신생아 환자에서 지방 유제 사용 시 어유 함유 여부에 따른 Parenteral Nutrition-Associated Liver Disease 발생 정도 분석

박정아 ( Jeong-a Park ),박지은 ( Ji-eun Park ),정민재 ( Min-jae Jeong ),김재송 ( Jae-song Kim ),손은선 ( Eun-sun Son ),은호선 ( Ho-seon Eun ) 한국정맥경장영양학회 2017 한국정맥경장영양학회지 Vol.9 No.1

Purpose: This study is a comparative evaluation of the incidence of parenteral nutrition-associated liver disease (PNALD) when administering intravenous fat emulsions containing fish oil. Methods: The medical records of patients who were in the neonatal intensive care unit at Severance Hospital from January, 2012 to December 2015, were reviewed retrospectively. Patients who were administered either soybean oil (SO) or SMOF (containing soybean oil, medium chain triglycerides, olive oil, and fish oil) more than 14 days were included. The patients were excluded if they were administered both agents or had underlying hepatic disease. An increase in bilirubin to 2 mg/dL was defined as PNALD. Results: PNALD occurred in only 8 out of a total of 77 patients: 6 out of 31 (19.4%) in the SO group and 2 out of 46 (4.3%) in the SMOF group (P=0.055). The number of patients, whose lab values, such as direct bilirubin, total bilirubin, asparate aminotransferase (AST), alanine amino-transferase, gamma-glutamyl transpeptidase, C-reactive protein, serum triglyceride, and alkaline phosphate, exceeded the normal range, were similar in both groups. The gestational age, birth body weight, and APGAR score at 1 min and 5 min were significantly higher in the SO group and the PN duration was significantly long in the SMOF group. Considering only term infants, there were no significant differences in baseline characteristics and incidence of PNALD. The number of patients whose AST exceeded the normal range was significantly higher in the SO group (P=0.034). Conclusion: The incidence of PNALD was similar in both groups. On the other hand, considering the tendency, there was a high correlation between the type of lipid emulsion and an increased direct bilirubin level in the SO group.

중환자실 재원 소아환자의 영양집중지원팀 자문 순응도에 따른 영양공급 중재 효과

박수진 ( Soo-jin Park ),박지은 ( Ji-eun Park ),권나영 ( Na-young Kwon ),김재송 ( Jae-song Kim ),손은선 ( Eun-sun Son ),유현지 ( Hyun-ji Yu ),방제연 ( Jae-yeon Bang ),김승 ( Seung Kim ),은호선 ( Ho-seon Eun ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.2

Purpose: This study performed a comparative evaluation of nutritional condition’s improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients. Methods: The medical records of 64 critically ill pediatric patients (2 to 18 years old), who were officially referred to a NST consultant in pediatric intensive care unit from January to August 2015, were reviewed. The patients were divided into 2 groups according to the compliance of NST consultation answers. The total delivered/required caloric and protein ratio, weight, serum total protein, serum albumin, hemoglobin, and hematocrit were compared. Results: According to the NST consultation answer, ‘nutrition support increase’ occupied the largest proportion at 38.5%; ‘maintenance’ and ‘decrease’ accounted for 35.7% and 18.2% respectively. The NST compliance group and non-compliance group were 20 and 14 patients, respectively. Although total delivered/required caloric ratio was significantly increased in the NST compliance group (19.7%, P=0.036), there was no significant difference in the NST non-compliance group (5.1%, P=0.692). The total delivered/required protein ratio was increased (15.1%, P=0.163) in the NST compliance group and decreased (-4.7%, P=0.774) in the NST non-compliance group. The NST non-compliance group (-8.6%, P=0.219) was further reduced weight than the NST compliance group (-1.0%, P=0.820). The serum albumin was significantly increased in the NST compliance group (13.1%, P=0.003), but there was no difference in the NST non-compliance group (7.1%, P=0.433). Conclusion: Although 56.7% of NST consultations were needed for nutritional interventions, a lower NST compliance (53.8%) is the limit of nutritional support. The NST compliance group was supplied adequately with more calories and protein than before consultation and a more improved nutritional status. Therefore, aggressive NST consultation can help increase the therapeutic effect by improving the nutritional status. This study will form the basis to seek ways to further enhance NST compliance.

미숙아에서 캥거루케어의 효과와 안정성

임주희 ( Joo Hee Lim ),신정은 ( Jeong Eun Shin ),이순민 ( Soon Min Lee ),은호선 ( Ho Sun Eun ),박민수 ( Min Soo Park ),박국인 ( Kook In Park ),남궁란 ( Gung Ran Nam ) 대한주산의학회 2015 Perinatology Vol.26 No.4

목적: 캥거루케어는 미숙아와 부모의 피부접촉을 포함하는 지지적 치료방법으로 미숙아의 감정적, 생리적, 인지적 효과를 보완하는 중재로서 널리 시행되고 있다. 본 연구는 국내에서 캥거루케어의 안정성을 확인하고, 의학적 효과와 심리적 효과를 분석하였다. 방법: 2012년 10월부터 2013년 9월까지 강남세브란스 병원에 입원한 총 45명의 미숙아를 대상으로 퇴원 시점까지 매일 1시간씩 시행하였다. 캥거루케어는 엄마 혹은 아빠 중 한 분에게 허용하였다. 의학적 평가는 역사적 대조군과 비교하였으며 부모의 심리적 평가는 캥거루케어를 시행하지 않은 대조군과 비교하였다. 결과: 평균 재태주령은 31.3±3.5주, 출생 체중은 1,080±250 g이었으며, 캥거루케어 시작 시기는 생후 18.3±8.4일이었다. 캥거루케어 대상 환아 중 저체온증, 서맥, 산소포화도 저하, 저혈압은 관찰되지 않았다. 캥거루케어 대상 환아의 사망이나 패혈증은 없었으며, 캥거루케어 시행 중 무호흡은 4명(9%)에서 발생하였으나 자극 후 자발적으로 회복되었다. 캥거루케어를 시행한 군에서의 재원일수는 대조군에 비해 유의하게 짧았다(P=0.041). 캥거루케어 시행 전후 시행한 Spielberger 불안측정도구는 49.7에서 48.5으로 감소하였고, Muller 모성애착자가평가도구는 98.4에서 99.5으로 증가하였다. 자가 측정 행복감 지수는 5%에서 70%로 증가하였다. Spielberger 불안측정도구상 캥거루케어군에서 대조군에 비해 수치가 낮았으나 통계적으로 유의하지 않았다. 모성애착자가평가도구의 경우 대조군에 비해 캥거루케어군에서 확연히 높은 수치를 보였다. 결론: 한국인 미숙아에서 안정성을 확인할 수 있었다. 캥거루케어의 점진적 확산과 적극적인 도입은 미숙아 치료의 보조적 요법으로서, 입원 기간의 감소와 산모의 정서적 안정과 모자간의 애착 강화로 긍정적인 영향을 보이므로, 적극적으로 시행하는 것을 추천할 수 있다. Purpose: This study aimed to identify the safety of Kangaroo Mother Care (KMC) and to analyze its medical and psychological effects. Methods: Forty five preterm infants, admitted to Gangnam Severance Hospital NICU from October 2012 to September 2013, were recruited. KMC was performed for 1 hour daily until the discharge by either mother or father. The medical effects in KMC group were compared with historical control group. Psychological effects in KMC group were made a comparison with the non-KMC group. Results: The mean gestational age was 31.3±3.5 weeks, and the mean birth weight was 1,080±250 g. KMC was started at the mean age of 18.3±8.4 days. No event of hypothermia, bradycardia, desaturation, or hypotension occurred. There was no event of death or sepsis. Four patients (9%) had apnea but recovered after the tactile stimulation. Duration of the hospitalization in KMC group was significantly shorter than control group (P=0.041). Spielberger’s anxiety scale decreased from 49.7 to 48.5. Muller’s maternal attachment inventory increased from 98.4 to 99.5. Reduction of the self-happiness score improved from 5% to 70%. The score for Spielberger’s anxiety scale tended to be lower in the KMC group than in the control group without statistically significant. Muller’s maternal attachment inventory score was significantly higher in the KMC group. Conclusion: KMC is a safe method to Korean preterm infants. Due to reduction of hospitalization and beneficial psychological effect, we believe that offering KMC to more preterm infants as a supplement therapy will be useful.

임상 ; 한국인 모유의 영양소와 영아의 성장과의 관계 분석 연구

이철 ( Chul Lee ),박민수 ( Min Soo Park ),박국인 ( Kook In Park ),남궁란 ( Ran Namgung ),이순민 ( Soon Min Lee ),민경복 ( Kyong Bok Min ),은호선 ( Ho Sun Eun ) 대한주산의학회 2012 Perinatology Vol.23 No.4

목적 : 본 연구는 건강한 수유부와 정상 만삭아를 대상으로 모유의 조성이 영아 성장에 미치는 영향을 확인하고자 하 였다. 방법 : 2011년 10월부터 2012년 3월까지 강남세브란스병원, 서울의 수유 센터 두 곳을 방문한 건강한 수유부와 영 아 173명을 대상으로 하였다. 수집된 모유는 Semisolid-state mid-infrared milk analyzer (MIRIS(R) Human Milk Analyzer, HMA, Miris AB, Uppsala, Sweden)를 이용하여 모유 1 mL를 1분간 분석기에 넣어 측정하였다. 결과 : 모유 성분의 분석을 통하여 섭취량/권장량(%)을 표준 체중 5 percentile 이상인 군과 5 percentile 미만인 군으로 나누어 비교한 결과, 열량은 130.2±34.1%, 68.2±31.7%, 단백질은 133.4±33.9%, 75.0±28.3%, 지방질은 189.6±94.7 %, 91.9±63.2%, 탄수화물은 120.7±17.6%, 72.3±26.5%으로 두 군간에 유의한 차이를 보였다(P<0.05). 표준 체중 25 percentile 이상인 군과 25 percentile 미만인 군으로 나누었을 때도 열량은 135.3±34.3%, 99.0±33.9% 이었으며, 단백 질은 136.7±35.0%, 108.0±33.9%, 지방질은 197.1±97.6, 141.6±79.8%, 탄수화물은 125.1±16.5%, 95.0±22.0%으로 두 군간에 유의한 차이를 보였다(P<0.05). Multiple logistic regression을 이용하여 분석한 결과 표준 체중이 5% 미만인 군에 영향을 미치는 인자는 탄수화물이 가장 유의한 인자이었고(P<0.05), 25% 미만인 군에 영향을 미치는 인자는 단백 질과 탄수화물이었다(P<0.05). 결론 : 본 연구에서는 영아의 체중이 작은 경우 모유 성분의 영양소가 유의하게 낮음을 확인하였다. 이를 통해 출생 후 체중 증가가 유의하게 적고, 성장 곡선상 낮은 체중 분포를 보일 경우 적극적인 모유수유와 더불어 수유부의 식습관 개 선을 통한 적정한 영양공급 및 나아가 영양 강화를 이루어 신생아의 성장 증가를 도모해야 하겠다. Purpose : The aim of this study was to determine the effect of the macronutrient composition of breast milk from Korean women on the growth of infants. Methods : 173 healthy lactating women and breast-fed infants who visited Gangnam Severance Hospital and two breast-feeding centers in Seoul from October 2011 to March 2012 were recruited. We checked the birth weight and body weight of infants while collecting breast milk from the mothers, and analyzed the macronutrient component of breast milk with a mid-infrared milk analyzer (MIRIS(R) Human Milk Analyzer, HMA, Miris AB, Uppsala, Sweden). Group analysis was performed depending on more or less than 5 percentile and 25 percentile of body weight. Results : The amount of daily intake/RDA for calories, proteins, lipids and carbohydrates of breast milk were significantly lower in the less than 5 percentile and 25 percentile group (P <0.05). Using multiple logistic regression analysis, the significant nutrient component that was insufficient in the less than 5 percentile and less than 25 percentile of body weight group respectively was carbohydrates (P <0.05). Conclusion : We conclude that each macronutrient level of breast milk is statistically low in infants with less body weight. These results suggest that nutritional consideration of breast milk is necessary for the growth of breast-fed infants.