A Multi-Center Educational Research Regarding Breastfeeding for Pediatrics Residents in Korea

Purpose@#Pediatricians have a significant responsibility to educate mothers about the importance of breastfeeding. However, there have been minimal efforts in the courses of resident training in Korea. The purpose of this study is to evaluate the change in knowledge and attitude before and after a 4-week breastfeeding educational intervention among multicenter residents. @*Methods@#Prospective interventional educational research was designed for residents at eight training hospitals in Korea. Institutional reviews were obtained in each hospital. The education curriculum consisted of 14 courses regarding breastfeeding theory and practice. These materials were used to teach pediatric residents for 4 weeks. Knowledge-based tests were administered before the course, and re-tests were administered after the course using different test items of similar levels. Test scores and survey responses were compared before and after the intervention. @*Results@#A total of 73 residents (1st year 20, 2nd year 23, 3rd year 16, and 4th year residents 14) from eight training hospitals completed the intervention. Their average age was 30.3±2.9 years, 17 (23.3%) were male, 22 (30.1%) were married, and eight had more than one child of their own. The mean pre-test score was 61.8±13.4 and the mean post-test score was 78.3±7.5 (P<0.001). The inter-grade difference in the score was significant in the pre-test (P=0.005), but not significant in the post-test (P=0.155). There were more responses of obtaining confidence after the intervention (P<0.001). @*Conclusion@#In our study, pediatric residents showed improvement in their knowledge and confidence level after 4 weeks of the breastfeeding curriculum. This will provide a basis for future policymaking in the training of pediatric residents regarding breastfeeding in Korea.

Resistance Exercise Improves Spatial Learning Ability Through Phosphorylation of 5’-Adenosine Monophosphate-Activated Protein Kinase in Parkinson Disease Mice / 대한배뇨장애요실금학회지

Purpose@#Exercise is a representative noninvasive treatment that can be applied to various diseases. We studied the effect of resistance exercise on motor function and spatial learning ability in Parkinson disease (PD) mice. @*Methods@#The rotarod test and beam walking test were conducted to evaluate the effect of resistance exercise on motor function, and the Morris water maze test was conducted to examine the effect of resistance exercise on spatial learning ability. The effect of resistance exercise on brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) expression and 5’-adenosine monophosphate-activated protein kinase (AMPK) phosphorylation was investigated by Western blot analysis. New cell generation was confirmed by immunohistochemistry for 5-bromo-2’-deoxyuridine. @*Results@#Resistance exercise improved coordination, balance, and spatial learning ability in PD mice. Resistance exercise enhanced new cell production, BDNF and TrkB expression, and AMPK phosphorylation in PD mice. The effect of such resistance exercise was similar to that of levodopa application. @*Conclusions@#In PD-induced mice, resistance exercise enhanced AMPK phosphorylation to increase BDNF expression and new neuron generation, thereby improving spatial learning ability. Resistance exercise is believed to help improve symptoms of PD.

Risk Factors of Persistent Pulmonary Hypertension of the Newborn in Neonates with Respiratory Diseases / 대한주산의학회잡지

PURPOSE: This study aimed to identify the risk factors of persistent pulmonary hypertension of the newborn (PPHN) in neonates with respiratory diseases. METHODS: We retrospectively analyzed 58 term newborn infants with respiratory diseases who were admitted to the neonatal intensive care unit of the Seoul Eulji Hospital between January 2008 and July 2014 and required airway intubation and mechanical ventilation within 24 hours of admission. The infants were divided into a PPHN group and a non-PPHN group. Their clinical characteristics; diagnoses at admission; initial blood test results; and changes in vital signs, blood gas analysis results, and ventilator parameters that occurred within 48 hours of admission were investigated. RESULTS: There were 16 infants in the PPHN group and 42 infants in the non-PPHN group. The incidence of secondary PPHN was 27.6%. The incidence of PPHN was significantly higher in infants with respiratory distress syndrome (RDS) associated with extrapulmonary air leakage and meconium aspiration syndrome (MAS) with secondary RDS as the cause. Respiratory rate over 80 breaths/min (P=0.032, OR 11.3, 95%, CI 1.23-103.57) and FiO2 over 0.8 (P=0.013, OR 16.8, 95% CI 1.82-154.68), when measured 6 hours after admission, were found to be statistically significant risk factors. CONCLUSION: The results suggest that there is an increased risk of PPHN during treatment of respiratory diseases when aggravation of tachypnea and increase in ventilator parameters are observed after 6 hours of admission.

A Novel Insertion in Exon 23 of the TCOF1 Gene in a Newborn Infant with Treacher Collins Syndrome

Treacher Collins syndrome (TCS) is the most common and well known mandibulofacial dysostosis with characteristic clinical features including downward slanting of palpebral fissures, coloboma of the lower eyelid, hypoplastic zygomatic arches, micrognathia, macrostomia, microtia, and other deformities of the ears. TCS is caused by mutations in at least 3 genes involved in pre-rRNA transcription: TCOF1, POLR1D and POLR1C. We experienced a 1-day-old female infant with characteristic clinical features of TCS. A novel, heterozygotic mutation within the TCOF1 gene (c.3874_3875insG, p.Ala1292Glyfs*30) was identified to cause a premature stop codon.

Colonization Rate of Methicillin-resistant Staphylococcus aureus in Neonates: A Single Center Experience / 소아감염

PURPOSE: The aim of this study is to investigate the colonization rate of Methicillin-resistant Staphylococcus aureus (MRSA) in neonates by different clinical characteristics, to presume the origin of MRSA acquisition, and to identify the risk factors associated with MRSA colonization. METHODS: We retrospectively reviewed the medical records of 1,733 neonates admitted to Seoul Eulji hospital Neonatal Intensive Care Unit between January 2008 and December 2011. Nasal, inguinal and rectal swab specimens were obtained upon admission and each week until discharge. We classified the route of MRSA acquisition as; hospital associated (HA-MRSA) and community associated (CA-MRSA) according to the case definition. RESULTS: Among 1,733 neonates, 415 (23.9%) were colonized with MRSA. Gestational age, birth weight, delivery type, maternal antibiotics usage before delivery, birth place and care place before admission were influencing factors in colonization of MRSA. The colonization rate was significantly high in neonates without maternal prophylactic antibiotics use before delivery than in the other group (relative risk 2.77, 95% CI 1.88-4.07; P<0.01), and outborns showed higher MRSA colonization rate compared to inborns (relative risk 2.28, 95% CI 1.17-4.42; P=0.015). CONCLUSION: We identified the neonatal MRSA colonization rate to be 23.9%. We estimated HA-MRSA colonization rate to be 10% (51/511) and CA-MRSA colonization rate to be 36% (309/858). We ascertained that risk factors in MRSA colonization in neonates were prophylactic use of antibiotics in mothers and the birth place.

Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

PURPOSE: This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. METHODS: A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. RESULTS: The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5+/-15.9 days (mean+/-SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. CONCLUSION: The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.

Neonatal innate immunity and Toll-like receptor / 소아과

The innate immune response is the first line of defense against microbial infections. Innate immunity is made up of the surface barrier, cellular immunity and humoral immunity. In newborn, immunologic function and demands are different to adults. Neonatal innate immunity specifically suppresses Th1-type immune responses, and not Th2-type immune responses, which are enhanced. And the impaired response of macrophages is associated with the defective innate immunity in newborn period. Toll-like receptors (TLRs) play a key roles in the detection of invading pathogens and in the induction of innate immune responses. In newborn, the expression of TLRs is age dependent, so preterm has low expression of TLRs. Also, there are defects in signaling pathways downstream of TLRs. As a consequence, the defects of TLRs activity cause the susceptibility to infection in the neonatal period.

The Importance and the Need of Early Pulmonary Surfactant Therapy in Premature Infant with Respiratory Distress Syndrome

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.

The Prevalence of Obesity and Metabolic Abnormalities in Korean Pediatric Population / 대한소아소화기영양학회지

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.

Statistics and Medical Cost of Preterm in Korea / 한양의대학술지

This article reviews the neonatal birth rate, premature birth rate, premature survival rate and the neonatal treatment costs in Korea. The neonatal birth rate has decreased steadily during past 40 years, which is a serious social problem. However, the premature birth rate has increased by about 8~9 % because most complicated pregnancies were early delivered and the social environment has changed. The survival rate of the preterm has increased remarkably due to improvements in neonatology in Korea from 40% in 1980, to 71% in 1990, and to 78% in 2000. The newest report in 2007 for survival rates of the preterm was 95.3% for low birth weight infants, 84.7% for very low birth weight infants and 67.7% for extremely low birth weight infants. The average total hospitalization cost per person who were admitted in the neonatal intensive care unit was 4,360,000 won. The portion of the hospitalization cost covered by the National health insurance was 77.1% and 22.9% of the total hospitalization cost was not covered by the National health insurance. The hospitalization cost increased as the birth weight decreased and as the hospitalization period increased.

Relationships of Self-esteem, Depression, and Suicidal Ideation in Youths: Focus on Auxiliary Policemen / 기본간호학회지

PURPOSE: The purpose of this study was to identify the degree and relationship between self-esteem, depression, and suicidal ideation of youths in the auxiliary police force. METHOD: This descriptive study was conducted using a structured questionnaire from February 1 to March 25, 2007. The participants were 180 youths from 19 to 25 years old (average 20.82 years old) who were auxiliary policemen. The data were analyzed using the SPSS Win 12.0 program. RESULTS: Six of the auxiliary police (3.34%) reported critical scores in suicidal ideation. There was a significant difference in depression according to work area. Self-esteem showed a significant negative correlation with depression (r=-0.38, p<.001) and suicidal ideation (r=-0.39, p<.001). There was a positive correlation between depression and suicidal ideation(r=0.53, p<.001). CONCLUSION: The findings suggest that auxiliary policemen have higher levels of depression and suicidal ideation. Therefore, further study is needed to develop and examine nursing interventions the enhance self-esteem, so that depression and suicidal ideation can be minimized.

Effects of the Program, Improving Adjustment to Military Life, on Stress, Depression, Idea of Suicide, Self-esteem, and Adjustment to Military Living in Auxiliary Police / 기본간호학회지

PURPOSE: This study was done to identify whether the program, improving adjustment to military life would have an effect on stress, depression, idea of suicide, adjustment to military living, and self-esteem in auxiliary police. METHOD: This quazi experimental study using a non-equivalent control group pretest and posttest design was conducted from February 1 to May 30, 2007. Using convenience sampling, the researcher recruited 120 auxiliary police and randomly assigned each to either the experimental and the control group. The experimental group received an 8-week program to improve adjustment to military life. RESULTS: Anxiety, stress, depression, idea of suicide, self-esteem, and adjustment to military living were significantly different between the experimental and control groups. CONCLUSION: These results suggest that programs to improve adjustment to military life would improve psychological health and adaptation of military living in auxiliary police. Replication studies are needed to confirm the effects of this program and to identify the long-term maintenance effects of the program.

A case of delayed hemorrhage of a subcapsular liver hematoma in a neonate / 소아과

A subcapsular liver hematoma (SLH) is a relatively common lesion in fetuses and neonates. Although an SLH ruptures rarely, it may be life threatening. We report on a term neonate with a delayed rupture of an SLH that occurred on day 7 of life. The infant had been resuscitated with intubation, positive pressure ventilation, and chest compression at birth because of meconium-associated perinatal depression. The SLH was diagnosed by abdominal ultrasonography and paracentesis, and the ruptured SLH was treated operatively. After intensive medical and surgical management, the infant was discharged healthy on day 27 of life. A newborn infant presenting with the sudden onset of extreme shock and pallor associated with abdominal distension should undergo differential diagnosis for SLH and a clinical evaluation concurrent with fluid resuscitation and timely surgery.

Risk Factors for Neonatal Infections in Full-term Babies in South Korea

PURPOSE: Since 1997, private postnatal care facilities (San-hu-jo-ri-won in Korean) have emerged to take the role of the family. As a result, neonates are now exposed to many people and are very vulnerable to infection. However, there has been no study on the influence of postnatal care facilities on neonatal infection. The aim of this study was to determine the risk factors of neonatal infection in full-term babies in Korea. MATERIALS and METHODS: We followed up 556 pregnant women and their babies for 4 weeks after their births at 2 hospitals in Seoul and Daejeon from October 2004 to September 2005. Among 512 full-term babies, 58 had infectious diseases. To determine the risk factors for infection, 53 infected neonates at 4-28 days of life and 413 healthy neonates were compared. RESULTS: The incidence of neonatal infection at 4 to 28 days after birth was 10.5%. After adjusting the related factors, the number of siblings (OR = 2.05, 95% CI = 1.13-3.71 for 1 or more) and postnatal care facilities or home aides (OR = 1.91, 95% CI = 1.07-3.45) were significant risk factors. Formula or mixed feeding (OR = 1.66, 95% CI = 0.91-3.04) increased the risk of neonatal infection but it was not statistically significant. CONCLUSION: When the newborns had siblings, stayed at postnatal care facilities, or were cared for by home aides, the risk of neonatal infections significantly increased. Further research on the feeding effect on neonatal infection and evaluation of prevention efforts are needed.

Hypotension in Prematurity

No abstract available.

Checklist for the Newborn during Hospitalization / 대한주산의학회잡지

No abstract available.

Post discharge care of prematurity / 소아과

Advances in neonatal care have been responsible for the improved survival of prematurity but have not resulted in decreased morbidity. Once the high-risk infants is discharged from the hospital, his or her many special care needs do not cease. A well-coordinated multidisciplinary approach is essential in the follow-up care of these infants. Special attention must be given to their growth and nutrition, immunization, vision and hearing, and sequelae of illnesses experienced during the neonatal period. The role of pediatrician in helping these infants attain their full physical, neurodevelopmental, emotional, and psychosocial potential by providing optimal care is invaluable.

Isolation rate of 4 type virus of acute gastroenteritis in full-term neonates during neonatal period / 소아과

PURPOSE: The most common causes of acute viral gastroenteritis in newborn period are rotavirus, astrovirus, norovirus and enteric adenovirus. This study was designed to investigate the clinical characteristics, clinical symptoms, isolation rate and distribution of these viruses in full-term neonates during neonatal period. We also studied the influence on the viral isolation rate by postnatal care place and feeding type. METHODS: We evaluated 112 healthy full-term neonates who were admitted to Eulji hospital, presenting with symptoms of acute viral gastroenteritis from September 2004 to August 2005. Epidemiologic, clinical and laboratory data were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus, astrovirus and norovirus and RT-PCR for enteric adenovirus were performed in study subjects. RESULTS: The mean age at the admission was 11.4+/-5.4 days, mean weight loss was 5.9+/-5.1%, mean hospitalization duration was 6.3+/-3.4 days. Moderate and severe weight loss were expressed in 51.7% and metabolic acidosis was in 13.4%. The percent of living in postnatal care facility (PCF) was 74.1 % and the percent of mixed feeding was 64.3%. Isolation rate of virus was 33%. The most prevalent virus was rotavirus (59.5%), followed by astrovirus (29.7%) and norovirus (10.8%). There was no differences in virus isolation rate by postnatal care place and by feeding type. The rotavirus was main virus in both home group and PCF group. But astrovirus was more detected in PCF and norovirus was more detected in home (P<0.05). According to monthly distribution of virus, acute viral gastroenteritis in newborn period was concentrated in September to December. CONCLUSION: The isolation rate of 4 type viruses was 33% and rotavirus was the leading cause of acute gastroenteritis during neonatal period. There was no differences in clinical characteristics on each viral groups.

Two cases of Chryseobacterium meningosepticum infection in a neonatal intensive care unit / 소아과

We report on two premature infants who developed nosocomial infection caused by Chryseobacterium meningosepticum in a neonatal intensive care unit (NICU). One premature infant developed sepsis, meningitis, and hydrocephalus, and was treated successfully with ciprofloxacin plus trimethoprim-sulfamethoxazole combination therapy for 4 weeks and with a ventriculoperitoneal shunt. The other premature infant, who was in a chronically debilitated state, had infection that had colonized only in the respiratory tract but had no clinical signs for 66 days. Extensive environmental surveillance demonstrated that the suction bottle apparatus was the source of infection. We prevented the spread of infection by closing the NICU temporarily, isolating the patients early in their infection, and eradicating the source of infection source.

A Case of Multiple Cardiac Myxomas Complicating Recurrent Right Hemiparesis in a Child who had a Wrong Diagnosis of Acute Disseminated Encephalomyelitis

Multiple cardiac myxomas are rare in children. However, myxomas may be lethal because of their various manifestations such as blood flow obstruction, embolization and constitutional changes. Especially, the cerebral infarction due to tumor fragmentation are more likely to be misdiagnosed of acute disseminated encephalomyelitis. We report a case of multiple cardiac myxoma complicating recurrent right hemiparesis in a 12-year-old child who at first had a wrong diagnosis of acute disseminated encephalomyelitis (ADEM). Consequently, a child who show unrepresentative symptom of ADEM, should be examined rapidly by various tools to rule out the cerebral infarction from cardiogenic cause.