Comparison between Korean and Japanese Nursing Students in Their Disaster Preparedness

PURPOSE: The purpose of this study is to identify differences in disaster awareness, disaster preparedness, and nursing knowledge and practices between Korean and Japanese nursing students. METHODS: The study subjects were 4th grade nursing students who completed their nursing education in Korea or in Japan. 359 students from Korea and 135 students from Japan participated in this study. Data were analyzed using IBM SPSS 21.0. The χ2 test and the t-test were used to analyze the homogeneity of subjects' general characteristics and disaster-related characteristics. The comparison between the Korean and Japanese nursing students in disaster awareness, disaster preparedness, and nursing knowledge and practices were conducted using ANCOVA. RESULTS: The Korean nursing students' disaster awareness, disaster preparedness, and nursing knowledge and practice were different from their Japanese counterparts'. The Korean nursing students recognized that the system of disaster management in Korea was insufficient and the negligence of management was one of the causes of the disaster. They wanted to participate in activities for disaster preparedness education and management. CONCLUSION: A disaster nursing curriculum dealing with disaster awareness, disaster preparedness, and nursing knowledge and practices, should be developed, implemented, and evaluated particularly for Korean nursing students.

Clinical Effects of Ureaplasma urealyticum Colonization in Maternal Vaginal Fluid at Second Trimester on Neonatal Outcomes of Premature Infant ≤35 Weeks' Gestational Age

PURPOSE: The purpose of this study was to evaluate the relationship between maternal genital Ureaplasma urealyticum colonization in the second trimester and the neonatal outcomes. METHODS: We studied 577 premature infants born at ≤35 weeks' gestational age (GA) at Hallym University, Kangnam Sacred Heart Hospital from January 2008 to December 2014. Maternal vaginal specimens were collected and polymerase chain reaction and/or culture tests were done in the second trimester of pregnancy. The subjects were divided into 2 groups: a Uu colonization-positive group (UU) and a Uu-negative (control) group. Subgroup analyses were performed in extremely premature (23–28 weeks' GA) and premature (29–35 weeks' GA) infants. Various clinical outcomes were compared. RESULTS: Of 577 preterm infants, 311 were delivered with maternal Uu infection (UU, 53.9%). Mean GA (30.0±3.6 weeks vs. 31.0±3.7 weeks, P=0.010) and birth weight (1,685.6±680.4 g vs. 1,932.7±733.1 g, P=0.003) were lower in the UU group than in controls. However, there were no significant differences in GA and birth weight in extremely premature group. Premature labor (P=0.002) and histological chorioamnionitis (P=0.032) was significantly more common in the UU group, especially in mothers who delivered in third trimester (29–35 weeks' GA). In particular, the incidence of moderate-to-severe BPD was statistically higher in UU extremely premature group (60.8% vs. 32.2%) (P=0.001). CONCLUSION: Maternal colonization with Uu was associated with an increase in premature delivery and lower birth weights. Moderate-to-severe BPD was more common in premature infants born at ≤28 weeks' GA with maternal Uu colonization.

Delayed Cord Clamping Compared with Cord Milking in Preterm Neonates

PURPOSE: To evaluate the safety and feasibility of delayed cord clamping compared with umbilical cord milking in premature infants less than 32 weeks of gestation. METHODS: This study was performed by 1:2 case-control match. Infants received delayed cord clamping (DCC) for one minute (DCC group, n=10, May 2014-October 2015) were compared with perinatal factors-matching controls, who received umbilical cord milking (CM, CM group, n=20, May 2014-October 2015) or who received immediate cord clamping (ICC, ICC group, n=20, January 2008-December 2008). The primary outcome was hematocrit during the first 28 days. Secondary outcomes included delivery room management, selected neonatal morbidities and mortality. RESULTS: Baseline characteristics were comparable in all the three groups. The median hematocrit level at 1st day and 3rd day was significantly higher in the DCC group (54.3±6.2%, 53.6±5.6%) as compared with the CM group (48.0±7.7%, 43.2±7.8%) or ICC group (47.2±7.5%, 45.8±6.3%). The DCC group had reductions in red blood cell transfusion within the first two weeks of life compared to the CM group (10% vs. 50%, P=0.03). The DCC group compared to the CM group had no increment in respiratory intervention in the delivery room and hypothermia on admission. There was no difference between DCC and CM in mortality, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, severe retinopathy of prematurity and sepsis. CONCLUSION: Delayed cord clamping for 1 minute in preterm infants may be a safe and feasible method to increase initial hematocrit and reduce transfusion compared with umbilical cord milking.

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age / 대한주산의학회잡지

PURPOSE: The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie. METHODS: We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups. RESULTS: Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3rd day and 7th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group. CONCLUSION: In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age / 대한주산의학회잡지

PURPOSE: The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie. METHODS: We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups. RESULTS: Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3rd day and 7th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group. CONCLUSION: In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Survival of Patients with Trisomy 18 Based on the Treatment Policy at a Single Center in Korea

PURPOSE: Although discussion about active treatment of trisomy 18 is increasing, there are no previous articles regarding this subject in Korea. In order to provide objective data about the clinical characteristics and survival of patients with trisomy 18, based on the treatment policy, to medical teams and parents with trisomy 18, we reviewed the medical records of such patients at a single center in Korea. METHODS: This is a retrospective study of 22 patients diagnosed with trisomy 18 at the Samsung Medical Center between 1995 and 2013. We collected data about the clinical characteristics, including demographics, birth history, diagnosis method, and associated anomalies. We analyzed the survival in days, according to three broad categories of treatment policy: give-up, conservative management and active treatment. RESULTS: Of the 22 patients with confirmed trisomy 18, the majority were female (19, 86%). The median gestational age was 39 weeks (range, 31-41 weeks) and the median birth weight is 2,029 g (range, 1,130-2,990 g). Among the anomalies associated with trisomy 18, ventricular septal defect (86%) and patent ductus arteriosus (81%) were the most common cardiac anomalies; giant cisterna magna (59%) was the most common central nervous system anomaly; and clenched hands (73%) and low set ears (59%) were the most common structural anomalies. The survival based on the treatment policy was the highest in the active treatment group, followed by the conservative management group. The give-up group had the lowest survival. CONCLUSION: It is possible to achieve an improvement in both survival and symptom relief for patients with trisomy 18, despite poor neurological outcome and high mortality. Medical personnel need to provide objective data on trisomy 18 to the parents, and determine the treatment policy through careful discussion.

Retinopathy of Prematurity in Infants with Birth Weights Greater than 1,000 Grams

PURPOSE: To understand the incidence of retinopathy of prematurity (ROP) in preterm infants with birth weights more than 1,500 g or gestational age 30 weeks, and/or unstable clinical course, we investigated the highest gestational age and birth weight of preterm infants who require ROP treatment and those who do not. METHODS: The subjects were preterm infants admitted in Samsung medical center between January 1, 2000 and December 31, 2013. We retrospectively reviewed the medical records of 847 premature infants whose birth weights were more than 1,000 g. RESULTS: Of the 847 infants, 105 (12.4%) had stage 1 ROP, 54 (6.4%) had stage 2, 31 (3.7%) had stage 3, 0 had stage 4, and 2 (0.2%) had stage 5 ROP. Thirty-three (3.9%) of the 847 infants developed stage 3-5 ROP. Twenty (2.4%) of these 33 (3.9%) stage 3-5 ROP infants required treatment. Among the stage 1-3 ROP infants who did not require treatment, the highest gestational age was 37(+1) weeks (stage 1) and birth weight was 2,362 g (stage 1). Among the stage 3-5 ROP infants who needed treatment, the highest gestational age was 32 weeks and birth weight was 1,495 g. CONCLUSIONS: Newborn infants with gestational age more than 38 weeks or birth weight more than 2,400 g did not develop ROP even if they had an unstable clinical course. In our study, no preterm infants with gestational age more than 33 weeks or birth weight more than 1,500 g required ROP treatment.

Adverse Events Associated with Azathioprine Treatment in Korean Pediatric Inflammatory Bowel Disease Patients / 대한소아소화기영양학회지

PURPOSE: This study was aimed to evaluate the frequency and course of adverse events associated with azathioprine treatment in Korean pediatric patients with inflammatory bowel disease. METHODS: Total of 174 pediatric patients (age range, 1 to 19 years) with inflammatory bowel disease who received azathioprine in order to maintain remission at Samsung Medical Center (Seoul, Korea) from January 2002 through December 2012 were included in this study. Medical records of these subjects were retrospectively reviewed regarding the development of adverse events associated with azathioprine treatment. RESULTS: Ninety-eight patients (56.3%) of 174 patients experienced 136 episodes of adverse events, requiring dose reduction in 31 patients (17.8%), and discontinuation in 18 patients (10.3%). The mean dose of azathioprine that had been initially administered was 1.32+/-0.42 mg/kg/day. Among the adverse reactions, bone marrow suppression developed in 47 patients (27.0%), requiring dose reduction in 22 patients (12.6%) and discontinuation in 8 patients (4.6%). Other adverse events that occurred were gastrointestinal disturbance (15.5%), hair loss (12.1%), pancreatitis (7.5%), arthralgia (6.9%), hepatotoxicity (2.9%), skin rash/allergic reactions (2.9%), headache/dizziness (2.3%), sepsis (0.6%), and oral mucositis (0.6%). CONCLUSION: Bone marrow suppression, especially leukopenia was most commonly associated with azathioprine treatment in Korean pediatric inflammatory bowel disease patients. Close observation for possible adverse events is required in this population with inflammatory bowel diseases who are under treatment with azathioprine.

A Case of Neck Abscess Caused by Salmonella Serotype D in a Patient with Liver Cirrhosis

Non-typhoidal salmonellosis, which is increasing nowadays in Korea as well as in the developed countries, is manifested as enteritis in most cases, but it also encompasses bacteremia, intraabdominal infections, and bone, joint and soft tissue infections. These rare diseases are known to result from primary gastrointestinal infection and subsequent bacteremia with or without symptoms. We experienced a case of neck abscess caused by Salmonella serotype D, which is a rare but important differential diagnosis of neck abscess. We herein report it.