• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.228-238
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• 2023

Intraventricular hemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. IVH is particularly common in preterm infants. Although advances in obstetric management and neonatal care have led to a lower mortality rate for preterm infants with IVH, the IVH-related morbidity rate in this population remains high. Therefore, the present review investigated the pathophysiology of IVH and the evidence related to interventions for prevention. The analysis of the pathophysiology of IVH was conducted with a focus on the factors associated with cerebral hemodynamics, vulnerabilities in the structure of cerebral vessels, and host or genetic predisposing factors. The findings presented in the literature indicate that fluctuations in cerebral blood flow, the presence of hemodynamic significant patent ductus arteriosus, arterial carbon dioxide tension, and impaired cerebral venous drainage; a vulnerable or fragile capillary network; and a genetic variant associated with a mechanism underlying IVH development may lead to preterm infants developing IVH. Therefore, strategies focused on antenatal management, such as routine corticosteroid administration and magnesium sulfate use; perinatal management, such as maternal transfer to a specialized center; and postnatal management, including pharmacological agent administration and circulatory management involving prevention of extreme blood pressure, hemodynamic significant patent ductus arteriosus management, and optimization of cardiac function, can lower the likelihood of IVH development in preterm infants. Incorporating neuroprotective care bundles into routine care for such infants may also reduce the likelihood of IVH development. The findings regarding the pathogenesis of IVH further indicate that cerebrovascular status and systemic hemodynamic changes must be analyzed and monitored in preterm infants and that individualized management strategies must be developed with consideration of the risk factors for and physiological status of each preterm infant.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.272-281
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• 2023

Objectives: Young mothers are vulnerable to postpartum depression due to role transition-related stress. Understanding the causes underlying these stressors is essential for developing effective interventions. Methods: This study analyzed the 2018 Indonesian Basic Health Research data. The Mini International Neuropsychiatric Interview was used to assess postpartum depression symptoms in mothers aged 15-24 years with infants aged 0-6 months. In 1285 subjects, the risk factors for postpartum depression were evaluated using multivariate logistic regression. Results: The overall prevalence of depression in the 6 months postpartum was 4.0%, with a higher prevalence in urban areas (5.7%) than in rural areas (2.9%). Urban and rural young mothers showed distinct postpartum depression risk factors. In urban areas, living without a husband (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.24 to 11.76), experiencing preterm birth (OR, 4.67; 95% CI, 1.50 to 14.50), having pregnancy complications (OR, 3.03; 95% CI, 1.20 to 7.66), and having postpartum complications (OR, 5.23; 95% CI, 1.98 to 13.80) were associated with a higher risk of postpartum depression. In rural areas, postpartum depression was significantly associated with a smaller household size (OR, 3.22; 95% CI, 1.00 to 10.38), unwanted pregnancy (OR, 4.40; 95% CI, 1.15 to 16.86), and pregnancy complications (OR, 3.41; 95% CI, 1.31 to 8.88). Conclusions: In both urban and rural contexts, postpartum depression relates to the availability of others to accompany young mothers throughout the postpartum period and offer support with reproductive issues. Support from the family and the healthcare system is essential to young mothers' mental health. The healthcare system needs to involve families to support young mothers' mental health from pregnancy until the postpartum period.

• 가정∙방문간호학회지
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• 제8권1호
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• pp.5-24
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• 2001

The purpose of this study was to develop a parenting intervention program and determine the efficacy of the program with low-birth weight infants and their mothers. Nine dyads for the experimental group and twelve dyads for the control group discharged from the Neonatal Intensive Care Unit of a University Hospital in Seoul were recruited for the study. For the intervention group, programmed education and support which focused on the maternal sensitivity of the infant's behavior. rearing environment. motherinfant interaction and infant care were given to each subject. Individual counseling and home visits were provided at discharge, one week after discharge. and one and three months of corrected age in every infant. Structured questionaires were administered and feeding interactions were videotaped and coded by a blinded certified observer. A Quasi-experimental design was conducted for this study. Postpartum depression, maternal self esteem. infant care burden, HOME. mother-infant interaction, and infant development were measured. Results were in favor of the intervention versus the control group. On the Beck depression inventory, intervention mothers showed decreasing trends in depressive symptom vs control mothers although, there were statistically no significant differences between the two groups at each time. The mean score of experimental group was 11.55(mild depression state) at discharge and became 8,6(normal state) at 1 month of corrected age. On the other hand, the mean score of the control group was 13.92(mild depression state) at discharge and became 14.0. Maternal self esteem in both groups improved over time. Infant care burden in both groups was also shown to increase over time. There was a significant difference between the two groups in HOME(p=.0340) at 3 months of corrected age. HOME scores of the experimental group and the control's were 31.10 and 25.58, respectively. Mothers' emotional and language responses were significantly high in the intervention group compared with the control group(p=.0155). Intervention group (53.33) showed a significantly high quality of motherinfant interaction compared with the in control group (42.80)(p =.0340). Intervention group mothers appeared have a better quality of mother-infant interaction behaviors. On the other hand, there was no statistical difference in the infant part between groups. Intervention group infants had higher trends in a general developmental quotient: although, there was no statistical difference between groups. The general developmental quotient of intervention infants was 102.56 and control's was 91.28. However, the developmental quotient of the domain of 'individuality-sociality' was higher in the intervention group infants compared with the control's(p=.0155). The concerns identified by parents revealed two domains of an infants' health management -knowledge and skills in caregiving of lowbirthweight-infants, characteristics of lowbirthweight infants, identifying a developmental milestone, coping with emergency situations and relaxation strategies of mothers from the infant care burden. Interview data with the mothers of low-birth weight infants can be used to develop intervention program contents. Limited intervention time and frequency due to time and cost limitations of this study should be modified. The intervention should be continuously implemented when low-birth weight infants become three years old. An NNNS demonstration appeared to be a very effective intervention for the mothers to improve the quality of mother-infant interactions. Therefore intervening in the mothers of low-birth weight infants as early after delivery as possible is desirable. This study has shown that home visit interventions are worthwhile for mothers only beyond the approach as an essential factor in ability of facilitating a growth fostering environment. In conclusion. the intervention program of this study was very effective in enhancing the parenting for the mothers of low-birth weight infants, resulting in health promotion of low-birth weight infants. The home-visit outreach intervention program of this study will contribute to the health delivery system in this country where there is a lack of continuous follow-up programs for low-birth weight infants after discharge from NICU, if it is activated as part of the home visit programs in community health systems.

• 대한간호학회지
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• 제26권1호
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• pp.165-176
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• 1996

The purpose of this study was to contribute to family nursing in the areas of reducing stress and improving coping for parents of mentally retarded children. Data were collected through self-report questionnaires during a period of 2 months between November 1994 and January 1995 in the Kyoung-in area. The subjects consist of 176 parents (88 mothers and 88 fathers) of mentally retarded children attending schools for the handicapped. The levels of general stress and of parental role stress were measured with the General stress scale and the Parental role stress scale, respectively. The coping scale developed by Folkman ＆ LaZarus was adopted to measure the level of coping, and the patterns of adaptation scale developed by Damrosch ＆ Perry was adopted to measure the patterns of adaptation. The data were analyzed by a SAS program using Fisher's exact test, paired t-test, and oneway ANOVA. The results are as follows ; 1. The level of general stress was significantly higher in mothers than in fathers. Mothers experienced a significantly greater level of parental role stress than fathers did. No significant difference in the level of coping was observed between mothers and fathers. There were differences in maternal and paternal patterns of adaptation. 2. The adaptation pattern of fathers was different according to their level of general stress, parental role stress and coping. The adaptation pattern of mothers was not different according to their level of general stress and parental role stress, but was according to their level of coping. 3. General stress experienced by fathers was different according to education, health status and support from their spouses. Satisfaction with family life, satisfaction with spouse and the support from spouse influenced coping used by fathers. Their level of parental role stress was not associated with any of their general characteristics. 4. In mothers, the level of general stress was different according to their health status, the level of parental role stress was related to satisfaction with family life and satisfaction with spouse. Their level of coping was associated with the sup port from spouse. The above findings indicate that mothers did not have more coping strategies than fathers did, despite the results which showed that mothers experienced greater stress than fathers did. Especially, the adaptation pattern of mothers was different according to their level of coping. Hence, nursing interventions directed at managing stress and improving coping should be used with mothers who use adaptation pattern 1. In particular, fathers should actively participate in parenting, and support their spouses.

• 부모자녀건강학회지
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• 제5권2호
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• pp.253-276
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• 2002

Mother and infant relationship has a great influence on child's developments. Expecially, mother and infant relationship is affected by mother and infant interactions during one year after birth and an omen of mother-infant interaction after birth is mother-fetus interaction. This study was conducted to develop mother-fetus interaction promotion program of talking and tactual stimulation aimed at enhancing sensitivity of primiparas and to evaluate the effect of the nursing intervention program on mother-fetus interaction and mother-infant play interaction. Non-eguivalent control group posttest design was used, and Blumer's symbolic interaction theory and Barnard's mother-infant interaction model was used a conceptual framework of this study. Fifty primiparas and infant(26 mother-infant dyads for intervention group and 24 dyads for control group) were recruited from three general hospital and an OBGY clinic located in Kwang Nung city. Data was collected from January 30th to December 20th in 2001. For the intervention group, programed education which focused on mother-fetus interaction in the 1st trimester. Telephone counselling was provided with interval of two weeks. For two groups, home visiting for data collection of mother- fetus interaction was conducted at 36 to 38 weeks of gestational age. And mother-infant play interactions were assessed at 4 to 6 weeks after birth using videotapes. Play situations were videotaped and two trained observers analyzed the tapes. The data were analyzed using chi-square test and Fisher's Exact Test to test the equivalence of two groups, and the effect of intervention progrom was determined with t-test and Wilcoxon Rank Sum test. The results were as follows: 1. The significant difference was found in mother-fetus interaction between two groups(t=2.085, P=0.0425). It indicated that intervention progrom was effective in improving mother-fetus interaction. 2. The significant difference was found in mother-infant play interaction between two groups(W=347.5, P=0.0001). In subscale analysis, three subscales showed significant differences between the groups: interactional behavior of mother(t=5.921, P=0.0001), interactional behavior of infant(t=5.736, P= 0.0000), and synchronic interactional behavior of mother and infant(t=7.940, P= 0.0000). In conclusion, this study has shown that the applied nursing intervention aimed at enhancing sensitivity of primiparas promoted mother-fetus interaction and mother-infant play interaction. Therefore, this study suggests that this nursing interventions to increase maternal sensitivity to the fetus's movement should be broadly applied to primiparas, which can be beneficial for formation of mother - infant relationship, and for promotion the social, affective, and cognitive developments of their children.

• Child Health Nursing Research
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• 제6권2호
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• pp.119-131
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• 2000

The purpose of this study was to identify the trends and contents of intervention towards children using meta analysis, to support the basis for using in the field and research method about nursing intervention. We used 27 materials which was reported from 1970 to August, 1999 : dissertation study and Korean Nurses' Academic society Journals, the Journal of Korean Academic society of Adult Nursing, The Korea Journal of Maternal and Child Health Nursing. The types of intervention we used came from 3 different researchers. Snyder showed cognitive, movement, social sensory intervention. McCloskey & Bulechek categorized as the following : self-care assistance, acute care management, life-style alteration, health promotion, life support intervention, Craft & Denehy classified psychosocial intervention and biophysiological intervention. Some findings are summarized as follow : Out of the 27 researches sensory intervention had the most in there thesis, recently cognitive intervention research has a tendency to increase. 18 researches has acute care management in there theses, and health promotion was found the least. Out of the 27 thesis 15 thesis was classified as biophysiological intervention and 12 had psychosocial. 27 thesis had 11 types of interventions which originally was categorized by Snyder, therefore sensory intervention thesis had the most. 11 types of intervention which originally was classified by McClosky & Bulechek, teaching and information had the most out of acute care management. Out of 27 thesis, 14 had dealt with newborns, especially newborns with sensory intervention. Therefore school age and above had cognitive intervention which was used for teaching and information. Infants, preschool, schoolage children received acute care management the most, health promotion intervention was used towards adolescences. Depending on the characteristics of dependent variables, it was analysed using meta however 17 thesis are possible except primary experimental research. Mean effect size comparison by Snyder classification, cognitive intervention was the largest mean(1.51), sensory intervention was larger(0.71) also, movement intervention was in the middle(0.56) as shown. Comparison done by McClosky & Bulechek, the intervention leading to life style alteration was the largest mean(1.97), teaching was used the most. Comparison by Craft & Denehy classification, psychosocial intervention was larger(1.15) than biophysiological intervention (0.67). The result of nursing intervention through age classification, the largest weighted mean effect size in the research was towards infants and neonates. The research which was focused on nursing intervention, has important meaning in nursing practice and knowledge development. When we know that children's nursing intervention is necessary and overcome our biased view, efficiency of children's nursing intervention are increased and professionalized. Therefore results will be important basic data to guide a development of child nursing intervention & classification.

• 대한지역사회영양학회지
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• 제11권4호
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• pp.449-458
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• 2006

The purpose of this study was to determine the characteristics of infants' temperaments and eating behaviors, mothers' eating behaviors and feeding practices in poor eating infants. The participants were 80 infants of 12-24 months (27 poor eaters and 53 matched normal controls) from a hospital and a public health center. Mothers were questioned about their eating behaviors and feeding practices, and infants' temperaments, eating behaviors, and nutrient intakes by one day food recall. Subjects were divided by mean nutrient adequacy ratio (MAR, < 0.75; poor eater). Intakes of Ca, P, Fe, Zn, thiamin, riboflavin, niacin, vitamin C, E, folate were below 75% RDA in poor eaters, whereas protein, thiamin, riboflavin, vitamin B$_6$, C, folate exceeded 125% RDA in good eaters. Rhythmicity of infants' temperaments and eating behaviors, restriction of mothers' eating behaviors and feeding practices were significantly lower, whereas activity levels of infants' temperaments were higher than good eaters. In multiple logistic regression model of poor eaters, activity of infants' temperaments (T, OR: 1.19, CI: 1.05 - 1.35) and attention spans of infants' eating behaviors (A, OR: 1.18, CI: 1.03 - 1.35) were significantly positive, whereas rhythmicity of infants' eating behaviors (R, OR: 0.79, CI: 0.61-0.94) was significantly negative [E (the legit) : -6.8644+0.1712$\times$T-0.2337$\times$R+0.1641$\times$A]. Our findings suggest that examination of eating behaviors, feeding practices, and temperaments will help target interventions to improve infants' food intakes, and these variables should be examined at the time of nutrition counseling.

• 정신신체의학
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• 제15권1호
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• pp.22-28
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• 2007

임신과 출산은 일부 여성들을 주요우울증 발병에 취약하게 한다. 산모의 10%에서 출산 후 수주 이내에 산후 우울증이 발병하며 이는 장차 아동의 인지적, 정서적 발달에 부정적 영향을 줄 수 있다고 알려졌다. 임신 중 우울증은 상대적으로 간과되어 왔지만 산후 우울증과 마찬가지로 흔하며 임산부의 정신병리가 태아의 생리 발달에 영향을 미친다는 증거가 축적되고 있어 주목을 받고 있다. 임신 및 출산과 관련된 우울증의 원인을 이해하기 위해서는 다양한 정신사회학적, 생물학적 위험 요인을 포괄적으로 고려할 필요가 있다. 임신과 관련된 우울증을 치료하기 위해 정신과 의사는 임신 및 치료 방법과 관련된 여러 가지 상황의 위험 혹은 이득을 포괄적으로 분석해야 하며 치료 방법을 능숙하게 결정할 수 있어야 한다. 임신 중 우울증에는 심리치료, 약물치료, 전기 충격 요법 등이 효과적이라고 알려져 있다. 산후 우울증을 치료하는 데에는 생물학적, 심리학적, 환경적 개입 등의 방법이 있으며, 구체적으로는 세로토닌 재흡수 억제제 등의 항우울제, 지지적 상담 등의 효과가 증명되었고, 증상이 심할 경우에는 Estrogen이 효과적이라고 알려져 있다. 한편, 임신 및 출산과 관련된 우울증의 신경내분비학적, 심리사회학적 병인을 규명하기 위한 연구들이 진행되고 있다. 향후 임산부의 산전 및 산후 관리에 있어서 임상각과 간의 통합적인 접근에 의한 우울증의 조기 진단 및 치료가 필요할 것으로 보인다.

• 여성건강간호학회지
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• 제7권3호
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• pp.241-255
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• 2001

This is a cross-sectional descriptive study which compares the level of postpartum women's physical, phychological, neurosensory fatigue between rooming-in and non rooming-in groups. The data were collected by using self-report questionnaire from April 1 to May 31, 2001. Subjects were 68 mothers who opted the rooming-in choice and 98 mothers who did not choose the rooming-in at one hospital in Seoul, Korea. They all had NSVD. The research questionnaire consisted of 36 items on general chracteristics and 30 items on postpartum fatigue developed by Pugh (1993). The data were analyzed by using the SPSS 10.0 window program. The results of this study were as follow: 1. There was significant statistical difference in general characteristics between rooming-in and non rooming-in groups in prenatal class attendance ($x^2$=3.935, p=0.047), maternal fetal attachment score (t=2.130, p=0.035), husband attendance during the labor and delivery ($x^2$=9.147, p=0.002), breast feeding ($x^2$=12.503, p=0.000), and self feeding time including bottle feeding (t=4.588, p=0.000). 2. There was no significant statistical difference in the level of total fatigue score between two groups (t=0.282, p=0.780). 3. The physical and neurosensory fatigue scores were slightly higher in rooming-in group ($21.63{\pm}4.92$, $18.53{\pm}4.60$) than those ($20.71{\pm}5.78$, $18.23{\pm}5.39$) of non rooming-in group. And the phychological fatigue score was slightly higher in non rooming-in group ($17.67{\pm}4.95$) than that ($17.04{\pm}4.63$) of rooming-in group. However, there was no significant statistical difference in the level of three sub-dimension fatigue between two groups (t=1.068, p=0.287; t=-0.827, p=0.410; t=0.368, p=0.714). 4. Even after controlling characteristics showed significant differences between two groups, there was no significant statistical difference in the level of fatigue between two groups (F=0.135, p=0.714). According to this study, there was no significant statistical difference in the level of postpartum fatigue whether they were rooming-in or not. Based on this result, the common notion of rooming-in mothers will be more fatigue than non rooming-in mothers is proved to be false. However, it is necessary to develop appropriate nursing interventions to meet the need of mothers who decide to rooming-in.

• Journal of Preventive Medicine and Public Health
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• 제34권4호
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• pp.337-346
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• 2001

Objective : To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. Methods Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. Results : The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. Conclusions : Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.