• Clinical and Experimental Pediatrics
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• 제58권8호
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• pp.301-308
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• 2015

Purpose: We evaluated three blood glucose self-monitoring for measuring whole blood glucose levels in preterm and low-birth-weight infants. Methods: Between December 1, 2012 and March 31, 2013, 230 blood samples were collected from 50 newborns, who weighed, ${\leq}2,300g$ or were ${\leq}36$ weeks old, in the the neonatal intensive care unit of Eulji University Hospital. Three blood glucose self-monitoring (A: Precision Pcx, Abbott; B: One-Touch Verio, Johnson & Johnson; C: LifeScan SureStep Flexx, Johnson & Johnson) were used for the blood glucose measurements. The results were compared to those obtained using laboratory equipment (D: Advia chemical analyzer, Siemens Healthcare Diagnostics Inc.). Results: The correlation coefficients between laboratory equipment and the three blood glucose self-monitoring (A, B, and C) were found to be 0.888, 0.884, and 0.900, respectively. For glucose levels ${\leq}60mg/dL$, the correlation coefficients were 0.674, 0.687, and 0.679, respectively. For glucose levels>60 mg/dL, the correlation coefficients were 0.822, 0.819, and 0.839, respectively. All correlation coefficients were statistically significant. And the values from the blood glucose self-monitoring were not significantly different from the value of the laboratory equipment, after correcting for each device's average value (P>0.05). When using laboratory equipment (blood glucose ${\leq}60mg/dL$), each device had a sensitivity of 0.458, 0.604, and 0.688 and a specificity of 0.995, 0.989, and 0.989, respectively. Conclusion: Significant difference is not found between three blood glucose self-monitoring and laboratory equipment. But correlation between the measured values from blood glucose self-monitoring and laboratory equipment is lower in preterm or low-birth-weight infants than adults.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.247-251
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• 2005

미숙아에서 드물기는 하나 심한 복부 팽만과 담즙이 섞인 구토, 혈변 등의 증상이 비교적 일찍 초래되는 경우 장중첩증을 감별 진단으로 고려하여야 한다. 저자들은 극소 저출생 체중 미숙아에서 괴사성 장염과 유사한 증상을 보였으나 생후 11일경에 수술로 진단된 회장 폐쇄를 동반한 태생기 회장-회장형 장중첩증 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Child Health Nursing Research
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• 제24권2호
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• pp.252-261
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• 2018

Purpose: This study aimed to evaluate the effects of an empowerment program on maternal stress, anxiety, depression and parenting confidence. Methods: A total of 44 mothers of preterm infants were assigned into an experimental or a control group (n=22 each). The experimental group received the usual nursing care and 7 sessions of an empowerment program. The control group only received the usual care. The program was implemented from June to December, 2016 in the neonatal intensive care unit of K university-affiliated hospital in Daegu, Korea. The outcome variables measured were parental stress (PSS: NICU), anxiety (STAI), depression (CES-D) and parenting confidence. Data were analyzed using t-test or repeated measures ANOVA. Results: Scores for both parental stress (t=3.07 p=.004) and depression (F=3.76, p=.26) were significantly lower in the experimental group than in the control group. However, there were no significant differences in anxiety between the groups (F=0.79, p=.505). Parenting confidence scores (F=9.05, p=.001) were significantly higher in the experimental group than in the control group. Conclusion: A maternal empowerment program can be an effective means of reducing parental stress and depression as well as enhancing parenting confidence, for mothers of preterm infants.

• Clinical and Experimental Pediatrics
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• 제63권2호
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• pp.48-51
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• 2020

Background: The etiopathogenesis of late preterm (LPT) birth is undetermined. Placental histopathology, which reflects an adverse intrauterine environment and is reportedly associated with preterm labor and neonatal morbidities, has not been studied in LPT infants. Purpose: We investigated placental pathological lesion as markers of an adverse intrauterine environment during LPT labor. Methods: This retrospective case-control study compared placental histopathological and clinical variables between LPT and term neonates. Placental variables included chorioamnionitis, funisitis, hemorrhage, abruption, infarction, calcification, and syncytial knots. Maternal variables included age, substance abuse, pregnancyassociated diabetes mellitus and hypertension, duration of rupture of membrane, antibiotic use, and magnesium sulfate, whereas, those of neonates included gestational age, birth weight, race, sex, and Apgar scores. Standard statistical proedures were applied to analyze the data. Results: Chorioamnionitis (50% vs. 17.8%, P<0.001) and funisitis (20% vs. 4.4%, P=0.002) were more common in term infants. Placental infarction rate was insignificantly higher in LPT infants (25.6% vs. 14.3%, P=0.08). The mothers in the LPT group were older (30.4 years vs. 28.1 years, P=0.05; odds ratio [OR], 1.06; 95% confidence interval [CI], 0.998-1.12, P=0.056) and more often suffered from hypertension (28.9 vs. 12.9 %, P=0.02), and received magnesium sulfate (48.9 vs. 20%, P< 0.001; OR, 2.86; 95% CI, 1.12-7.29, P<0.05). Duration of rupture of membrane was higher in term infants (13.6 hours vs. 9.1 hours, P<0.001). Chorioamnionitis (OR, 0.33; 95% CI, 0.13-0.79; P<0.05) was associated with a lower risk of LPT delivery. Conclusion: Placental infection is not a risk factor for LPT births. There is a nonsignificant predominance of vascular anomalies in LPT placentas. Higher maternal age, magnesium sulfate therapy, and maternal hypertension are clinical risk factors for LPT labor.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권4호
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• pp.238-245
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• 2015

Purpose: The aim of this study was to evaluate bolus transit during esophageal swallow (ES) and gastroesophageal reflux (GER) events and to investigate the relationship between the characteristics of ES and GER events in a population of term and preterm newborns with symptoms of gastroesophageal reflux disease (GERD). Methods: The study population consisted of term and preterm newborns referred to combined multichannel intraluminal impedance (MII) and pH monitoring for GERD symptoms. The frequency and characteristics of ES and GER events were assessed by two independent investigators. Statistical significance was set at p<0.05. Results: Fifty-four newborns (23 preterm) were included in the analyses. Median bolus head advancing time corrected for esophageal length (BHATc) was shorter during mealtime than during the postprandial period (median, interquartile range): 0.20 (0.15-0.29) s/cm vs. 0.47 (0.39-0.64) s/cm, p<0.001. Median bolus presence time (BPT) was prolonged during mealtime: 4.71(3.49-6.27) s vs. 2.66 (1.82-3.73) s, p<0.001. Higher BHATc (p=0.03) and prolonged BPT (p<0.001) were observed in preterm newborns during the postprandial period. A significant positive correlation between BHATc and bolus clearance time was also observed (${\rho}=0.33$, p=0.016). Conclusion: The analysis of ES and GER events at the same time by MII provides useful information to better understand the physiopathology of GERD. In particular, the analysis of BHATc during the postprandial period could help clinicians identify newborns with prolonged esophageal clearance time due to impaired esophageal motility, which could allow for more accurate recommendations regarding further tests and treatment.

• 대한간호학회지
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• 제46권6호
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• pp.793-803
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• 2016

Purpose: Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants. Methods: Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015. Results: The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; 'environmental support' (4 items), 'parental support' (3 items), 'interaction' (3 items), 'critical thinking' (3 items), 'professional development' (3 items), and 'partnership' (3 items). The Cronbach's ${\alpha}$ coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76. Conclusion: The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

• Perinatology
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• 제29권4호
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• pp.159-164
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• 2018

Objective: To compare neonatal respiratory morbidity of twins according to birth order related to gestational age and mode of delivery. Methods: We performed the retrospective research of the medical records of 3,224 neonates (1,612 twin pairs) born in a single center from January 2011 to December 2015. Subjects were classified into four gestational age groups: very (<32 weeks), moderate (32-33 weeks), late (34-36 weeks) preterm, and term (${\geq}37weeks$) groups. We investigated clinical characteristics and respiratory morbidity according to birth order related to gestational age group and mode of delivery. Results: We found increased risk of respiratory morbidity in second-born twin than first-born twin (P=0.039). Second-born twin was associated with increased risk of respiratory distress syndrome (RDS) in late preterm group (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.30-5.95), and transient tachypnea of newborn in term group (OR 1.4, 95% CI 1.03-1.81). In vaginal delivery mode, there was no difference of respiratory morbidity between first and second-born twin in each group, but in cases of Cesarean delivery, second-born twin was related with a greater risk of RDS in late preterm group (OR 2.3, 95% CI 1.07-5.09). Birth order and Cesarean section independently increased the risk of RDS (adjusted OR [aOR] 1.69, 95% CI 1.12-2.54; aOR 2.14, 95% CI 1.25-3.66, respectively). Conclusion: Second-born twin and Cesarean delivery are associated with increased risk of RDS, especially in late preterm twins.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권1호
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• pp.39-45
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• 2009

목 적: 영양지원팀(nutritional support team, NST)은 영양부족이 위험성이 있는 환자에게 영양을 효율적으로 제공하기 위해 운영된다. 미숙아는 소화, 흡수의 미숙, 비축된 영양의 부족, 요구량의 증가, 다양한 질환에의 이환으로 인하여 영양 불균형의 위험성이 높으며 경구영양이 완전히 진행되기까지는 총정맥영양(total parenteral nutrition, TPN)에 의존하므로 적극적인 영양지원을 필요로 한다. 이에 본 연구에서는 NST 활동이 신생아중환자실에 입원하여 TPN을 투여 받는 미숙아들의 임상경과에 미치는 영향을 검토함으로써 NST의 임상적 의의를 평가하고자 하였다. 방 법: 2003년 7월에서 2006년 7월까지 분당서울대 병원 신생아중환자실에 입원하여 TPN을 시행 받은 미숙아 48명을 대상으로 하여 후향적으로 의무기록을 검토하였다. 대상 환아들을 NST 활동 여부에 따라 각각 NST 설립 이전 시기인 2003년 7월에서 2005년 2월까지 입원한 미숙아군과 NST 활동 시기인 2005년 3월에서 2006년 7월 사이에 입원한 미숙아군으로 나누어 각 군에서의 임상 지표들을 비교분석하여 NST 활동이 미치는 영향을 평가하였다. 통계학적 분석을 위해 Mann-Whitney 검정과 Fisher's exact test를 적용하였고, pvalue 0.05 미만을 통계적으로 유의하다고 판정하였다. 결 과: 대상 환아 48명(남아 27명, 여아 21명)의 재태기간은 평균 $28^{+1}$주(범위: 25주~$32^{+6}$주), 출생체중은 평균 1,008.5${\pm}$242.5 g (범위: 520~1,490 g), 재원기간은 평균 74${\pm}$40일(범위: 26~274일)이었다. 영양사, 약사 또는 NST가 환아의 TPN에 개입하기까지의 기간이 NST 활동 전에는 14.8${\pm}$21.0일 소요되었으나 NST 활동 이후 0.5${\pm}$2.0일로 유의하게 감소하였다(p=0.000). TPN 투여기간은 NST 활동 전의 41.5${\pm}$26.2일에서 NST 활동 후에는 20.5${\pm}$16.6일로 유의하게 감소하였다(p=0.001). TPN을 통해 투여된 칼로리는 NST 활동 전후로 각각 88.1${\pm}$19.0 kcal/kg/day와 98.8${\pm}$8.2 kcal/kg/day로서 유의하게 상승하였고(p=0.016), 단백 투여량은 각각 2.74${\pm}$0.50 g/kg/day와 3.36 g/kg${\pm}$0.34 g/kg/day (p=0.000), 지방 투여량은 각각 2.53${\pm}$0.86 g/kg/day와 3.40 g/kg${\pm}$0.52 g/kg/day로서 두 군 간에 유의한 차이를 보였다(p=0.000). 환아들의 금식기간이 NST 활동 전후 각각 10.5${\pm}$11.3일과 5.9${\pm}$7.3일로서 NST 활동 시작 후 유의하게 감소하였으며(p=0.017), 환자들이 완전 경장영양으로 진행하기까지 소요된 기간도 각각 44.7${\pm}$26.1일과 24.0${\pm}$17.6일로 NST 활동 후 의미 있게 감소하였다 (p=0.001). 항생제 투여기간도 NST 활동 전의 34.8${\pm}$30.8일에서 NST 활동과 더불어 15.6${\pm}$15.2일로 유의하게 감소하였다(p=0.007). 결 론: 신생아중환자실에 입원한 미숙아에게 있어 NST 활동에 의한 적극적인 영양지원은 적절한 영양을 공급하여 영양상태를 개선하는 측면과 더불어 임상적 측면에서도 장점이 있으므로 미숙아의 영양지원에 있어 NST 활동이 갖는 의의가 크다고 하겠다.

• Clinical and Experimental Pediatrics
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• 제51권6호
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• pp.616-621
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• 2008

목 적 : 미숙아에서는 선천 부신 과형성에 대한 선별검사의 위양성률이 높으나 이에 대한 추적관찰의 기준이 명확하지 않다. 이에 저자들은 소집단에서의 선별검사 결과를 통해 미숙아에서의 선천 부신 과형성에 대한 선별검사의 해석 방법 및 합리적인 추적관찰의 방법을 알아보고자 하였다. 방 법 : 2005년 1월부터 2007년 6월까지 서울대학교 병원 및 분당 서울대학교 병원에서 태어난 미숙아 중, 생후 7일 이내에 전혈에서의 17-OHP를 효소 면역측정법으로 검사한 427명을 대상으로 하였다. 이들에서 17-OHP 값과 재태 기간, 출생체중, 전신적 질환 및 출생 전에 투여 받은 덱사메타손과의 관계를 분석하였고, 17-OHP의 변화의 경향을 알아보았다. 결 과 : 대상 미숙아들의 17-OHP 선별검사의 값은 매우 다양하였다(범위 0.1-143.3 ng/mL). 17-OHP 선별검사 값은 재태 기간(r=-0.535, P<0.01), 출생체중(r=-0.435, P<0.01), 5분 Apgar 점수(r=-0.431, P<0.01)와 유의한 음의 상관관계가 있었다. 17-OHP 선별검사 값은 출생 후 신생아 호흡 곤란 증후군(P<0.05), 동맥관 개존증(P<0.01) 또는 기관지폐 형성 이상(P<0.01)이 있었던 군에서 유의하게 높았으며, 생후 1주 이내에 치료가 필요한 저혈압이 있었던 미숙아에서 유의하게 높았다(P<0.05). 17-OHP 선별검사 값은 선별검사 7일 이내에 산모가 덱사메타손 투여 받은 군에서 투여 받지 않은 군에 비해 유의하게 낮았다(P<0.05). 17-OHP 값이 안정범위까지 감소하는데 걸리는 시간의 정중값은 42일이었으며, 이 기간은 재태 기간과 유의한 음의 상관관계가 있었고(r=-0.541, P<0.01), 기관지폐 형성 이상이 있었던 경우에 유의하게 연장되었다(P<0.01) 전체 대상 중 추적 관찰 시 선천 부신 과형성으로 확진된 경우는 없었다. 결 론 : 미숙아에서의 17-OHP 선별검사 값은 그 편차가 매우 크며, 재태 기간이 어릴수록 높은 경향이 있고 출생 전 dexamenthasone 투여 및 출생 후 질환에 의해 영향을 받는다. 미숙아의 선별검사를 해석할 때에는 이를 고려해야 하며, 혈액 검사의 수치와 미숙아의 임상 양상을 종합하여 추적관찰의 방법을 결정해야 할 것으로 생각한다.

• Neonatal Medicine
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• 제18권1호
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• pp.104-110
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• 2011

목적: 미숙아에게 필요한 영양성분을 알기 위해서는 그들의 모유 성분을 분석하는 것이 도움이 된다. 저자들은 미숙아 모유의 장기적인 철분함량의 변화를 관찰하고 만삭아 모유와 비교하였으며, 이를 토대로 모유수유만 하는 미숙아에서 철분 보충의 필요성과 지침에 대해 알아보고자 하였다. 방법: 재태연령 34주 미만이거나 출생체중 1,800 g 미만의 미숙아를 출산한 산모 103명으로부터 생후 1, 2, 4, 6, 8, 12주의 모유를 수집하였고, 만삭아의 모유는 24명의 산모로부터 생후 1주째에 수집하여 철분함량을 분석하였다. 결과: 생후 2주에서 8주 사이의 미숙아 모유내의 철분함량은 유의한 차이가 없었으며(36.3${\pm}$23.1~45.8${\pm}$26.0 $\mu$g/dL), 이는 생후 1주째의 미숙아모유 (23.1${\pm}$14.6 $\mu$g/dL)나 만삭아 모유(25.2${\pm}$7.55 $\mu$g/dL)의 철분함량보다는 유의하게 높았다. 교정나이로 만삭이 된 미숙아의 모유(42.2${\pm}$19.4 $\mu$g/dL)는 만삭아의 모유보다 유의하게 높은 철분함량을 나타내었다. 결론: 미숙아 모유의 철분함량은 생후 3개월까지 큰 차이가 없었으며, 이는 필요량보다 적어 모유수유만 할 경우 AAPCON(2004)에서 권유하는 대로 2 mg/kg/day의 철분을 보충하는 것이 좋겠다.