Survey on the Status of Breastfeeding in Korean Medical Institution Workers

Background@#Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. @*Methods@#A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. @*Results@#Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. @*Conclusion@#In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.

Introduction of Community-Based Preconception Care for Men and Women of Childbearing Age in Seoul

Community-based preconception care for men and women of childbearing age has been introduced in Seoul. The program aims to focus on problem areas such as low birth rate, fertility issues potentially due to late marriages, preterm or premature births, and low-birthweight in newborn babies. The district administration officials of Seoul, as well as, academics from the Korean Society of Maternal and Child Health, developed a protocol by using a questionnaire and laboratory test for screening risk factors in pregnancy. The protocol was tested on a trial basis in four local districts in Seoul from July 2017 to 2018, extended to 12 local districts in 2019, and all 25 districts in Seoul in 2020. The protocol includes AntiMullerian Hormone tests to assess women’s ovarian reserve and male health checkups that include semen analysis and physical examinations of genitalia. These tests are conducted for early detection and treatment of infertility, especially in cases of late marriages. In order to prevent women being abandoned during pregnancy (leading them to single-parenting), the protocol also emphasizes building a gender-sen sitive environment by encouraging more male participation. A monitoring group comprised of Seoul city district officials and academics from the Korean Society of Maternal and Child Health, regularly visited the local districts to observe improvements and keep the program officials up to date. In addition, the group also conducted a mobile phone survey for feedback on the program. The interest and support of the resi dents in Seoul city, and positive results and development in pregnancy care and childbirth, are needed to stabilize and extend this protocol.

Central line-associated bloodstream infections in the neonatal intensive care unit / 소아과

No abstract available.

Analysis of Maternal Child Health Services in Korea to Promote the Health of the High Risk Newborn in Times of 70 Years after Liberation and Division

Korea is one of the countries where the fertility rates are very low. Non-marriage and delayed marriage result in the high risk pregnancy. The high risk pregnancy increases the birth rate of the high risk newborn, causing the recent increase in the number of preterm infants. The high risk newborn should be treated in the neonatal intensive care unit. After discharge, the specific follow-up program should be continued until 2~3 years of age. The burden of the costs of high risk newborn plays a substantial role in the low fertility rate in Korea. The government should analyse the current maternal child health service system in the country. After a critical review, more specified support should be given to the family whose high risk newborn should be cared properly.

The Readmission of Preterm Infants of 30-33 Weeks Gestational Age within 1 Year Following Discharge from Neonatal Intensive Care Unit in Korea

PURPOSE: This study was conducted to evaluate the readmission rate of preterm infants of 30-33 weeks gestational age (GA) within 1 year following discharge from the neonatal intensive care unit (NICU). METHODS: This research was a part of the Retrospective Study to Evaluate Rehospitalization & Health Care Utilization after NICU Discharge in Preterm Infants (< or =33 weeks) II (RHANPI II) project conducted by the Committee on Data Collection and Statistical Analysis of the Korean Society of Neonatology. Enrolled infants (n=1,257) of 46 hospitals from April to September 2012, were retrospectively studied. RESULTS: The average GA and birth weight of the study population was 32(+2)+/-1(+1) weeks and 1,785+/-386 g, respectively. The cumulative readmission rate during the 360 days following discharge from the NICU was 27.3%. The cumulative readmission rate according to GA was 36.4%, 30.1%, 25.9% and 22.7% for infants born at 30, 31, 32 and 33 weeks GA, respectively. The corresponding respiratory readmission rate was 16.3%; this was 59.8% of total readmissions. There was no significant difference in the respiratory readmission rate according to GA group (log-rank test for trend, P-value=0.0558). Of the infants who were readmitted with respiratory problems, 57.0% (n=53/93) tested positive for respiratory syncytial virus (RSV). CONCLUSION: The cumulative readmission rate during the 360 days following discharge from the NICU was 27.3%. Respiratory problems were the most common cause of readmission, and RSV was the most common virus associated with respiratory readmission. Additionally, there was no difference in the rate of respiratory readmission according to GA group.

Electronic Medical Records in Neonatal Intensive Care Unit

With developing information technology, hospital information systems such as computerized provider order entry system (CPOE) and picture archiving and communication system (PACS) are being increasingly used by many hospitals. The hospital information systems improve the efficiency of hospital management and patient care. Currently, electronic medical records (EMR) are not used as much as CPOE and PACS. However, EMR will soon be the cornerstone of hospital patient care systems. Because EMR for the neonatal intensive care unit (NICU) is different from that for adult care unit, neonatologists should have a basic knowledge of EMR and should play an important role in implementing EMR system in NICU.

Animal Models of Periventricular Leukomalacia / 한국실험동물학회지

Periventricular leukomalacia, specifically characterized as white matter injury, in neonates is strongly associated with the damage of pre-myelinating oligodendrocytes. Clinical data suggest that hypoxia-ischemia during delivery and intrauterine or neonatal infection-inflammation are important factors in the etiology of periventricular leukomalacia including cerebral palsy, a serious case exhibiting neurobehavioral deficits of periventricular leukomalacia. In order to explore the pathophysiological mechanisms of white matter injury and to better understand how infectious agents may affect the vulnerability of the immature brain to injury, novel animal models have been developed using hypoperfusion, microbes or bacterial products (lipopolysaccharide) and excitotoxins. Such efforts have developed rat models that produce predominantly white matter lesions by adopting combined hypoxia-ischemia technique on postnatal days 1-7, in which unilateral or bilateral carotid arteries of animals are occluded (ischemia) followed by 1-2 hour exposure to 6-8% oxygen environment (hypoxia). Furthermore, low doses of lipopolysaccharide that by themselves have no adverse-effects in 7-day-old rats, dramatically increase brain injury to hypoxic-ischemic challenge, implying that inflammation sensitizes the immature central nervous system. Therefore, among numerous models of periventricular leukomalacia, combination of hypoxia-ischemia-lipopolysaccharide might be one of the most-acceptable rodent models to induce extensive white matter injury and ensuing neurobehavioral deficits for the evaluation of candidate therapeutics.

Symptomatic Hepatitis A Virus Infection in a Newborn

Hepatitis A virus (HAV) infection is a common cause of acute hepatitis, but is rarely responsible for neonatal hepatitis. HAV infection is usually transmitted by the fecal-oral route, but during the neonatal period can be transmitted by the intrauterine vertical route or postnatal horizontal route. HAV infection is usually self-limited, but it can be potentially life-threatening in adults. The clinical course and symptoms are mild and the infection can be asymptomatic in newborns. Recently, we experienced a case of symptomatic neonatal hepatitis A. To our knowledge, this is the first case of neonatal hepatitis with HAV infection in Korea.

A Case of Partial Trisomy 9 due to Maternal Balanced Translocation t(9;21)(q21.2;q11.2) / 대한주산의학회잡지

Trisomy 9 syndrome was first reported by Retheore in 1970 and has been rarely reported. This syndrome consists of partial and complete trisomy 9. It is characterized by growth and mental retardation, craniofacial abnormalities including microcephaly, hypertelorism, prominent nose, deep-set ears and down-slanting palpebral fissures. Congenital heart diseases and congenital dislocations of knee are also common in trisomy 9 syndrome. Here, we report a very rare case of partial trisomy 9 due to maternal balanced translocation t(9;21). He showed craniofacial abnormalities, brain malformation, cardiac defect, hydronephrosis and congenital dislocations of hip and knee joints.

A Case of Partial Trisomy 9 due to Maternal Balanced Translocation t(9;21)(q21.2;q11.2) / 대한주산의학회잡지

Trisomy 9 syndrome was first reported by Retheore in 1970 and has been rarely reported. This syndrome consists of partial and complete trisomy 9. It is characterized by growth and mental retardation, craniofacial abnormalities including microcephaly, hypertelorism, prominent nose, deep-set ears and down-slanting palpebral fissures. Congenital heart diseases and congenital dislocations of knee are also common in trisomy 9 syndrome. Here, we report a very rare case of partial trisomy 9 due to maternal balanced translocation t(9;21). He showed craniofacial abnormalities, brain malformation, cardiac defect, hydronephrosis and congenital dislocations of hip and knee joints.

A Case of Gilbert's Syndrome with Severe Neonatal Hyperbilirubinemia

Gilbert's syndrome is caused by a reduction in the activity of uridine diphosphate glucuronosyltransferase (UGT) and induces chronic, non-hemolytic unconjugated hyperbilirubinemia. It has been suggested that 3-10% of the population has Gilbert's syndrome. Commonly, Gilbert's syndrome causes mild symptoms. However, a case of Gilbert's syndrome with severe neonatal hyperbilirubinemia is presented here. The patient developed jaundice three days after birth. Five days after birth, the patient's total serum bilirubin level was 34 mg/dL. The patient received intensive phototherapy and was given oral phenobarbital. Hemolytic hyperbilirubinemia was excluded on the basis of laboratory tests. Heterozygote polymorphisms of the promoter region (-3279T>G) and exon 1 (211G>A) were found in UGT1A1 gene. After discharge, the patient did not require any further treatment. This is the first case of proven Gilbert's syndrome with severe neonatal hyperbilirubinemia in Korea.

A Case of Gilbert's Syndrome with Severe Neonatal Hyperbilirubinemia

Gilbert's syndrome is caused by a reduction in the activity of uridine diphosphate glucuronosyltransferase (UGT) and induces chronic, non-hemolytic unconjugated hyperbilirubinemia. It has been suggested that 3-10% of the population has Gilbert's syndrome. Commonly, Gilbert's syndrome causes mild symptoms. However, a case of Gilbert's syndrome with severe neonatal hyperbilirubinemia is presented here. The patient developed jaundice three days after birth. Five days after birth, the patient's total serum bilirubin level was 34 mg/dL. The patient received intensive phototherapy and was given oral phenobarbital. Hemolytic hyperbilirubinemia was excluded on the basis of laboratory tests. Heterozygote polymorphisms of the promoter region (-3279T>G) and exon 1 (211G>A) were found in UGT1A1 gene. After discharge, the patient did not require any further treatment. This is the first case of proven Gilbert's syndrome with severe neonatal hyperbilirubinemia in Korea.

A Case of Infantile Spasms in Tuberous Sclerosis with Fetal Cardiac Tumors / 대한소아신경학회지

Tuberous sclerosis(TS), a type of neurocutaneous syndrome, is inherited in an autosomal dominant manner. Approximately 60% of children with TS have rhabdomyomas of the heart, and 40% of fetuses in whom rhabdomyomas are detected by a prenatal ultrasonography eventually end up with TS. Therefore, when multiple cardiac rhabdomyomas are detected by a fetal ultrasonography, TS should be suspected and further examination should be considered after birth. Infantile spasms is a common type of seizure among young children with TS. We describe a patient with TS who showed cardiac tumors on a fetal ultrasound. Also, hypomelanotic macules, retinal tumors, brain cortical tubers, nodules in subependymal regions, and infantile spasms was detected after birth.

Neonatal Intestinal Pseudo-obstruction Associated with Deficiency of the Interstitial Cells of Cajal in a Premature Infant

The interstitial cells of Cajal are the pacemakers in the gastrointestinal tract that modulate gastrointestinal motility. A case of a neonate with intestinal pseudo-obstruction caused by a decreased number of the interstitial cells of Cajal is presented. A premature male infant born at 32 weeks of gestation showed progressive abdominal distention beginning 3 days after initiation of enteral feeding at 15 days of life. No etiologic factors were identified on radiologic studies, a gastrographin enema, and an intestinal biopsy other than a markedly decreased number of the intestinal cells of Cajal. An ileostomy, followed by repair of the ileostomy was done, which resulted in but a limited improvement of the abdominal gas pattern. Respiratory distress, pancytopenia, and abdominal distention persisted, and the infant expired on 142 days of life.

Townes-Brocks Syndrome Associated with Hypothyroidism in a Korean Newborn: A Case Report

Townes-Brocks syndrome (TBS) is an autosomal dominant disorder with multiple malformations which include dysplastic ears, hearing loss, preaxial polydactyly and/or triphalangeal thumbs, imperforate anus, renal anomalies, congenital heart defects, and mental retardation. However, hypothyroidism is not a common feature of TBS. There have been only three reported cases of TBS associated with hypothyroidism. We report the first case of TBS associated with hypothyroidism in Korea.

A Case of Intrauterine Intracranial Hemorrhage due to Coagulopathy Caused by Chronic Intrauterine Liver Failure

The term "neonatal hepatitis" is used to designate hepatic inflammation of unknown cause. Liver failure is present with coagulopathy, metabolic instability, cholestasis, or other manifestations. It can be present with a chronic pattern with near normal serum aminotransferases, consistent with a prenatal liver injury. There have been case reports which show intrauterine intracranial hemorrhages associated with trauma, malformations or maternal coagulopathy. However, to our knowledge, there is no report of intrauterine intracranial hemorrhage resulting from fetal coagulopathy caused by chronic prenatal liver injury. We report a rare case of intrauterine intracranial hemorrhage due to intrauterine coagulopathy caused by chronic intrauterine liver failure.

A Case of Simple Renal Cortical Cyst in Neonate

We report a case of simple renal cortical cyst in neonate with review of literature. A female infant weighing 3, 400 g was delivered. Because of single umbilical artery found on physical examination, abdominal ultrasonogram was performed. A 3 mm sized renal cortical cyst was found in right kidney, but no associated symptoms or signs including renal functions were found. Follow up ultrasonogram was performed a month later and it was spontaneously disappeared.

A Case Report of Non-surgical Removal of Fragmented Remnant of Umbilical Vein Catheter Using an Intravascular Snare / 대한주산의학회잡지

Umbilical catheters have been used in NICUs for drawing blood samples, measuring blood pressure, and administering fluid and medications for more than 50 years. When the patient does not need the umbilical catheter or complications associated with umbilical catheters have risen, the catheter must be removed. In this process, the catheter may snap or be cut off and the fragment may migrate to a near vessel or to the heart and cause infection, thrombosis, or arrythmia. We report a case where in the process of removing an umbilical vein catheter, the catheter was stuck to the dried umbilical cord and pulling at it caused the catheter to snap. An immediate roentgenogram showed the fragmented catheter had migrated to the left pulmonary artery. Using an intravascular snare with a femoral approach, we were able to collect the remaining catheter and remove it from the patient's body without any complications.

A Case of Meckel-Gruber Syndrome / 대한주산의학회잡지

Meckel-Gruber syndrome is a rare autosomal recessive disorder characterized by the triad of posterior meningoencephalocele, cystic change of kidney and polydactyly. It is associated with varying degree of multiple congenital anomalies. So the karyotype is normal, but the phenotype is highly variable. This syndrome is lethal and the patient seldom survive more than a few days to weeks. Prenatal diagnosis may be possible by elevated alpha fetoprotein level in amniotic fluid and sonographic examination. Regarding the 25% recurrence risk, obstetrician and pediatrician should do genetic counseling and serial antenatal examination. Here we describe a female neonate who showed multiple congenital anomalies including cystic change of left kidney, polydactyly of left hand, short neck, micrognathia, low set ears, subaortic stenosis, patent ductus arteriosus and atrial septal defects which could best be designate as Meckel-Gruber syndrome. She died at 22 days of life. We report a case of Meckel-Gruber syndrome with brief review of some related literatures.

Neonatal Sepsis

No abstract available