전형적 괴사성 장염으로 발전 하지 않은 미숙아의 창자 벽 공기 3례

최의경,김혜림,최정윤,김수영,정의석,이주영,최창원,김병일 대한신생아학회 2014 Neonatal medicine Vol.21 No.3

Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants’ systemic manifestations were mild or absent, and all of them completely recovered within 2–3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC.

신생아 surfactant 처치의 현 주소

최의경 한국모자보건학회 2023 한국모자보건학회 학술대회 연제집 Vol.2023 No.2

家庭에서 할 수 있는 Screen Printing에 對해서 : Silk Screen(photo stencil method)과 Helizarin염료를 중심으로

崔義京 梨花女子大學校 文理大學 家政學部 1963 家政 Vol.- No.11

Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea

최의경,Jeong Hee Shin,Gi Young Jang,최병민 대한신생아학회 2018 Neonatal medicine Vol.25 No.4

Purpose: This study was performed to determine the clinical features of full-term infants with hypoxemia detected by pulse oximetry and to establish the diagnosis of critical congenital heart disease (CCHD). Methods: We retrospectively reviewed the medical records of neonates who had been admitted to the neonatal intensive care unit within 2 weeks of birth at Korea University Ansan Hospital between January 2013 and October 2017 (n=450). We classified these neonates based on the presence of hypoxemia at admission and investigated neonatal characteristics, initial symptoms, echocardiographic findings, and final diagnosis associated with hypoxemic diseases. Results: Of 450 term infants, 265 infants (58.9%) were identified hypoxemia by pulse oximetry at admission. The most common symptoms of them were cyanosis and tachypnea. Among them, 80.1% of infants (214/265) were diagnosed with respiratory tract disease and 8.3% of infants (22/265) had congenital heart disease. Thirteen infants (13/265, 4.9%) had CCHD and were treated with urgent surgery or transcatheter intervention within 28 days of birth. Majority of infants with respiratory tract disorder were transferred from hospital immediately after birth, but 46.1% of infants (6/13) with CCHD remained asymptomatic after birth and were admitted after 48 hours after birth. In addition, other hypoxemic illnesses were identified as neonatal infectious and neurological diseases. Conclusion: This study showed the importance of assessment in neonates with hypoxemia, including those diagnosed with CCHD. The possibility of CCHD should be considered in the differential diagnosis in neonates demonstrating hypoxemia after 48 hours of birth. A larger prospective study is needed to assess the effectiveness and outcomes of pulse oximetry for neonatal screening in Korea.

갑상샘 저하증으로 진단된 극소저체중출생아에서의 생후 초기 의 장관영양 식이양상 비교

최의경 ( Eui Kyung Choi ),이현승 ( Hyeon Seung Lee ),이은희 ( Eun Hee Lee ),김세연 ( Sae Yun Kim ),이병국 ( Byoung Kook Lee ),정영화 ( Young Hwa Jung ),허주선 ( Ju Sun Heo ),신승한 ( Seung Han Shin ),김이경 ( Ee Kyung Kim ),김한석 대한주산의학회 2015 Perinatology Vol.26 No.1

Purpose: We investigated the effects of hypothyroidism on feeding advancement in very low birth weight infants (VLBW). Methods: This study was a retrospective case-control study of 14 very low birth weight infants (VLBWIs) diagnosed with hypothyroidism and other 14 infants were recruited as age- and weight-matched controls without hypothyroidism or hypothyroxinemia in Seoul National University Children’s Hospital between January 2007 and August 2009. We examined whether these infants gained weight more, achieved full-volume enteral feedings sooner, had fewer episodes of increased pre-gavage residuals, and had fewer days of parenteral nutrition. Results: Until full enteral feeding (120 mL/kg/day) was not statistically significant between the groups. In the hypothyroidism group, during the first 14 days after birth, the volume of feeding was smaller [14.7 (0.5-84.0) mL/ kg/day, P=0.041], the episodes of increased pre-gavage residuals were frequently observed [16.7 (0.2-78) times, P=0.036], and the duration of central line was significantly longer [18 (10-50) days, P=0.018]. In hypothyroidism group, mean day at first L-thyroxine supplementation was 24.2±10.2 days after birth. L-thyroxine administration boosted thyroid function for hypothyroidism infants, helped them tolerate a larger amount of enteral feeding [from 89.5 (2.9-160.8) to 146.9 (31.8-178.8) mL/kg/day, P=0.002] and decreased episodes of excessive gastric residuals [from 5.5 (0-41.6) to 0 (0-44) time, P=0.026]. However, no more weight gain was statistically found. Conclusion: In VLBW infants, hypothyroidism may induce feeding intolerance. L-thyroxine supplementation was effective in feeding advancement on preterm infants with hypothyroidism.

이야기 다시 말하기 조건이 취학전 아동의 이야기 다시 말하기 산출의 개선에 미치는 효과

문선모(文善模),최의경(崔義敬) 서울대학교 교육연구소 2014 아시아교육연구 Vol.15 No.1

이 연구는 만 5세 취학전 아동을 실험참가자로 하여 이야기 다시 말하기 조건이 이야기 다시 말하기 산출의 개선에 미치는 효과를 검증하였다. 실험에는 혼합, 피험자간, 피험자내 설계가 사용되었다. 피험자간 변인은 이야기 다시 말하기 조건(이야기 다시 말하기 · 이야기 구조기반 이야기 다시 말하기· 통제)이었으며, 피험자내 변인은 검사시기(사전·사후)였다. 준거변인은 이야기 다시 말하기 전체 산출 및 개개 구조요소 산출에서 사후검사와 사전검사의 차이점수였다. 그 결과, 이야기 다시 말하기를 이야기 지도 수업을 적용하고 함께 이야기 구조요소에 대한 구체적 단서를 발판으로 제공하여 이야기 구조기반으로 가르치거나 또는 일반적 단서 중심으로 가르치는 것이 이야기 다시 말하기 방법을 가르치지 않는 것보다 이야기 다시 말하기 전체산출과 해결 구조 요소산출의 개선에 효과적이었다. 또한 이야기 구조 요소별 산출의 개선은 해결, 배경, 순서, 구성 요소 간에는 유의한 차이가 없었으나, 이들 4개 요소는 문제 요소보다 유의하게 높았다. 이런 결과는 이야기 다시 말하기 조건에 관계없이 동일하게 나타났다. The purpose of this study was to investigate the effects of conditions of story retelling on the improvement of story retelling production in preschool children. For the purpose three conditions of story retelling were treated: (1) story retelling condition which children were trained to retell with gently probing, (2) story structure-based story retelling condition which children were trained to retell both with guiding questions on story structures and with teaching story mapping emphasizing elements of story structure, and (3) control condition which children were not received such training. In the experiments a mixed, between-subjects, within-subjects, design was used. One between-subjects variable was conditions of story retelling (story retelling ?story structure-based story retelling?control). One within-subjects variable was testing time (pre?post). The criterion variables were scores of difference score between pretest and posttest in total production and individual elements production of story retelling. Participants were 27 children, age 5 years, selected from one preschool and were assigned randomly to three conditions. These children were received six sessions which consisted of one pretest, four training and one posttest. And six storybooks were used for story retelling. Both story retelling condition improved total production and individual elements production of story retelling. The improvement in the production of individual elements of story structure were different significantly between resolution, setting, order, plot, and problem elements. These differences in the improvement showed similar trends regardless of story retelling conditions.

초극소저체중출생아에서 발생한 제대정맥도관 관련 심낭압전 1예

김성희,최의경,박규희,신홍주,장기영,최병민 대한주산의학회 2022 Perinatology Vol.33 No.4

Umbilical venous catheters (UVCs) are frequently used in extremely low birth weight (ELBW) infants for intravenous access. It is important to position correctly to prevent complications, including arrhythmia, pleural effusion, pericardial effusion, and cardiac tamponade. Pericardial effusion remains asymptomatic in the early stages and cardiac tamponade suddenly appears as a cardiac arrest. The authors report a case of successful management of malpositioned UVC-related cardiac tamponade in an ELBW infant with 23 weeks 5 days of gestation and 688 g of birth weight. He was resuscitated successfully after emergency pericardiocentesis and prompt removal of catheter. To our knowledge, it is the youngest survived case complicated by UVC-related cardiac tamponade reported in the literature. Our case confirms the necessity of the placement at a correct position of a UVC after its insertion and pericardial effusion should be suspected in sick infants with UVCs and progressive cardiomegaly. A timely diagnosis with echocardiography and pericardiocentesis may prove life-saving.

The Case Report of Newborn Prenatally infected by Human Immunodeficiency Virus in Republic of Korea

이경은,이원영,최의경,신정희,최병민,김윤경 대한소아감염학회 2019 Pediatric Infection and Vaccine Vol.26 No.1

Trans-placental neonatal human immunodeficiency virus (HIV) infection is common in Africa; however, it is not yet reported in the Republic of Korea. With the increasing incidence of HIV infection, especially in the reproductive age group, the risk of the vertical transmission of HIV is also increasing. We report the first case of HIV infection acquired in-utero in a newborn in Korea. The baby is growing well with normal development.

A Case of Congenital Hypothyroidism in a Preterm Infant Presenting with Meconium Obstruction

김혜림,최정윤,최의경,신승한,김이경,김한석,최정환 대한신생아학회 2014 Neonatal medicine Vol.21 No.4

Many infants with congenital hypothyroidism have few or no clinical manifestationsat birth. In preterm infants, discovering related signs and symptoms of congenitalhypothyroidism is even more difficult, despite the higher incidence of transientthyroid function abnormalities. Therefore, these patients need to be closely monitoredduring the early neonatal period. We report a case of a very low birth weight infantpresenting with meconium obstruction concurrent with congenital hypothyroidismin the early neonatal period. Unless diagnosed and treated appropriately, meconiumobstruction of prematurity may lead to feeding intolerance, intestinal perforation,necrotizing enterocolitis, and sepsis. It is important for medical caregivers to understandthat meconium obstruction can be an early sign of congenital hypothyroidismin preterm infants with abdominal distension.

Clinical Utility of Rapid Plasma Neutrophil Gelatinase-Associated Lipocalin Assays for Diagnosing Acute Kidney Injury in Critically Ill Newborn Infants

Lindsey Yoojin Chung,최원식,최의경,신정희,임형은,최병민 대한신생아학회 2017 Neonatal medicine Vol.24 No.4

Purpose: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early marker of acute kidney injury (AKI). This study was designed to evaluate the clinical utility of the rapid plasma NGAL assay for diagnosing AKI in critically ill newborn infants in the neonatal intensive care unit (NICU). Methods: The medical records of 178 critically ill newborn infants >34 weeks of gestational age who underwent plasma NGAL measurement during the first week of life in the Korea University Ansan Hospital NICU from February 2011 to August 2015 were retrospectively reviewed. Plasma NGAL levels were measured at bedside by using a commercial competitive immunoassay kit simultaneously with serum creatinine (Cr) level determination. Results: Of 178 newborn infants enrolled in this study (study group), 25 infants had AKI (AKI group) while 153 infants had no AKI (control group). The plasma NGAL level in the AKI group (114.0 [76.5–281.5] ng/mL) was significantly higher than that in the control group (74.0 [52.5–122.5] ng/mL, P=0.001). Moreover, plasma NGAL levels were found to be correlated with serum Cr levels in the study group (r=0.208, P= 0.005). Plasma NGAL achieved an area under the receiver operating characteristic curve of 0.705 for detecting AKI (95% confidence interval: 0.593–0.817). The best cutoff plasma NGAL level for AKI diagnosis was 100 ng/mL. Conclusion: The rapid plasma NGAL assay has diagnostic value for AKI in critically ill newborn infants >34 weeks of gestational age. Further investigations with a larger population are needed to confirm the potential use of plasma NGAL levels for diagnosing AKI in newborn infants.