar 점수, 동맥혈 가스검사의 pH, 출생일 TH 농도를 분석한 결과, 재태주령(Odds ratio 0.586, 95% CI 0.370-0.927, P=0.022)과 TH 농도 (Odds ratio 1.046, 95% CI 1.010-1.085, P=0.013)가 독립적으로 합병증 발생에 유의한 영향을 미치는 위험 인자였다. 결 론 : 합병증이 발생한 미숙아는 합병증이 발생하지 않은 미숙아나 만삭아에 비해 출생일 혈청 TH의 농도가 높으며, 미숙아의 출생일 혈청 TH 농도는 미숙아 합병증 발생에 독립적으로 영향을 미치는 인자이다.

• Journal of Nutrition and Health
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• 제34권6호
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• pp.656-663
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• 2001

본 연구에서는 정상 만기 산모(30명), 조산모(10명) 및 PIH산모가(8명)출산 초기에 분비한 초유시료에서 5종의 다량 무기질(나트륨 칼륨 칼슘, 인, 마그네슘)과 3종의 미 량원소(철분. 아연. 구리)의 농도를 분석하여 재태기간이나 모체의 합병증에 따른 모유의 무기질 함량을 비교하였고 또한 임신기 무기질 섭취 량과 초유의 무기질 함량과의 상관성을 조사하였다 정상 만기 산모의 임신기 영양소 섭취량은 단백질과 인을 제외하고는 권장량에 미치지 못했으며 칼슘, 철분과 아연의 섭취량은 권장량에 크게 미달되었다. 세 그룹 산모들의 임신기 1일 평균 영양소 섭취량을 비교했을 때, 조산모 그룹에서 칼슘을 제외한 모든 영양소의 섭취량이 가장 저조하였으며 이들의 인과 나트륨 섭취량은 정상 만기 산모의 섭취량 보다 유의적으로 낮았다(p < 0.05). PIH 산모의 영양소 섭취량은 정상 만기 산모그룹과 유사하였지만 이들의 임신기 칼슘 섭취량은 1일 평균 500.9mg으로 세 그룹 중 가장 적었다 세 그룹 산모들의 초유내 무기질 함량을 비교한 결과, 조산모 유즙의 칼륨과 인의 농도는 정상만기 산모의 유즙내 농도 보다 유의적으로 낮았으며(p < 0.05) , 반면 조산모와 PIH산모의 유즙내 철분 함량은 정상 만기 산모의 유즙에 서 보다 유의적으로 높았다(p <0.05). 그 외 그룹간 무기질 및 미량원소의 초유내 함량의 유의적 차이는 없었다. 한편 임신기 모체의 무기질 섭취량과 분만 초기에 분비되는 초유의 무기질 함량과의 상관성 분석에서 정상 만기 산모와 조산모 그룹간의 유의성 있는 상관관계가 관찰되지 않았으나 PIH 산모에서는 칼슘 섭취량과 초유의 칼슘 농도 사이에 유의적인 양의 상관성이 나타났다(p <0.05). 이와 같은 결과로부터 조산모 초유의 일부 무기질 함량이 정상 만기 산모 초유에서 보다 낮은 경향이므로 체내 무기질 저장량이 적고 성장속도가 빠른 조산아의 특성을 고려할 때, 조산모 초유의 무기질 영양은 다소 미흡하다고 사료되나 향후 PT의 성숙유에 대한무기질 함량과 조산아의 섭취량 및 성장패턴을 고려한 무기질 영양평가가 요구된다. 한편 PIH산모의 칼슘섭취 부족이나 또는 이들이 분비한 유즙의 높은 철분 함량과 관련하여 PIH산모에 대한 체계적인 무기질 대사 연구가 병행되어야 할 것이다

• Neonatal Medicine
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• 제25권2호
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• pp.78-84
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• 2018

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.48-53
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• 2004

목 적: 기계적 환기 요법 시 삽입된 비위관으로 인한 식도 운동 기능의 저하와 가해진 양압이 위식도 압력차를 감소시켜 미숙아에서 위식도 역류가 증가한다고 알려져 있으나, 아직 국내에서는 보고된 바가 없기에 본 연구에서는 미숙아에서 기계적 환기 요법이 위식도 역류에 미치는 영향과 유발 요인을 조사하였다. 방 법: 2000년부터 2004년까지 부산대학교병원 신생아 집중치료실에 입원하여 신생아 호흡 곤란 증후군, 신생아 가사 등의 원인으로 기계적 환기 요법을 받은 11명을 대상으로 하였다. 24시간 식도 산도 측정은 DIGITRAPPER MK III (Synectics Medical AB, Stockholm, Sweden)를 이용하였고, 탐촉자로는 antimony electrode를 사용하였다. 역류의 정도를 알아보는 지표들로는 역류 지수, 역류 횟수, 5분 이상 지속되는 역류 횟수, 가장 긴 역류의 지속 시간, 총 역류 횟수 중 5분 이상 지속된 역류 횟수의 비 등 5개의 지표 중 2개 이상이 기준에 합당할 경우 의미있는 위식도 역류로 정의하였다. 결 과: 전체 환아의 평균 재태 기간은 30.9주, 출생시의 평균 체중은 1,568 g, 검사 당시의 평균 나이는 2.8일이었다. 미숙아 중 4명(남아 3명, 여아 1명)에서 의미있는 위식도 역류가 있었다. 역류가 없었던 군이 재태 기간이 짧았고, 평균 체중이 작았으며, 검사 당시의 평균 나이가 많은 경향은 보였지만 대상 수가 적어 통계학적인 의미를 두기 어려웠다. 의미있는 위식도 역류가 동반된 군과 역류가 없었던 군 사이에 호흡기 설정에서는 의미있는 차이가 없었다. 결 론: 본 연구에서 위식도 역류를 증가시키는 요인을 발견할 수는 없었으며, 기계적 환기 요법시 위식도 역류의 빈도가 이전 연구들과 비슷한 결과를 보여 기계적 환기 요법이 미숙아의 위식도 역류에 큰 위험 요인은 아닌 것으로 판단된다.