Insulin resistance is associated with new-onset cardiovascular events in nondiabetic patients undergoing peritoneal dialysis

( Chang Yun Yoon ),( Mi Jung Lee ),( Youn Kyung Kee ),( Eun Young Lee ),( Young Su Joo ),( In Mee Han ),( Seung Gyu Han ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Shin Wook Kang ),( T 대한신장학회 2014 Kidney Research and Clinical Practice Vol.33 No.4

Background: Chronic exposire to high glucose-containing peritoneal dialysis solution and consequent abdominal obesity are potential sources of insulinresistance in patients requiring prevalent peritoneal dialysis. The aim of this studywas to elucidate the prognostic values of insulin resistance on new-onset cardiovascularevents in nondiabetic patients undergoing prevalent peritoneal dialysis. Methods: A total of 201 nondiabetic patients undergoing prevalent peritonealdialysis were recruited. Insulin resistance was assessed by homeostatic modelassessment of insulin resistance (HOMA-IR). The primary outcome was new-onsetcardiovascular events during the follow-up period. Cox proportional hazard analysiswas performed to ascertain the independent prognostic value of HOMA-IR for theprimary outcome. Results: The mean age was 53.1 years and male was 49.3% (n¼99). The meanHOMA-IR was 2.672.1. In multivariate linear regression, body mass index (β¼0.169,P¼0.011), triglyceride level (β¼0.331, Po0.001), and previous cardiovasculardiseases (β¼0.137, P¼0.029) were still significantly associated with HOMA-IR. During a mean follow-up duration of 36.8716.2 months, the primary outcomewas observed in 36 patients (17.9%). When patients were divided into tertilesaccording to HOMA-IR, the highest tertile group showed a significantly higherincidence rate for new-onset cardiovascular events compared to the lower twotertile groups (P¼0.029). Furthermore, multivariate Cox analysis revealed thatHOMA-IR was an independent predictor of the primary outcome (hazardratio¼1.18, 95% confidence interval¼1.03-1.35, P¼0.014). Conclusion: Insulin resistance measured by HOMA-IR was an independent riskfactor for new-onset cardiovascular events in nondiabetic patients undergoingprevalent peritoneal dialysis.

Low Mitochondrial DNA Copy Number is Associated With Adverse Clinical Outcomes in Peritoneal Dialysis Patients

Yoon, Chang-Yun,Park, Jung Tak,Kee, Youn Kyung,Han, Seung Gyu,Han, In Mee,Kwon, Young Eun,Park, Kyoung Sook,Lee, Mi Jung,Han, Seung Hyeok,Kang, Shin-Wook,Yoo, Tae-Hyun Wolters Kluwer Health, Inc. All rights reserved. 2016 Medicine Vol.95 No.7

<P>Mitochondrial dysfunction may play an important role in abnormal glucose metabolism and systemic inflammation. We aimed to investigate the relationship between mitochondrial DNA (mtDNA) copy number and clinical outcomes in peritoneal dialysis (PD) patients.We recruited 120 prevalent PD patients and determined mtDNA copy number by PCR. Primary outcome was all-cause mortality, whereas secondary outcomes included cardiovascular events, technical PD failure, and incident malignancy. Cox proportional hazards analysis determined the independent association of mtDNA copy number with outcomes.The mean patient age was 52.3 years; 42.5% were men. The mean log mtDNA copy number was 3.300.50. During a follow-up period of 35.4 +/- 19.3 months, all-cause mortality and secondary outcomes were observed in 20.0% and 59.2% of patients, respectively. Secondary outcomes were significantly lower in the highest mtDNA copy number group than in the lower groups. In multiple Cox analysis, the mtDNA copy number was not associated with all-cause mortality (lower two vs highest tertile: hazard ratio [HR]=1.208, 95% confidence interval [CI]=0.477-3.061). However, the highest tertile group was significantly associated with lower incidences of secondary outcomes (lower two vs highest tertile: HR [95% CI]=0.494 [0.277-0.882]) after adjusting for confounding factors.The decreased mtDNA copy number was significantly associated with adverse clinical outcomes in PD patients.</P>

열차하중이 장대레일궤도의 도상 횡방향 저항력에 미치는 영향

한상윤(Sang-Yun Han),한택희(Taek-Hee Han),원덕희(Duk-Hee Won),김대혁(Dea-Hyeok Kim),강영종(Young-Joung Kang) 한국철도학회 2012 한국철도학회 학술발표대회논문집 Vol.2012 No.5

장대레일 궤도의 비선형 해석은 주로 온도하중만을 고려하여 분석이 되었으나, 실제로 열차하중이 레일에 가해졌을 시 축하중에 의하여 부반력들이 발생하고, 이러한 부반력은 레일의 들림현상이 발생시킨다. 도상 횡방향 저항력의 저하는 장대레일 궤도의 좌굴에 큰 영향을 미친다. 열차하중을 고려한 장대레일 궤도의 좌굴거동을 분석하기 위하여 첫 단계로서 선형해석을 통하여 열차하중 재하 시 침목에 발생하는 연직방향 반력을 산출하고, 두 번째 각각의 침목에 발생하는 반력에 따른 도상 횡방향 저항력의 변화량은 산정하여, 마지막으로 재료 및 기하비선형해석 시 각각의 침목위치에 재 산정된 도상 횡방향 저항력의 값을 적용하여 해석을 수행 하였다. High thermal axial force and vehicle loads cause the track to shift in a lateral direction and the formation of track geometry imperfections (track irregularity). When the thermal stress level and track irregularity with vehicle load reach a critical value, the track loses stability. In many studies, the stability of CWR tracks is analyzed. However these studies are only considered in temperature load. The ballast resistance is changed by wheel load. When the wheel load is applied, rails and ties are moved upward or downward. In this case the friction between ties and ballasts is decreased or increased. In this study the change of the ballast resistance of each tie was applied to the nonlinear analysis of CWR tracks.

소아 일반촬영 검사 시 보호자 참여의사와방사선에 대한 인식도 조사

곽종혁(Jong-Hyeok Kwak),박찬혁(Chan-Hyeok Park),윤진호(Jin-Ho Yun),현진경(Jin-Kyeong Hyeon),김준혁(Jun-Hyeok Kim),오용석(Yong-Seok Oh),김성건(Seong-Geon Kim),최민경(Min-Kyeong Choi),한미래(Mi-Rae Han),김길환(Gil-Hwan Kim),이하나(Ha-N 대한영상의학기술학회 2018 대한영상의학기술학회 논문지 Vol.2018 No.1

Purpose:This study was conducted to improve the quality of the examination and facilitate the communication be-tween the radiologist and the guardians by investigating participants and their perception of radiation about general radiography of children. Materials and Methods:From June 1, 2017 to December 31, 2017, the questionnaires were surveyed for the guardians of children who visited the P Hospital in Yangsan, Kyung-nam Province. The number of subjects was calculated using statistical power analysis using G * power 3.1 analysis. Estimated sample size was calculated as 93 when it was the moderate effect size of 0.15 for the simple regression analysis, 95% for the power of test, the significance level of 0.05, and the awareness of radiation exposure prevention of 1, which is related to the degree of awareness of the guardian. A total of 210 people were selected considering the recovery rate and insufficient number of responses. All items were evaluated on a 5-point Likert-type scale, except for questions related to general and participant intention. In this study, data were analyzed using SPSS 21.0 for windows statistical package program and variables were evaluated based on Chronbach s Alpha coefficient. Descriptive statistics were used to analyze the general characteristics and participation intention of the sample. T-test, One-way ANOVA, Pearson correlation, and Simple regression analysis were used to comply with the purpose of the study. Result: The results of the reliability analysis of the variables were more than 0.6 in Chronbach’s Alpha, 0.645 for Psychological status at general radiography of children, 0.667 for radiation recognition, and 0.666 for radiation exposure prevention recognition. In the recognition survey of guardian participant intention, to this question “Have you ever been involved in the general radiography of children in the past?” Yes (66.2%) and No (33.8%) were answered. The reason for participating in the general radiography of children were request of radiologist (46.0%) own volition and by child’s request (20.9%). To the question of “Do you think it is necessary for parents to participate in the gen-eral radiography of children?” yes (84.3%) and no (15.7%) were responded. The question “If you are willing to participate, why?” showed 80.8% for the stability of the child and 18.1% for the confirmation of the exact examination according to the site. The question “What if there is no intention to participate?” were 54.8% , 19.4%, and 12.9% due to radiologist’s duty, negative health effects and vague fear of radiation exposure respectively. There was a statistically significant difference according to gender and age of children (p<0.05) in the analysis of the psychological status of the guardians in the general radiography of children. There was statistically significant difference according to gender and educational background (P<0.05). There was a statistically significant difference according to age, gender, childhood age and educational background in the perception of prevention of radiation exposure of guardians in general radiography of children (p<0.05). Conclusion:From the results of the study, the guardians at the general radiography recognized the need for accompanying examination with them due to the stable and accurate examination of the children. However, it was not considered as distrust of radiologists or dangerous to the physical hazards of radiation exposure. Therefore, it is desirable to eliminate the psychological anxiety of the children and to induce the guardians to accompany in the pediatric examination. In addition it is considered that the plans to explain the examination method and the necessity of wear protective equipment are needed. 목 적:소아 일반촬영 검사 시 보호자들의 참여 여부와 방사선에 대한 인식도를 파악함으로써 검사자인 방사선사와 보호자의 상호 의사소통을 원활히하고 검사의 질을 향상시키고자 본 연구를 시행하였다. 대상 및 방법: 경남 양산 소재 P대학병원에 내원한, 소아 아동이 있는 보호자를 대상으로 2017년 6월 1일부터 2017년 12월 31일까지 설문조사하였으며 연구 대상의 수는 Statistical power analysis using G * power 3.1 analysis를 이용하여 산출하였고, 예상 표본수는 단순 회귀분석을 위한 중간 정도의 효과크기 0.15, 검정력 95%, 유의수준 0.05, 보호자의 인식도와 관련성이 있는 변인인 방사선 피폭방지인식도를 1로 하였을 때 93명으로 계산 되었고, 회수율과 불충분한 응답 수를 고려하여 총 210명을 선정 일반적 사항 및 참여의사 여부에 관련된 문항을 제외한 모든 문항을 Likert 방식의 5점 척도로 평가하였다. 본 연구에서는 SPSS 21.0 for windows 통계 패키지 프로그램을 사용 하여 자료 분석하였고 Chronbach s Alpha계수를 근거로 변수를 평가하였다. 표본의 일반적 특성 및 참여의사 여부를 분석하기 위해 기술통계를 하였으며 연구의 목적에 부합 되도록 평균차 분석 (T-test) 및 일원배치분산분석(One-way ANOVA), 상관관계분석(Pearson correlation), 단순 회귀분석(Simple regression analysis)등을 시행하였다. 결 과:변수의 신뢰도 분석결과는 소아 일반촬영 시 심리 상태 0.645, 방사선 인식도 0.667, 방사선 피폭 방지 인식도 0.666으로 Chronbach s Alpha 0.6이상이었다. 소아일반촬영 시 보호자 참여의사 여부 인식도조사에서 “ 과거에 소아 일반촬영에 참여해 본적이 있는가?”라는 질문에 그렇다(66.2%), 아니다(33.8%)로 나타났다. 소아 일반촬영에 참여해 본 경우, 참여한 이유는 방사선사의 요청 (46.0%), 본인의 의지(28.8%), 아이의 요청 (20.9%)로 나타났다. “소아 일반촬영 시 보호자의 참여가 필요하다고 생각하는가?”라는 질문에 그렇다(84.3%), 아니다(15.7%)로 나타났다. “참여할 생각이 있다면 그 이유는 무엇인가?”라는 질문에는 아이의 안정을 위해(80.8%), 부위에 따른 정확한 검사확인을 위해(18.1%)라고 나타났으며, “참여할 생각이 없다면 그 이유는 무엇인가?”라는 질문에는 방사선사의 업무이기 때문에(54.8%), 건강에 나쁜 영향을 미치기 때문에(19.4%), 방사선 피폭에 대한 막연한 두려움 때문에(12.9%)로 나타났다. 소아 일반촬영 시 보호자의 심리 상태 인식도 분석에서는 성별, 소아 연령에 따라 통계적으로 유의한 차이가 있었고(p<0.05), 소아 일반촬영 시 보호자의 방사선 인식도 분석에서는 성별, 학력에 따라 통계적으로 유의한 차이가 나타났으며(p<0.05), 소아 일반촬영 시 보호자의 방사선 피폭 방지에 대한 인식도 분석에서는 연령, 성별, 소아 연령, 학력에 따라 통계적으로 유의한 차이가 있었다(p<0.05). 결 론:연구 결과에서 볼 때 소아 일반촬영 시 보호자들은 우선적으로 아이의 안정과 정확한 검사를 위해 방사선사와 동반검사가 필요하다고 인식하고 있었으며, 방사선사의 불신이나 방사선의 피폭에 대한 신체적 위해요소에는 그다지 위험하다고 인식하고 있지 않았다. 그러므로 소아 일반촬영 검사 시 그들의 심리적 불안감을 해소하고 정확한 검사를 위해 보호자의 동반을 유도하는 것이 바람직하며 검사방법과 보호 장구 착용의 필요성을 설명할 수 있는 방안이 필요한 것으로 사료되어진다.

Poster Session : PS 1376 ; Nephrology : Delta Neutrophil Index as an Independent Predictor of Mortality in Septic Acute Kidney Injury Patients Under-going Continuous Renal Replacement Therapy

( In Mee Han ),( Dong Ho Shin ),( Youn Kyung Kee ),( Chang Yun Yoon ),( Eunyoung Lee ),( Young Su Joo ),( Seung Gyu Han ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Shin Wook Kang ),( T 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Delta Neutrophil Index (DNI) indicates the fraction of circulating immature granulocytes, which is known to increase in infectious and/or septic conditions. However, the relationship between DNI and mortality in septic acute kidney injury (AKI) patients is not yet fully elucidated. Therefore, we assessed whether DNI is associated with mortality in septic AKI patients requiring continuous renal replacement therapy (CRRT). Methods: We retrospectively enrolled 285 patients with septic AKI who were treated with CRRT at Yonsei University Health System between August 2009 and September 2012. The patients were dichotomized into high and low DNI groups based on the cutoff value from receiver operating characteristics of DNI values at the time of CRRT initiation. Log-rank test and Cox proportional hazards analysis were conducted to evaluate the effect of DNI as a prognostic factor for 28-day all-cause mortality. Results: The mean age of the enrolled patients was 61.0 ± 14.7 years and 180 patients (63.2%) were male. The high DNI group (DNI > 5.6%) was composed of 149 patients (52.3%). During the study period, 192 patients (67.1%) died. Mortality rate during the 28-days was significantly increased in the high DNI group compared to low DNI group (79.9% vs. 53.3%, P < 0.01, log rank test p Conclusions: This study demonstrates that DNI at CRRT initiation could be an useful predictor for mortality in septic AKI patients requiring CRRT.

LC, Acute : PE-117 ; Incidence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal

( Yun Jung Choi ),( Jeong Han Kim ),( Ja Kyung Koo ),( Cho I Lee ),( Ji Young Lee ),( Jae Hoon Yang ),( Soon Young Ko ),( Won Hyeok Choe ),( So Young Kwon ),( Chang Hong Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: In year 2011, a revised classification system of renal dysfunction in patients with cirrhosis was proposed by the acute dialysis quality initiative (ADQI) and the international ascites club (IAC) Working Group [Gut 2011;60:702-709]. We aimed to evaluate the incidence of renal dysfunction according to this proposal. Methods: We retrospectively reviewed medical records of cirrhotic patients who admitted at konkuk university hospital from year 2008 to 2010. The data of first admission date was used for data collection. Definitions of acute kidney injury (AKI) and chronic kidney disease (CKD) were made by proposed diagnostic criteria of kidney dysfunction in cirrhosis. Results: Total 590 patients admitted. Child-Pugh class A/B/C were 178/242/170 (30.2%, 41%, 28.8%). 70 patients (11.9%) were diagnosed with AKI. Most common cause was dehydration, 28 patients. 3 patients were type 1 hepatorenal syndrome and 16 patients were pre-renal type AKI caused by volume deficiency after variceal bleeding. 3 patients were diagnosed with AKI induced by septic shock. On the other hand, 10 patients (1.7%) were diagnosed with CKD. Among these, 1 patient was already diagnosed with end stage renal disease because of IgA nephropathy and 6 patients had underlying diabetes or hypertension. 3 patients had unknown cause of chronic renal insufficiency. Presence of type 2 hepatorenal syndrome was not found. 6 patients (1%) were diagnosed with AKI on CKD. Conclusions: Incidence of renal dysfunction in cirrhosis is not infrequent (Total 14.6%). Diagnosis of type 2 hepatorenal syndrome was still difficult and that of acute-on-chronic kidney disease needs long term follow up evaluation of renal function in cirrhotic patients. Prospective cohort study is warranted for the evaluation of clinical course in cirrhotic patients with renal dysfunction.

Original Article : Prevalence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal

( Yun Jung Choi ),( Jeong Han Kim ),( Ja Kyung Koo ),( Cho I Lee ),( Ji Young Lee ),( Jae Hoon Yang ),( Soon Young Ko ),( Won Hyeok Choe ),( So Young Kwon ),( Chang Hong Lee ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.2

Background/Aims: A revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal. Methods: The medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis. Results: Six hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD. Conclusions: Both AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains diffi cult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction. (Clin Mol Hepatol 2014;20:185-191)

Obesity, Metabolic Abnormality, and Progression of CKD

Yun, Hae-Ryong,Kim, Hyoungnae,Park, Jung Tak,Chang, Tae Ik,Yoo, Tae-Hyun,Kang, Shin-Wook,Choi, Kyu Hun,Sung, Suah,Kim, Soo Wan,Lee, Joongyub,Oh, Kook-Hwan,Ahn, Curie,Han, Seung Hyeok,Park, Seohyun,Jhe Elsevier 2018 American Journal of Kidney Diseases Vol.72 No.3

<P><B>Rationale & Objective</B></P> <P>Recent studies have yielded conflicting findings on the association between obesity and progression of chronic kidney disease (CKD). Few studies have evaluated whether metabolic abnormalities may accelerate the rate of progression of CKD.</P> <P><B>Study Design</B></P> <P>Prospective observational cohort study.</P> <P><B>Setting & Participants</B></P> <P>1,940 participants from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD)</P> <P><B>Predictors</B></P> <P>Obesity and metabolic abnormality. Obesity was defined as body mass index ≥ 25kg/m<SUP>2</SUP>. Metabolic abnormality was defined as the presence of 3 or more of the following 5 components: hypertension, fasting glucose level > 125mg/dL or the presence of type 2 diabetes, triglyceride level > 150mg/dL or use of lipid-lowering drugs, high-density lipoprotein cholesterol level ≤ 40mg/dL in men and ≤ 50mg/dL in women, and high-sensitivity C-reactive protein level > 1mg/L.</P> <P><B>Outcome</B></P> <P>A composite of a 50% decline in estimated glomerular filtration rate from the baseline value or end-stage kidney disease.</P> <P><B>Analytic Approach</B></P> <P>Multivariable cause-specific hazards models implemented to assess the association between obesity, metabolic abnormality, and CKD progression.</P> <P><B>Results</B></P> <P>During a mean follow-up of 3.1 years, the primary outcome occurred in 395 (20.4%) patients. In multivariable analyses, after adjustment for confounding factors, obesity and metabolic abnormality were significantly associated with 1.41-fold (95% CI, 1.08-1.83; <I>P</I> =0.01) and 1.38-fold (95% CI, 1.03-1.85; <I>P</I> =0.03) increased risk for adverse renal outcomes, respectively. Patients were categorized into 4 groups depending on the presence of obesity and metabolic abnormality. Compared with those with neither obesity nor metabolic abnormality, those with obesity and metabolic abnormality had a greater risk for CKD progression (HR, 1.53; <I>P</I> =0.03). Those with obesity without metabolic abnormality also had a higher rate of CKD progression (HR, 1.97; <I>P</I> =0.01).</P> <P><B>Limitations</B></P> <P>Observational study, limited power to detect cardiovascular disease outcomes, unmeasured confounders.</P> <P><B>Conclusions</B></P> <P>Both metabolic abnormality and obesity are associated with a significantly increased risk for CKD progression. Notably, obese patients without metabolic abnormality also have an elevated risk for CKD progression.</P>

HC, Acute : PE-117 ; Incidence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal

( Yun Jung Choi ),( Jeong Han Kim ),( Ja Kyung Koo ),( Cho I Lee ),( Ji Young Lee ),( Jae Hoon Yang ),( Soon Young Ko ),( Won Hyeok Choe ),( So Young Kwon ),( Chang Hong Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: In year 2011, a revised classification system of renal dysfunction in patients with cirrhosis was proposed by the acute dialysis quality initiative (ADQI) and the international ascites club (IAC) Working Group [Gut 2011;60:702-709]. We aimed to evaluate the incidence of renal dysfunction according to this proposal. Methods: We retrospectively reviewed medical records of cirrhotic patients who admitted at konkuk university hospital from year 2008 to 2010. The data of first admission date was used for data collection. Definitions of acute kidney injury (AKI) and chronic kidney disease (CKD) were made by proposed diagnostic criteria of kidney dysfunction in cirrhosis. Results: Total 590 patients admitted. Child-Pugh class A/B/C were 178/242/170 (30.2%, 41%, 28.8%). 70 patients (11.9%) were diagnosed with AKI. Most common cause was dehydration, 28 patients. 3 patients were type 1 hepatorenal syndrome and 16 patients were pre-renal type AKI caused by volume deficiency after variceal bleeding. 3 patients were diagnosed with AKI induced by septic shock. On the other hand, 10 patients (1.7%) were diagnosed with CKD. Among these, 1 patient was already diagnosed with end stage renal disease because of IgA nephropathy and 6 patients had underlying diabetes or hypertension. 3 patients had unknown cause of chronic renal insufficiency. Presence of type 2 hepatorenal syndrome was not found. 6 patients (1%) were diagnosed with AKI on CKD. Conclusions: Incidence of renal dysfunction in cirrhosis is not infrequent (Total 14.6%). Diagnosis of type 2 hepatorenal syndrome was still difficult and that of acute-on-chronic kidney disease needs long term follow up evaluation of renal function in cirrhotic patients. Prospective cohort study is warranted for the evaluation of clinical course in cirrhotic patients with renal dysfunction.

Neonatal Outcomes in Term Births according to Gestational Weeks

( Yun Jeong Park ),( Young Hwa Kwak ),( Hee Yon Kim ),( Sang Won Han ),( Eui Hyeok Kim ) 대한주산의학회 2020 Perinatology Vol.31 No.1

Objective: This study aimed to determine neonatal outcomes and morbidities according to gestational weeks in term births. Methods: This was a retrospective observational study of 626 singleton deliveries from 37 0/7 to 41 6/7 gestational weeks in National Health Insurance Service Ilsan Hospital using electronic medical record data from January 1, 2011 to December 31, 2017 Neonatal outcomes and morbidity in women who attempted vaginal delivery were compared at each gestational week. Results: Early term births (37 0/7 to 38 6/7) accounted for 38.7% of full-term births (242/626). The rate of neonatal intensive care unit (NICU) admission was the lowest at 39 gestational weeks (25.0%) and highest at 41 weeks (30.8%). Compared to 39 gestational weeks, the rate of NICU admission days for more than 5 days and 5-minute Apgar score less than 7 were higher at 37 gestational weeks (26.6% vs. 11.3%, P=0.028 and 7.6% vs. 2.0%, P=0.011, respectively). The intubation rate was lower in 39 weeks than in 37 weeks without statistical significance. The incidence of meconium-stained amniotic fluid increased with gestational weeks from 37 weeks (1.3% at 37 weeks, 30.8% at 41 weeks, P<0.001). Severe neonatal morbidities were very low and not different according to gestational weeks. Conclusion: Among term births, our study showed that the prevalence of neonatal morbidities was highest at 37 gestational weeks and lowest at 39 gestational weeks. However, there was no significant difference in severe morbidities. Further studies are urgently required to determine the appropriate timing of delivery to avoid common neonatal complications.