The Impact of Surgical Intervention on Neurodevelopmental Outcomes in Very Low Birth Weight Infants: a Nationwide Cohort Study in Korea

성세인,이나현,김현호,김혜선,한예슬,양미선,안소윤,장윤실,박원순 대한의학회 2019 Journal of Korean medical science Vol.34 No.43

Background: To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18–24 months, using data from the Korean Neonatal Network (KNN). Methods: Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18–24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. Results: A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1–2.6 and 2.3 with 95% CI of 1.1–4.9. Conclusion: Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18–24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.

Insensible Water Loss during the First Week of Life of Extremely Low Birth Weight Infants Less than 25 Gestational Weeks under High Humidification

성세인,안소윤,서현주,유혜수,한영미,이명숙,장윤실,박원순 대한신생아학회 2013 Neonatal medicine Vol.20 No.1

Purpose: Extremely-low-birth-weight infants (ELBWIs), especially those ≤24 gestational weeks (GW), presented extremes in IWL and changes of water balance. The purpose of the present study was to retrospectively investigate fluid and electrolyte balance in infants of ≤24-GW during the first postnatal week under high humidification. Methods: Medical records of extremely-low-birth-weight infants (ELBWIs) who were born and admitted to the Neonatal Intensive Care Unit at Samsung Medical Center during March 2004–September 2010 were reviewed. Fluid intake, urine output, insensible water loss (IWL) and electrolyte balance of 22-GW (n=14), 23-GW (n=40) and 24-GW (n=67) infants nursed in high humidity (95%) were compared with ≥26-GW (n=65) infants nursed in 60% humidity Results: Survival rate until discharge was 33%, 82%, 75% and 89.3% in 22-GW, 23-GW, 24-GW and ≥26-GW infants, respectively. Compared to ≥26-GW infants, fluid intake and IWL was higher in 22-GW and 23-WG, but not as different in 24-GW. At postnatal day (P) 3–5, urine output was significantly lower in ≥26-GW infants than in the other age groups. Serum sodium level was significantly higher in 22-, 23- and 24-GW (P1–2) than in ≥26-GW infants. Hypernatremia (>150 mEq/dl sodium) was more frequent in 22-GW (71%), 23-GW (41%) and 24-GW (21%) than in ≥26-GW infants (14%). Conclusion: High-humidity environments significantly decreased fluid intake and improved electrolyte imbalance in 24-GW, but not in 22- and 23-GW infants. Increased IWL in the latter might be related to more immature skin, implicating the need for additional nurturing conditions.

The Youngest Survivor with Gestational Age of 215 /7 Weeks

성세인,안소윤,유혜수,장윤실,박원순 대한의학회 2018 Journal of Korean medical science Vol.33 No.3

The decision whether or not to resuscitate extremely low gestational age (GA) infants is recommended to be individualized according to antenatal counseling with parents, neonatologists, and obstetricians. A GA of 220 /7 –236 /7 weeks is generally considered as the lower end of the range where infants can be candidates for selective resuscitation. Below this lower end of periviable gestation, resuscitation is usually not considered and survivors are rarely reported. To date, the youngest survivor is an infant with a GA of 216 /7 weeks reported in the English medical literature. Here, we report the case of a female infant, the first twin conceived through in vitro fertilization, with a GA of 215 /7 weeks, who was resuscitated initially according to strong parental wishes after antenatal counseling and is still surviving at 43 months of age with fairly good neurodevelopmental outcome.

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

성세인,최수영,박재현,이명숙,유혜수,안소윤,장윤실,박원순 대한의학회 2014 Journal of Korean medical science Vol.29 No.4

The purpose of this study was to evaluate prognostic factors associated with surgicalligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limitsof viability. Ninety infants who were born at 23-25 weeks of gestation and who receivedsurgical ligation were included and their cases were retrospectively reviewed. Infants wereclassified into two different groups: survivors with no major morbidity (N), and nonsurvivorsor survivors with any major morbidity (M). Clinical characteristics were comparedbetween the groups. Possible prognostic factors were derived from this comparison andfurther tested by logistic regression analysis. The mean gestational age and the mean birthweight of M were significantly lower than those of N. Notably, the mean postnatal age attime of ligation in N was significantly later than that of the other group (17 ± 12 vs11 ± 8 days in N and M, respectively). An adjusted analysis showed that delayed ligation( > 2 weeks) was uniquely associated with a significantly decreased risk for mortality orcomposite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). Inconclusion, delayed surgical ligation for PDA ( > 2 weeks) is associated with decreasedmortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

마이크로프로세서를 理用한 直線 및 圓弧補間

成世鎭,車貴守 충남대학교 공업교육연구소 1984 論文集 Vol.7 No.2

In case of using the numerical control machine(CNC) for the metal cutting machine, the accuracy of the interpolator is more important than the speed of it. This paper presents a interpolator having high accuracy and simple algorithm. The interpolator is realized by general purpose 6502 microprocessor without designing a special purpose processor. Error generated by the interpolator is less than half of basic unit and the speed of the interpolator is faster than that of metal cutting machine. And the various functions, such as speed control function, manual operating function and material finishing function are all operated as expected.

예비역 청년 돌봄 프로젝트를 소개합니다

성세현 미래사목연구소 2022 사목정보 Vol.15 No.2

FUZZY q-IDEALS OF BCI-ALGEBRAS WITH DEGREES IN THE INTERVAL (0; 1]

성세경,안선신 충청수학회 2012 충청수학회지 Vol.25 No.2

The notion of an enlarged q-ideal and a fuzzy q-ideal in BCI-algebras with degree are introduced. Related properties of them are investigated.

임상 ; 초극소 미숙아(<1,000 g)에서 분만 형식 (제왕절개 vs. 질식분만)에 따른 예후

성세인 ( Se In Sung ),김진규 ( Jin Kyu Kim ),유혜수 ( Hye Soo Yoo ),안소윤 ( So Yoon Ahn ),김은선 ( Eun Sun Kim ),최석주 ( Suk Joo Choi ),장윤실 ( Yun Sil Chang ),박원순 ( Won Soon Park ) 대한주산의학회 2010 Perinatology Vol.21 No.4

목적: 최근 미숙아와 저체중 출생아의 생존율이 급격히 증가하고 있으며, 일부에서 제왕절개가 이들의 생존율을 향상시킨다고 주장한다. 본 연구는 단일기관에서 초극소 미숙아의 제왕절개 비율과 이들의 예후에 대해 알아보고자 하였다. 방법: 2000년 1월부터 2008년 12월까지 9년간 삼성서울병원에서 출생하여 신생아 집중치료실에 입원하였던 초극 소미숙아(<1,000 g) 415명 중 제왕절개를 시행 받은 325명의 특징, 예후를 조사하여 이들을 대조군인 질식분만을 통해 출생한 90명과 비교하였다. 결과: 초극소 미숙아 415명 중 325명(78%)이 제왕절개로 출생하였으며, 재태주수가 높을수록 제왕절개 비율도 상 승하였다. 재태주수, 부당경량아, 산모의 임신성 고혈압 유무, 산모의 산전 스테로이드 투여 여부가 초극소 미숙아의 예후와 연관이 있었으며 이들 교란 요인은 이후의 분석에서 교정되었다. 교란요인에 따라 층화분석하였을때, 제왕절 개군과 질식분만군에서 28일 이내 생존율의 차이가 없었다. 다중 로지스틱 분석에서도 두 군(제왕절개군과 질식분만군) 간의 생존율과 이환율(뇌실 내출혈, 기관지폐 이형성증 등)의 차이가 없었다. 결론: 단일기관 연구 결과 초극소 미숙아(<1,000 g)에서 제왕절개가 이들의 단기 예후를 향상시키지는 않았다. Objective: Some studies have suggested that delivery by Cesarean section is associated with a better prognosis for the extremely low birth weight infants (ELBWIs). The purpose of this study is to review neonatal outcomes according to the mode of delivery in ELBWIs. Methods: Medical records of 415 ELBWIs (<1,000 g) who were born and admitted to the neonatal intensive care unit (NICU) at Samsung Medical Center (SMC) from January 2000 to December 2008 were reviewed retrospectively. Clinical characteristics and outcomes of the ELBWIs delivered by Cesarean section (C-group, N=325) were compared with those of vaginally delivered infants (V-group, N=90). Logistic regression was performed to verify the significance of outcome difference, and to obtain odds ratios for mortality and morbidities according to the mode of delivery. Potential confounders were adjusted in this multivariate logistic regression analysis. Results: Among the 415 ELBWIs, 325 (78%) were delivered by C-section. Gestational age and the rate of Cesarean section delivery showed positive correlation. Gestational age, small-for-gestational age status, pregnancy-induced hypertension and antenatal steroid administration were found to interact with the outcomes of ELBWIs and were corrected in the subsequent analysis. The analysis was stratified by confounders, and comparison between the two groups showed no differences in mortality within 28 days. Multivariate logistic regression also showed no significant differences in mortality and morbidities according to the mode of delivery. Conclusions: In our study, Cesarean section was not associated with better outcomes for the extremely low birth weight infants.~

두빈-존슨 증후군 환자에서 발생한 급성 A형 간염으로 인한 지속성 담즙 정체 1예

성세용,정호연,라상호,차재황,김문영,백순구,조미연 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 두빈-존슨 증후군은 선천적 고빌리루빈 혈증을 나타내는 대사 장애 중 주로 포합 빌리루빈 혈증이 관찰되며 간에서 포합된 빌리루빈이 세담관으로 분비되는 과정에 이상으로 발생하는 증후군이다. 두빈-존슨 증후군에서 빌리루빈 수치는 일반적으로 2-5 mg/dL 정도이며 다른 일반적인 간기능 검사는 정상이다. 저자들은 과거에 두빈-존슨 증후군을 진단 받은 환자에서 발생한 급성 A형 간염으로 인한 지속성 담즙 정체 1예를 경험하였기에 보고하는 바이다. 증례: 34세 남자 환자는 5일 전 발생한 열과 우상복부 통증을 주소로 본원에 내원하였다. 과거력상 1995년도에 간조직 검사를 통해 두빈-존슨 증후군을 진단 받았다. 내원 당시 활력 징후는 130/92 mmHg, 맥박 61회/분, 호흡수 18회/분, 체온 36.7℃이었다. 구역질, 전신 쇠약감 및 식욕 부진 호소하였고 신체 검진에서 전신 황달 및 공막 황달이 관찰되었고 우상복부 압통 소견이 관찰되었다. 혈액 검사상 백혈구 4030/mm3, 혈색소 15.3 g/dL, 혈소판 142000/mm3이었고 혈청 생화학 검사상 AST/ALT 11745/11779 IU/L, ALP/GGT 154/285 IU/L, CK/LDH 1024/7500 IU/L, total bilirubin/direct bilirubin 14.2/12.7 mg/dL 소견 보였다. 혈액 응고 검사상 PT INR 3.15 로 상승되었고 소변 검사상 bilirubin 2+ 소견 보였다. 면역 혈청 검사상 HAV IgM (+) 소견 보여 급성 A형 간염으로 진단하였다. 이미지 검사상 간비장 종대 이외에 특이 소견 관찰되지 않았다. 내원 후 보전적 치료 후에 증상 호전되었고, 내원 8개월째에 시행한 검사상 AST/ALT 43/22 IU/L, ALP/GGT 88/50 IU/L, PT INR은 1.10으로 급성 간염은 회복되었으나 total bilirubin/direct bilirubin은 36/30.6 mg/dL 까지 상승하였고, 급성 A형 간염 발생 10개월째, 최근 시행한 검사상 18.2/16.8 mg/dL으로 담즙 정체 지속되는 상태로 외래 추적 관찰 중이다.

정사(正史)와 야사(野史)

성세진 전력전자학회 2017 전력전자학회지 Vol.22 No.4