Withholding Enteral Feeding and Its Clinical Consequences in Extremely Low Birth Weight Infants during NICU Stay / 대한주산의학회잡지

PURPOSE: To evaluate the causes of nil per os (NPO) before reaching full enteral feeding and compare the clinical outcomes of extremely low birth weight infant (ELBWI) by NPO duration. METHODS: We retrospectively reviewed the medical records of 92 ELBWI who were born and admitted to Neonatal intensive care unit (NICU) of Seoul National University Children's Hospital from January 2009 to December 2011. We analyzed the perinatal factors and causes of NPO. To compare neurodevelopmental outcomes and growth, we used K-ASQ (Korean ages & stages questionnaires) and growth Z-score. RESULTS: There were total 163 fasting episodes before reaching full enteral feeding. Mean NPO time was 6.7+/-5.6 days and mean frequency of NPO was 1.8 episodes. Most common cause of NPO was the medication for patent ductus arteriosus (PDA) closure (47.5%) and the next was the feeding intolerance (25.3%). Longer NPO group (more than 7 days) showed longer time to full enteral feeding and hospital day. Incidence of necrotizing enterocolitis was significantly higher in the longer NPO group. But there was no difference between two groups in the incidence of sepsis, cholestasis, and osteopenia. Changes in height Z-score from birth to postmenstrual age 35 weeks were significantly higher in the longer NPO group. In longer NPO group, catch-up of weight Z-score at CA 8 months was poor. And number of patients with score under cutoff level in K-ASQ was higher. CONCLUSION: NPO duration seems to be related with long term growth and neurodevelopment. Effort to minimize fasting time is needed by keeping enteral feeding during PDA medication and active management for feeding intolerance.

A Case of Non-Immune Hydrops Fetalis due to Umbilical Venous Malformation and Noonan Syndrome / 대한주산의학회잡지

Anomalies of the fetal venous system are rare. Major portion of fetal venous anomalies are malformation of umbilical vein and ductus venosus. Abnormal umbilico-systemic shunt, bypassing the ductus venosus makes direct connection between the high-pressure umbilical system and the low-pressure systemic system. And it makes adverse to the fetal hemodynamics. Fetal hemodynamic distress may induce fetal growth retardation, hepatomegaly, cardiomegaly, hydrops fetalis and fetal death. We report a case of non-immune hydrops fetalis which was associated with abnormal umbilical vein pathway. Our patient had bifurcated umbilical veins. Main branch of umbilical vein was drained directly to the left internal iliac vein and another branch was drained to the portal vein. After birth, extrahepatic shunt through main branch of umbilical vein that bypassed the portal system was persisted and thrombocytopenia was combined due to consumption in thrombus of a dilated anomalous umbilical vein. Later this case was diagnosed as Noonan syndrome with a genetic testing.

Foodservice Management and Food Safety Knowledge and Practices of Employees in Elderly Welfare Facilities

This study examined the current status of foodservice management in elderly welfare facilities and evaluated food service workers' food safety practices and knowledge. For this, the directors of 20 elderly welfare facilities (each with fewer than 50 residents) located in Seoul were interviewed and a survey of 40 foodservice workers was conducted to determine their food safety knowledge and practices. The facilities accommodated an average of 28 residents. All the facilities were self-operated and approximately 62% were dependent on payments by residents. Only 15% had a dietitian in charge of menu planning, food purchasing, and food safety management. Approximately 50% had their facility managers take responsibilities for menu planning and food safety management. Most of the facilities provided food safety training within their own facility and sanitized their utensils, cutting boards, and dishcloths on a daily basis. A limited number of foodservice workers, insufficient training programs, and budget constraints were some of the major barriers to food safety management. Their average score on food safety practices was 1.62, and that on food safety knowledge was 17.6 out of 19 points. These results indicate that the foodservice workers had good food safety knowledge and appropriate food safety practices. There was a significant correlation only between food safety practices related to receiving and storing food products and knowledge of personal hygiene.