무균성 뇌막염 환자에서 뇌척수액과 대변 채취 시점에 따른 PCR의 유용성

김묘징,이혜진,최정민,정수진,허재원 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.7

임신 중 Methimazole을 복용한 산모의 자녀에서 발생한 선천성 피부 무형성증 1례

김묘징,김미진,조규랑,최희원,정진아,이영석,김영훈,유재호 대한소아내분비학회 2008 Annals of Pediatirc Endocrinology & Metabolism Vol.13 No.1

Aplasia cutis congenita is a rare congenital anomaly characterized by focal absence of skin at birth. It most commonly manifests as a solitary defect on the scalp, but sometimes it may occur as multiple lesions. Frieden classified aplasia cutis congenita into nine types according to the associated anomalies, but a unifying theory has not been identified to explain the etiology of this disease. We report a case of a newborn with isolated aplasia cutis congenita on the scalp at birth, whose mother was treated with methimazole up to the 22 weeks of gestation due to hyperthyroidism.

Effects of Orogastric Tubes on the Videofluoroscopic Swallowing Study Findings in Infants

김묘징,Sung Min Kang,이경우,Sook Joung Lee,Young Hwan Kim 대한연하장애학회 2019 대한연하장애학회지 Vol.9 No.2

Objective: An orogastric tube is used frequently in infants because infants are obligate nose breathers and nasogastric tubes can cause partial nasal obstruction. This study examined whether the presence of an orogastric tube couldaffect the swallowing parameters assessed by a videofluoroscopic swallowing study in infants with dysphagia causedby a variety of reasons. Methods: Tests were conducted in 15 infants aged less than 150 days after birth who used an orogastric tube due todysphagia. Two tests were conducted. The first was conducted with an orogastric tube inserted. Subsequently, theorogastric tube was removed with a 5-minute break before the second test. Skilled physiatrists then analyzed therecorded video. The number of sucks required for one swallow, abnormalities of the pharyngeal phase, and penetration-aspiration scales were evaluated. Results: After removing the orogastric tube, the number of sucks required for one swallow reduced significantly (2.50±1.73 vs. 3.45±2.54, P=0.04). On the other hand, no statistical significance was observed in the results of the pharyngealphase and penetration-aspiration scale (5.60±3.16 vs. 5.9±3.81, P=0.41) with and without the orogastric tube. Conclusion: These findings showed that the insertion or non-insertion of an orogastric tube might not affect theswallowing abnormalities in the pharyngeal phase and the risk of aspiration. In addition, an orogastric tube mayhave a negative effect on the swallowing function in the oral phase

부산 지역 응급의료정보센터를 통한 산모와 신생아 전원에 대한 연구

김묘징,김미진,이명철,유재호 대한신생아학회 2011 Neonatal medicine Vol.18 No.1

목적: 산모와 신생아 환자의 응급 진료는 치료의 특수성 때문에 치료할 수 있는 의료 기관 및 자원이 한정적이며, 상황에 따라 유동적으로 변화한다. 이에 저자들은 부산 지역 1339 응급의료 정보 센터를 통해 산모와 신생아 환자의 전원 상태를 조사하고, 주산기 의료 전달 체계의 현황을 파악하고자 하였다. 방법: 2009년 1월 1일부터 2009년 12월 31일까지 부산 지역1339 응급 의료 정보 센터 전산 시스템에 입력된 자료를 이용하였다. 전원이 의뢰된 산모 378명과 신생아 136명을 대상으로 전원 성공률, 전원 결정까지 접촉한 의료 기관 수 및 소요 시간, 전원 이유, 전원 거절 이유를 후향적으로 조사하였다. 결과: 산모는 전원 성공률이 65.5%였고, 전원 결정까지 접촉한 의료 기관은 2.7개, 소요 시간은 평균 24.4분(11.3-29.8분)이었다. 전원을 의뢰한 이유는 미숙아 분만이 가장 많았고, 전원이 거절된 이유는 의료진 부족, 의료 장비 부족, 병상 부족 순이었다. 신생아는 전원 성공률이 71.3%였고. 전원 결정까지 접촉한 의료 기관은 2.4개, 소요 시간은 평균 15.6분(7.9-21.3분)이었다. 전원을 의뢰한 이유는 호흡기 증상이 가장 많았고, 전원이거절된 이유는 병상 부족, 의료 장비 부족, 의료진 부족 순이었다. 결론: 응급 의료 정보 센터를 통해 많은 산모와 신생아가 전원되나 전원 성공률은 높지 않았다. 산모와 신생아 환자에 대한주산기 진료 체계의 적정성 평가와 함께 앞으로 통합적이고 지역화된 주산기 의료 전달 체계의 구축을 위해서는 국가적 차원의 접근이 필요하겠다. Purpose: In relation to perinatal healthcare, medical institutions and resources are limitative and also are in a state of flux due to the therapeutic specialty. We analyzed requests for interhospital transfers received by Busan 1339 Emergency Medical Information Center (EMIC) to grasp the state of perinatal healthcare delivery system. Methods: This study was conducted on the basis of data inputted into the computing system of Busan 1339 EMIC, between January 1 and December 31, 2009. In connection with 378 pregnant women and 136 newborns who were required to transfer, retrospective analyses were made of the success rate of transfer (SR), the number of contacted hospitals, the time required for transfer and the reason of transfer and refusal. Results: In the case of pregnant women, the SR were 65.5%. They came in contact with 2.7 hospitals, and it took 24.4 minutes. As for the reason of transfer, preterm labor accounted for the highest proportion. In the case of newborns, the SR were 71.3%. They came in contact with 2.4 hospitals, and it took 15.6 minutes. The most common reason of transfer were respiratory symptoms. In the reason of refusal with pregnant women and newborn, the lack of medical staff, medical equipments and wards accounted for great. Conclusion: Many pregnant women and newborns have been transferred to hospitals by EMIC, but the SR has not been higher yet. Accordingly, there is a need to evaluate the propriety of perinatal treatment system, as well as to set up effective perinatal healthcare delivery system.

극소 저체중출생아에서 대사성 골질환 발생의 생화학적 예측 인자

김묘징,김미진,변신연,이혜진,유재호 대한소아내분비학회 2010 Annals of Pediatirc Endocrinology & Metabolism Vol.15 No.1

Purpose: The aim of present study was to assess the utility of serum biochemical markers for predicting the metabolic bone disease (MBD) in very low birth weight infants (VLBWI). Methods: Medical records of 104 VLBWI from 2003 to 2008 were reviewed in this retrospective study. Study patients were divided in MBD and control group according to the finding of wrist radiography performed at 4 weeks of life. We compared the serum biochemical markers including alkaline phosphate (ALP), calcium (Ca), phosphate (P) between two groups at birth, 1 and 4 weeks of life. The value of serum vitamin D (Vit. D) was measured at 4-5 weeks of life. Results: The mean gestational age and birth weight of study patients were 30+6±2.0 weeks and 1,308.2±136.7 g. The incidence of MBD was 28.9% (31/104). At birth, higher values of serum ALP (438.1±129.1 mg/dL vs 360.5±122.8 mg/dL) were found in MBD group. At 1 week of life, higher values of serum Ca (11.0±1.7 mg/dL vs 10.3±1.7 mg/dL) and lower values of serum P (3.2±1.2 mg/dL vs 4.1±1.3 mg/dL) were found in MBD group. At 4 weeks of life, higher values of serum ALP activities (1,397.6±635.6 U/L vs 789.0±573.0 U/L), lower values of serum P (4.2±2.0 mg/dL vs 5.4±1.8 mg/dL) and Vit. D (17.7±7.2 ng/mL vs 30.0±15.5 ng/mL) were found in MBD group. Risk factors of MBD were male and Vit. D deficiency with high ALP at 4 weeks of life. Conclusion: These results suggest that high ALP concentrations at 4 weeks of life may predict MBD with Vit. D deficiency in VLBWI. 목 적: 최근 극소 저체중출생아들의 생존율이 증가하면서 대사성 골질환의 유병률도 증가하는 추세이다. 이에 저자들은 미숙아 대사성 골질환을 예측하는 인자로써 출생 후 시기에 따른 혈청 생화학 검사의 유용성을 알고자 하였다. 방 법: 2003년 3월부터 2008년 12월까지 일신 기독 병원 신생아 집중 치료실에 입원하였던 출생체중 1500 g 미만 환아들을 대상으로 의무 기록지를 통해 후향적으로 분석하였다. 생후 4주에 손목의 단순 방사선 촬영을 통해 대사성 골질환군과 대조군을 설정하였다. 생화학 검사로 ALP, 인, 칼슘을 출생 첫날, 생후 일주일째, 생후 4주째 검사하여 비교하였다. 비타민 D는 생후 4-5주에 측정하였다. 결 과: 대상 환아 104명의 평균 재태주수와 출생체중은 30+6±2.0주, 1,308.2±136.7 g이었다. 전체 대상군 중 31 (29.8 %)명에서 대사성 골질환이 발생하였다. 생후 첫날 실시한 생화학 검사에서 대사성 골질환군은 ALP (438.1±129.1 U/L vs 360.5±122.8 U/L)가 증가하여 있었다(P˂0.05). 생후 일주일째 생화학 검사에서 대사성 골질환군은 칼슘(11.0±1.7 mg/dL vs 10.3±1.7 mg/dL)은 증가하여 있었고, 인(3.2±1.2 mg/dL vs 4.1±1.3 mg/dL)은 감소하여 있었다(P˂0.05). 출생 4주째 실시한 생화학 검사에서 대사성 골질환군의 ALP (1397.6±635.6 U/L vs 789.0±573.0 U/L)는 증가하여 있었고(P˂0.05), 인(4.2 ±2.0 mg/dL vs 5.4±1.8 mg/dL)과 비타민 D (17.7±7.2 ng/mL vs 30.0±15.5 ng/mL)는 감소하여 있었다(P˂0.05). 대사성 골질환 발생의 위험 인자를 평가하기 위해 실시한 로지스틱 회귀분석에서 대사성 골질환은 남아, 출생체중이 작은 경우, 진단 시점까지 총 정맥 영양 기간이 긴 경우 발생이 많았다. 생화학 검사에서 생후 4주째 비타민 D 결핍이 있는 경우 대사성 골질환의 발생이 증가하였고, 이는 생후 4주째 ALP 수치 증가와 일치하는 양상을 보였다. 결 론: 극소 저체중출생아에서 대사성 골질환은 높은 빈도를 보였다. 생후 4주째 ALP 수치가 증가하여 있는 극소 저체중출생아에서 비타민 D 결핍과 대사성 골질환의 발생에 대한 주의를 기울이고, 적극적인 의학적 개입이 필요하리라 생각된다.

Autosomal dominant familial neurohypophyseal diabetes insipidus caused by a mutation in the arginine-vasopressin II gene in four generations of a Korean family

김묘징,김영은,기창석,유재호 대한소아내분비학회 2014 Annals of Pediatirc Endocrinology & Metabolism Vol.19 No.4

Autosomal dominant neurohypophyseal diabetes insipidus is a rare form of central diabetes insipidus that is caused by mutations in the vasopressin-neurophysin II (AVP-NPII) gene. It is characterized by persistent polydipsia and polyuria induced by deficient or absent secretion of arginine vasopressin (AVP). Here we report a case of familial neurohypophyseal diabetes insipidus in four generations of a Korean family, caused by heterozygous missense mutation in exon 2 of the AVP-NPII gene (c.286G>T). This is the first report of such a case in Korea.

신생아실에서 퇴원한 후기 조산아들의 재입원에 대한 고찰

김묘징 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.8

목 적 : 신생아실에서 만삭아에 준한 경과 관찰 후 퇴원한 후기 조산아들의 재입원과 관련된 위험 요인과 재입원 원인을 알고자 연구를 계획하였다. 방 법 : 2003년 1월부터 2008년 12월까지 일신 기독 병원 신생아실에서 만삭아에 준한 경과 관찰 후 퇴원한 후기 조산아들 중 생후 28일 이내에 재입원하였던 135명의 신생아들의 의무 기록지를 후향적으로 조사하였다. 재입원의 위험 요인을 알고자 대조군과 비교 분석하였다. 결 과 : 재입원과 관련된 위험 요인 연구에서 재태주수, 출생체중, 성별, 분만 방법, 산모의 나이, 교육 정도, 결혼 여부, 진통과 분만 과정상의 합병증은 관련이 없었고, 모유 수유(71.9% vs 44.4%), 짧은 신생아실 경과 관찰 기간(3.3±1.6일 vs 4.1±2.0일), 초산모(60.0% vs 45.3%)와 임신 합병증이 있었던 경우(31.9 % vs 18.8%) 통계적으로 유의하게 재입원율이 높았다. 재입원 시점은 출생 후 평균 6.2±3.6일로, 출생 5-6일 사이에 재입원하는 경우가 40.7%로 가장 많았다. 재입원 시 83.7%가 황달을 주소로 입원하여 가장 흔한 원인이었고, 자연 분만(43.4% vs 1.8 %), 산모의 나이가 적은 경우(29.8±3.4세 vs 32.1±4.2세), 임신과 관련된 합병증 동반이 적은 경우(28.3% vs 50%)가 황달로 인한 재입원과 관련 있었다. 결 론 : 후기 조산아들의 재입원과 관련된 위험 요인은 모유 수유, 짧은 신생아실 경과 관찰 기간, 초산모와 임신 합병증이 있었던 경우였고, 재입원 시점은 평균 6.2±3.6일, 가장 흔한 재입원 원인은 황달이었다. Purpose : To evaluate the risk factors for hospital readmission during the neonatal period among late preterm infants who were discharged after nursery care. Methods : In this retrospective study, we reviewed medical records of 135 late preterm infants readmitted to the neonatal intensive care unit (NICU) during the neonatal period, after discharge from nursery of IL Sin Christian Hospital from January 2003 to December 2008. We compared the risk factors of the hospital readmission group with the control group. Results : The gestational age and birth weight of 135 study infants were 36+1±0.5 weeks and 2,718.4±296.9 gm, respectively. Identified risk factors of hospital readmission were breastfeeding (71.9% vs. 44.4%), short duration of nursery stay (3.3±1.6 days vs. 4.1±2.0 days), firstborn (60.0% vs. 45.3%), and maternal pregnancy complication (31.9% vs. 18.8%). Jaundice accounted for the majority of hospital readmissions (83.7%), and the age at hospital readmission was 6.2±3.6 postnatal days, mostly at 5-6 postnatal days (40.7%). Identified risk factors of hospital readmission due to jaundice were spontaneous normal vaginal delivery (43.4% vs. 1.8%), younger maternal age (29.8±3.4 yrs vs. 32.1±4.2 yrs), and lower maternal pregnancy complication (28.3% vs. 50%). Conclusion : Identified risk factors of hospital readmission were breastfeeding, short duration of nursery stay, firstborn, and maternal pregnancy complication. Jaundice accounted for the majority of hospital readmissions, and the age at hospital readmission was 6.2±3.6 postnatal days.

The Effects of Inhaled Albuterol in Transient Tachypnea of the Newborn

김묘징,유재호,정진아,변신연 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.2

Purpose: Transient tachypnea of the newborn (TTN) is a disorder caused by the delayed clearance of fetal alveolar fluid. ß-adrenergic agonists suchas albuterol (salbutamol) are known to catalyze lung fluid absorption. This study examined whether inhalational salbutamol therapy could improveclinical symptoms in TTN. Additional endpoints included the diagnostic and therapeutic efficacy of salbutamol as well as its overall safety. Methods:From January 2010 through December 2010, we conducted a prospective study of 40 newborns hospitalized with TTN in the neonatal intensive careunit. Patients were given either inhalational salbutamol (28 patients) or placebo (12 patients), and clinical indices were compared. Results: The durationof tachypnea was shorter in patients receiving inhalational salbutamol therapy, although this difference was not statistically significant. The durationof supplemental oxygen therapy and the duration of empiric antibiotic treatment were significantly shorter in the salbutamol-treated group. Noadverse effects were observed in either treatment group. Conclusions: Inhalational salbutamol therapy reduced the duration of supplemental oxygentherapy and the duration of empiric antibiotic treatment, with no adverse effects. However, the time between salbutamol therapy and clinical improvementwas too long to allow definitive conclusions to be drawn. Further studies examining a larger number of patients with strict control over dosageand frequency of salbutamol inhalations are necessary to better direct the treatment of TTN.

A case of pulmonary vascular air embolism in a very-low-birth-weight infant with massive hydrops

김묘징,유희준,이차곤,박수경,장윤실,박원순 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.12

Pulmonary vascular air embolism is a rare and, universally, almost a fatal complication of positive pressure ventilation in newborn infants. Here, we report a case of this unusual complication in a very-low-birth-weight infant who showed the clinical and radiological features of this complication along with pulmonary hypoplasia and massive hydrops. The possible pathogenesis has been discussed and a brief review of related literature has been presented.

A Case of Cystic Pneumomediastinum with Thymic Hyperplasia in a Newborn

김묘징,정진아 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

Spontaneous pneumomediastinum in a term newborn without mechanical ventilation or underlying lung disease is rare. We present a case of a newborn baby who developed respiratory distress after birth and cystic pneumomediastinum which improved spontaneously with thymic hyperplasia as demonstrated on chest radiography, CT and MRI. The combination of cystic pneumomediastinum and thymic hyperplasia in a newborn has not been reported, thus far.