신증후군에서 초기 혈청 IgE에 따른 임상양상의 비교

이재호,장미영 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

The charaterization of syndrome is edema, hypoproteinemia, proteinuria, and hyperlipidemia. It has been reported that serum IgE levels was high in patients with nephrotic syndrome. To assess the association between serum IgE levels and clinical features in nephrotic syndrome, we measured the serum IgE levels in 19 patients with nephrotic syndrome at initial period of disease. We patients of nephrotic syndrome into two groups according to the serum IgE levels. The high IgE serum level is group 1 and the normal serum IgE level is group 2. We compared the clinical features between two groups. The results are as follows; In both group, all of them had generalized edema, hypoproteinemia, proteinuria, and hyperlipidemia. But the group 1 had more wide spectrum of clinical features that group 2. The total serum protein levels of group 1 were lower than that of group 2, but there were no difference between two groups in the levels of 24 hr urine total protein, and serum albumin, cholesterol, IgG, IgA, IgM, C and C statistically, The serum levels of IL-4 and CD were increased in both, but no difference between two groups. From these results, we could get the conclusion that clinical features of nephrotic syndrome is associated with the IgE. But, we have to extend this study further for the detail and useful results in clinics.

심근의 단독 비경화증(Isolated Noncompaction of Ventricular Myocardium)의 임상 양상

문은경,이훈영,장미영,길홍량,정용헌 대한소아과학회 2002 小兒科 Vol.45 No.12

Optimal oxygen saturation in premature infants

Chang, Mea-Young The Korean Pediatric Society 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.9

There is a delicate balance between too little and too much supplemental oxygen exposure in premature infants. Since underuse and overuse of supplemental oxygen can harm premature infants, oxygen saturation levels must be monitored and kept at less than 95% to prevent reactive oxygen species-related diseases, such as retinopathy of prematurity and bronchopulmonary dysplasia. At the same time, desaturation below 80 to 85% must be avoided to prevent adverse consequences, such as cerebral palsy. It is still unclear what range of oxygen saturation is appropriate for premature infants; however, until the results of further studies are available, a reasonable target for pulse oxygen saturation ($SpO_2$) is 90 to 93% with an intermittent review of the correlation between $SpO_2$ and the partial pressure of arterial oxygen tension ($PaO_2$). Because optimal oxygenation depends on individuals at the bedside making ongoing adjustments, each unit must define an optimal target range and set alarm limits according to their own equipment or conditions. All staff must be aware of these values and adjust the concentration of supplemental oxygen frequently.

신생아의 신경 보호 또는 신경 손상 방지 전략

장미영 ( Mea Young Chang ) 대한주산의학회 2010 Perinatology Vol.21 No.2

Brain injury secondary to hypoxia-ischemia is the predominant form of all brain injury encountered in the perinatal period and one of the most commonly recognized causes of severe, long-term neurologic deficits in children. Much progress has been made toward understanding the mechanisms contributing to ongoing brain injury after intrapartum hypoxia ischemia. Multiple pathways of oxidative stress, inflammation, and excitotoxicity lead to both early and late phases of cell damage and death. Therapies targeting these different pathways have shown potential in protecting the brain from ongoing injury. A search for therapies that can prevent injury progression or enhance repair of the immature brain continues and recent evidence suggests that therapies may be combined to enhance the protective and reparative processes, and consideration for the best time to perform these interventions are necessary. In this article, I will focus briefly on the pathogenetic biochemical events leading to neuronal death and then, in particular, the neuroprotective interventions based on these biochemical events.

Postoperative Complications of Esophageal Atresia and Role of Endoscopic Balloon Dilatation in Anastomotic Strictures

Jin Young Cho,Mea-young Chang,Mi Hyeon Gang,Yong Wook Lee,Jun Beom Park,Jae Young Kim,Hyun Jin Kim 대한소아소화기영양학회 2022 Pediatric gastroenterology, hepatology & nutrition Vol.25 No.6

Purpose: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. Methods: We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients’ baseline characteristics, associated anomalies, and postoperative complications were reviewed. Results: Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2–15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2–7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. Conclusion: Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.

Modification of nutrition strategy for improvement of postnatal growth in very low birth weight infants

Ah Young Choi,Yong Wook Lee,Mea-young Chang 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.4

Purpose: To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants. Methods: The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1 (n=37); prior to the PN and EN regimen being modified, period 2 (n=50); following the PN-only regimen modification, period 3 (n=37); following both PN and EN regimen modification. The modified PN regimen provided 3 g/kg/day of protein and 1 g/kg/ day of lipid on the first day of life. The modified EN regimen provided 3.5–4.5 g/kg/day of protein and 150 kcal/kg/day of energy. We investigated growth rate, anthropometric measurements at 40 weeks postconceptional age (PCA) and the incidence of extrauterine growth restriction (EUGR) at 40 weeks PCA. Results: Across the 3 periods, clinical characteristics, including gestational age, anthropometric measurements at birth, multiple births, sex, Apgar score, surfactant use and PDA treatment, were similar. Growth rates for weight and height, from time of full enteral feeding to 40 weeks PCA, were higher in period 3. Anthropometric measurements at 40 weeks PCA were greatest in period 3. Incidence of weight, height and head circumference EUGR at 40 weeks PCA decreased in period 3. Conclusion: Beginning PN earlier, with a greater supply of protein and energy during PN and EN, is advantageous for postnatal growth in VLBW infants.

임상 ; 신생아의 중증 고빌리루빈혈증에서 뇌자기공명영상의 의의: T1 강조영상에서의 담창구 음영증가를 중심으로

유선영 ( Sun Young You ),죄혜정 ( Hye Jeong Jwa ),장미영 ( Mea Young Chang ) 대한주산의학회 2011 Perinatology Vol.22 No.4

목적 : 본 연구는 중증 고빌리루빈혈증으로 치료한 신생아들에서 급성기에 보이는 뇌자기공명영상의 의의에 대하여 알아보고자 하였다. 방법 : 2006년 1월부터 2011년 4월까지 중증 고빌리루빈혈증으로 진단받고 충남대학교병원 신생아집중치료실에 입원하였던 재태연령 37주, 출생체중 2500 g 이상의 신생아들에서 퇴원 전 뇌자기공명영상을 촬영하였던 환아 총 60명을 대상으로 하였다. T1강조영상에서 양측 기저핵 부위 담창구의 신호증가가 보이는 군과 정상 신호를 보이는 군으로 분류하여 두 군간의 임상적 특징과 경과를 비교하였다. 결과 : 환아의 62%에서 뇌자기공명영상의 이상 소견이 보였으며 T1 강조영상에서 양측 기저핵 부위 담창구의 신호 증가가 보이는 소견 뿐만 아니라 신경학적 이상 징후를 동반하지 않는 두개내 출혈도 비교적 흔히 관찰되었다. T1 강조영상에서 양측 기저핵 부위 담창구의 신호증가를 보인 군이 정상신호를 보인 군보다 용혈, 빈혈, 교환수혈 등의 빈도가 높았으나 이외 인구학적 특성과 신경학적 예후에는 차이가 없었다. 결론 : 중증 고빌리루빈혈증으로 치료하였던 신생아에서 T1강조영상에서 양측 담창구의 고신호 강도는 급성 빌리루빈뇌증의 초기 소견으로 간주되어 보다 주의 깊은 신경학적 추적 관찰이 필요하나, 비교적 양호한 신경학적 예후를 가지는 것으로 사료되며 가역적 병변일 가능성이 높다. Purpose : We evaluated the brain magnetic resonance imaging (MRI) findings and significance in newborns with severe hyperbilirubinemia. Methods : This study included 60 newborns with severe hyperbilirubinemia at the neonatal intensive care unit (NICU) of the Chungnam National University Hospital from January 2006 to April 2011. The patients were grouped according to with or without high signal intensities in the globus pallidus (GP) on T1-weighted MRI. We compared the clinical characteristics and neurodevelopmental outcomes between the groups. Results : Thirty-seven of the 60 newborns (62%) showed symmetric high signal intensities in the GP on T1-weighted MRI or intracranial hemorrhage. The group that had high signal intensities in the GP on T1-weighted MRI showed a higher tendency of hemolysis, anemia and exchange transfusion. Demographic characteristics and neurodevelopmental outcomes were similar between the groups. Conclusion : We suggest that the GP involvement in severe hyperbilirubinemia of newborn is described as high signal intensities on T1-weighted MRI in the early stage but this lesion is a transient phenomenon that have relatively good long-term prognosis.

뇌수막염을 동반한 신생아 Gardnerella vaginalis 패혈증

진혜영 ( Hye Young Jin ),오상민 ( Sang Min Oh ),장미영 ( Mea Young Chang ) 대한주산의학회 2007 Perinatology Vol.18 No.2

Modification of nutrition strategy for improvement of postnatal growth in very low birth weight infants

Choi, Ah Young,Lee, Yong Wook,Chang, Mea-young The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.4

Purpose: To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants. Methods: The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1 (n=37); prior to the PN and EN regimen being modified, period 2 (n=50); following the PN-only regimen modification, period 3 (n=37); following both PN and EN regimen modification. The modified PN regimen provided 3 g/kg/day of protein and 1 g/kg/day of lipid on the first day of life. The modified EN regimen provided 3.5-4.5 g/kg/day of protein and 150 kcal/kg/day of energy. We investigated growth rate, anthropometric measurements at 40 weeks postconceptional age (PCA) and the incidence of extrauterine growth restriction (EUGR) at 40 weeks PCA. Results: Across the 3 periods, clinical characteristics, including gestational age, anthropometric measurements at birth, multiple births, sex, Apgar score, surfactant use and PDA treatment, were similar. Growth rates for weight and height, from time of full enteral feeding to 40 weeks PCA, were higher in period 3. Anthropometric measurements at 40 weeks PCA were greatest in period 3. Incidence of weight, height and head circumference EUGR at 40 weeks PCA decreased in period 3. Conclusion: Beginning PN earlier, with a greater supply of protein and energy during PN and EN, is advantageous for postnatal growth in VLBW infants.

신생아 수신증의 원인과 임상 경과에 대한 고찰

강현영,장미영,이재호,Kang Hyun-Young,Chang Mea-Young,Lee Jae-Ho 대한소아신장학회 2005 Childhood kidney diseases Vol.9 No.1

목 적 :본 연구자는 초음파로 진단된 신생아 수신증의 원인을 규명하고 임상 경과 등을 후향적으로 추적 관찰하여 수신증 환아를 효과적으로 관리하는 방법을 모색하고자 하였다. 방 법 1998겪부터 2003년까지 충남대학교병원 신생아중환자실에 입원하였던 환아 중 신초음파로 진단된 수신증 환아 54명을 분석하였다. 결 과 :신초음파로 진단된 수신증 환아는 전체 신생아중환자실에 입원하였던 환자 2,539명중 54명(2.1%)이었으며, 남녀비는 3.5:1이었다. 54명에서의 77신단위의 수신증은 경증 33신단위(42.8%), 중등도 24신단위(31.1%), 중증 20신단위(26.1%)이었으며, 평균 추적관찰 기간은 9.31개칙(0-30)이었다 수신증의 원인으로는 46신단위 중에서 요관 신우 이행부 협착이 15신단위(32.6%), 다낭성 이형성 신이 3단위(6.5%), 요관 방광 이행부 협착과 거대요관이 각각 2단위(4.3%), 방광요관역류 1단위(2.1%), 중복 신장이 1단위 (2.1%)이었다. 수신증의 자연경과와 수술적 치료에서는 33신단저의 경증 수긴증 중에서 25신단위(75.8%), 24신단위의 중등도 수신증 중에서 14신단위(58.3%). 20신단위의 중증 수신증 중에서 1신단위(5%)께서 자연 경감되었다. 수술적 치료를 받은 중증 수신증 12신단위 중 9신단위가 요관 신우 이행부 협착으로 가장 많았으며 진단에서 수술까지의 평균 기간은 10.3개월이었다. 결 론 :신생아 수신증을 추적 관찰하는 동안 수신증의 정도가 심할 수록 낮은 자연 경감률을 나타내므로, 신생아 수신증에서 요로 폐색이 있거나 중등도 이상의 수신증이 있을 경우에는 일정한 주기로 초음파 검사와 배설성 신주사 추적검사를 시행하여 질병의 경과와 신장기능을 평가함으로써 효과적인 수술 시기를 결정해야 한다. Purpose : The most important management of congenital hydronephrosis consists of the early diagnosis and evaluation of the pathologic abnormalities of congenital hydronephrosis. This study was conducted to investigate the different causes of hydronephrosis and its clinical outcome. Methods : 54 live neonates who were hospitalized and diagnosed with congenital hydronephrosis at Chungnam National University Hospital from Aug. 1998 to Aug. 2003 were retrospectively analyzed. Results : Hydronephrosis(renal pelvic AP diameter $gt;5 mm) was postnatally detected in 54 cases(2.1%) among 2,539 neonates who were hospitalized from Aug. 1998 to Aug. 2003. There were three times more males than females. Additional imaging studies revealed that ureteropelvic junction obstruction was the most common postnatal diagnosis(48.7%), followed by multicystic dysplastic kidney, vesicoureteral reflux and duplication kidney with ureterocele. Spontaneous regression of hydronephrosis was revealed in 25 renal units(75.8% ) of mild hydronephrosis, 14 renal units of moderate hydronephrosis and 1 renal unit of severe hydronephrosis. Operative correction were carried out in 14 renal units(70%) of severe hydronephrosls. Conclusion : The most common established cause of congenital hydronephrosis in this study was ureteropelvic junction obstruction. There are many cases of spontaneous regression in mild to moderate congenital hydronephrosis. Urinary tract infections occur in many neonates with hydronephrosis. Therefore, early detection and evaluation of congenital hydronephrosis and continuous follow-up at regular intervals are necessary for conservation of renal function. (J Korean Soc Pediatr Nephrol 2005;9:69-75)