VATER Association 1예

최명재,박영일,김상우,고일향 인제대학교 1986 仁濟醫學 Vol.7 No.4

We have experienced a case of VATER association in a newborn infant who presented with typical anomalies. The diagnosis was made with physical and autopsy findings consisted of anal atresia, tracheoesophageal fistula with esophageal atresia, left radial dysplasia with limb anomalies, right renal agenesis, cardiac anomalies, vesicoperineal fistula, and vesicorectal fistula. Brief review of the related literatures is also presented.

신생아 패혈증의 진단 및 예방책

최명재 ( Myoung Jae Chey ) 대한주산의학회 2002 大韓周産醫學會雜誌 Vol.13 No.4

Comparisons of Clinical Characteristics Affecting Readmission between Late Preterm Infants and Moderate Preterm Infants or Full-Term Infants

Jae Seok Shin,Yu Bin Kim,Yong Hee Lee,Gyu Hong Shim,Myoung Jae Chey 대한신생아학회 2016 Neonatal medicine Vol.23 No.4

Purpose: We aimed to describe the differences in clinical characteristics that affect readmission between late and moderate preterm or full-term infants. Methods: Medical records were reviewed for 881 patients with gestational ages of ≥31+0 weeks who were born at Inje University Sanggye Paik Hospital between1 Janu- ary 2013 and 20 September 2015. The patients were categorized into three subgroups as follows moderate preterm infants: those born at 31-33 weeks’ gestation (n=73), late preterm infants: those born at 34–36 weeks’ gestation (n=169),and full-term infants: those born at ≥37 weeks’ gestation (n=639). We compared the late and moderate preterm or full-term infants in terms of clinical characteristics that affect read- mission. Results: The readmission rate was 18.9% in the late preterm infants, 21.9% in the moderate preterm infants, and 16.7% in the full-term infants. The independent risk factors of readmission were gestational age in the late preterm infants, positive pres- sure ventilation at birth in the moderate preterm infants, and air-leak syndrome in the full-term infants. In addition, antenatal care at the first trimester of pregnancy was an independent protective factor against readmission in the full-term infants. Conclusion: Our results suggest that gestational age may affect the readmission rate of late preterm infants.

Risk Factors of Operation in Neonates with No Less Than 35 Weeks of Gestational Age with Bilious Vomiting

( Jae Seok Shin ),( Yong Hee Lee ),( Gyu Hong Shim ),( Myoung Jae Chey ) 대한주산의학회 2016 大韓周産醫學會雜誌 Vol.27 No.4

Purpose: Bilious vomiting in neonates is an urgent condition that frequently requires neonatal surgical involvement. We aimed to describe the prevalence of surgical intervention and compare clinical characteristics between neonates with and without operation. Methods: The medical records and images were reviewed for neonates with no less than 35 weeks of gestational age who have a bilious vomiting and admitted to the neonatal intensive care unit (NICU) at Inje University Sanggye Paik Hospital from January 2010 to December 2015. Results: Fifty neonates with bilious vomiting were analyzed whose were admitted to our NICU and not transferred during the period. Twenty-one (42%) neonates had laparotomies of which 9 were malrotations with volvulus, 6 Hirschsprung`s disease, 2 duodenal atresia or stenosis, 2 small bowel obstructions, 1 neonatal necrotizing enterocolitis, and 1 meconium ileus. Gestational age was 39⁺² weeks (35⁺⁰-40⁺⁶ weeks); birth weight was 3,120 g (1,885-4,650 g). There were 24 (48%) abnormal X-rays, 25 (50%) abnormal abdominal sonographies and/or contrast studies. Univariate analysis indicate that frequency of vomitus, volume of vomitus, abdominal distension, delayed passage of meconium, neonatal cholestasis, abnormal X-rays, abnormal abdominal sonographies or contrast studies were significant predictors of operation. Multivariate analysis showed that frequency of vomitus (P=0.002, odds ratio [OR] 5.7, 95% confidence interval [CI] 1.9-17.1) and abnormal abdominal sonographies or contrast studies (P=0.007, OR 22.2, 95% CI 2.3-212.1) were independent risk factors for operation. Conclusion: Frequency of vomitus and abnormal abdominal sonographies or contrast studies in neonates with bilious vomiting may be the most important indicator to predict the need for surgery.

두흉부 유합 중복기형아 부검 1례

최명재,박영일,조혜제,서정욱,지제근 인제대학교 1987 仁濟醫學 Vol.8 No.3

Conjoined twins are very rare congenital malformation in which they are united intimately at some point in their bodily anatomy. We experienced a case of cephalothoracopagus syncephalus male twins, which were born to a 30 year old nulliparous Korean housewife by Caesarean section at the gestational period of 30 weeks in this hospital. There were laterally fused heads and a single foregut, shared equally by the two individuals. Other internal organs were duplicated, which were located in the anterior and posterior regions of the joined bodies. Brief review of the related literatures is also presented.

Clinical Outcomes of Minimally Invasive Surfactant Therapy via Tracheal Catheterization in Neonates with a Gestational Age of 30 Weeks or More Diagnosed with Respiratory Distress Syndrome

Moon Young Seo,Gyu Hong Shim,Myoung Jae Chey 대한신생아학회 2018 Neonatal medicine Vol.25 No.3

Purpose: Minimally invasive surfactant therapy (MIST) is currently used as a method of surfactant replacement therapy (SRT) for the treatment of respiratory distress syndrome (RDS) in preterm infants with a gestational age of less than 30 weeks. However, few studies have been conducted on MIST in neonates with a gestational age of 30 weeks or more. In this study, we compared MIST with endotracheal intubation as a rescue SRT for spontaneously breathing neonates with a gestational age of 30 weeks or more who were diagnosed with RDS. Methods: We investigated the clinical characteristics of spontaneously breathing neonates admitted to the neonatal intensive care unit of the Inje University Sanggye Paik Hospital from January 1, 2014 to December 31, 2016. These neonates were born at a gestational age of 30 weeks or more and were diagnosed with RDS. The neonates who were administered surfactant by MIST were categorized into the MIST group (n=16) and those who underwent endotracheal intubation were categorized into the control group (n=45). Thereafter, the clinical characteristics between the groups were compared. Results: Compared to the control group, the MIST group was less likely to require mechanical ventilation within 72 hours (P<0.001). The frequency of bradycardia during SRT was also low in the MIST group (P=0.033). Conclusion: MIST is considered relatively feasible and safe for treating RDS for reducing the need for mechanical ventilation and decreasing the occurrence of bradycardia during surfactant administration in neonates with a gestational age of 30 weeks or more.

재태연령 32주 미숙아에서 재태연령군에 따른 낭종성 뇌실 주위 백질 연화증 발생 위험 요인

심규홍 ( Gyu Hong Shim ),최명재 ( Myoung Jae Chey ) 대한주산의학회 2016 Perinatology Vol.27 No.1

목적: 본 연구는 32주 미만의 미숙아에서 재태연령군에 따른 낭종성 뇌실주위 백질연화증의 발생률과 발생에 대한 위험 요인을 알아보고자 시행하게 되었다. 방법: 대상은 2009년 1월부터 2015년 6월까지 인제대학교 상계백병원에서 출생하고, 신생아 중환자실에 입원하여 4주이상 생존한 재태연령 32주 미만의 미숙아를 대상으로 후향적 의무기록 분석을 통하여 연구를 진행하였다. 이를 토대로 낭종성 뇌실주위 백질연화증의 발생률과 발생에 대한 위험 요인에 대한 조사를 재태연령군에 따라 진행하였다. 결과: 32주 미만의 미숙아에서 낭종성 뇌실주위 백질연화증의 발생률은 15.1% (26/172) 였다. 전체 환자군에 대한 다변량 분석에서는 이중 grade 2 이상의 뇌실 내 출혈[P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI)1.641-18.285], 28일 이상의 산소 사용 유무(P=0.025, OR 3.086, 95% CI 1.152-8.264) 및 stage 2 이상의 신생아 괴사성장염(P=0.042, OR 3.731, 95% CI 1.047-13.333)이 독립적인 위험 요인으로 분석되었다. 28주를 기점으로 세분화 하였을 대 28주 미만에서는 임신성 고혈압과 뇌실 내 출혈이 독립적인 위험 요인이었고, 28-31주의 미숙아에서는 28일 이상의 산소 사용 유무 와 배양 검사로 확진된 패혈증 유무가 독립적인 위험요인으로 나왔다. 결론: 이러한 결과는 임신성 고혈압과 뇌실 내 출혈은 28주 미만의 미숙아에서 낭종성 뇌실주위 백질연화증의 발생 위험을 증가시킬 수 있다는 것을 보여주고, 28일 이상의 산소 사용과 배양 검사로 확진된 패혈증은 28+0-31+6주 미숙아에서 낭종성 뇌실주위 백질연화증의 발생 위험을 증가시킬 수 있다는 것을 보여준다. Purpose: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. Methods: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. Results: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancyinduce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28+0-31+6 weeks. Conclusion: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28+0-31+6 weeks.

침투성 상피암세포주와 비침투성 상피암세포주의 TGF alpha에 대한 반응의 차이

손영숙(Young-Sook Son),최명재(Myoung-Jae Chey),Elaine Fuchs,정명희(Myung Hee Chung),박찬웅(Chan Woong Park) 대한약리학회 1993 대한약리학잡지 Vol.29 No.1

SCC 12와 SCC 13 세포주는 피부의 상피암 조직에서 유래되었다. 본 연구에서는, 세포배양으로 in vivo 피부의 거의 모든 특징들을 재현할 수 있는 raft 배양법을 이용하여, 두 종류의 상피 암세포주의 진피 침투성 정도를 비교해 보았다. SCC 12 세포주의 raft 배양에서는, collagen matrix로 침투하는 많은 세포군들이 관찰되었고, 또한 기저세포와 유사한 세포들이 분화층 중간에 관찰되었다. 그러나 SCC 13 세포주의 raft 배양에서는 침투성 세포들이 전혀 관찰되지 않았다. 어떤 인자가 SCC 12 세포주의 침투성에 관여하였는지를 조사하기 위하여, 세포이동 또는 matrix 파괴에 관여하는 각종 단백질 즉, type 1 collagenase, Fn, Fn 수용체와 EGF 수용체 등의 기본 생합성속도를 침투성과 비침투성 세포주에서 측정하였다. 그 중 type 1 collagenase의 생합성만이 침투성 세포주에서 현저히 높게 나타났다. 침투성 SCC 12 세포주에서 관찰된 높은 type 1 collagenase 생합성과 이들 세포주의 침투성과의 연관관계 및 그 기작을 조사하기 위하여 두 세포주에서 TGF alpha에 대한 반응의 차이를 조사하였다. 비침투성 세포주에서는, TGF alpha에 의해 type 1 collagenase의 생합성이 처음 12시간 동안에 현저한 증가를 보였으나 24시간부터 그 유도가 down-regulation되는 현상을 보였다. 그러나 침투성 세포는 TGF alpha에 의해 계속적인 type 1 collagenase의 유도를 보였다. 이에 저자들은 EGF 수용체의 down-regulation으로 인해 type 1 collagenase의 down-regulation이 유도되고, 이와 같은 regulation의 결함으로 인해 SCC 12 세포주가 collagen matrix로 침투하는 현상을 나타낼 것으로 제시하였다. Both SCC 12 and SCC 13 cell lines were derived from squamous cell carcinoma (SCC) of the skin (Wu and Rheinwald, 1981). In the present study, we compared the inherent invasive activity in their raft cultures where most in vivo characteristics of epidermis can be reproduced by cell culture method. The raft culture of SCC 12 cell line produced many invading colonies within the collagen lattice and basal-like cells in the middle of differentiating cell layers, but no invasive activity was observed in the SCC 13 raft culture. We investigated which factors are implicated in inherent invasive activity of SCC 12 cell line by examining basal levels of type I collagenase, EGF receptor, fibronectin, and its receptor in two cell lines. Among them, only type I collagenase was significantly higher in invasive SCC 12 cells than in non-invasive SCC 13 cells. Furthermore, we tried to investigate mechanisms underlying between SCC 12 cell s inherent invasive activity and its high basal level of type I collagenase. As one of them, discrepancy in TGF alpha mediated responses between two cell lines was observed. In SCC 13 cells, TGF alpha initially stimulated type I collagenase at 12 h after TGF alpha treatment and then its down regulation was followed from 24 h even though TGF alpha was continuously present in the medium. However in SCC 12 cells, TGF alpha continuously stimulated type I collegenase up to 48 h. We propose that defect in EGF receptor s down-regulation may be involved in lack of type I collagenase s down-regulation and its possible connection to invasive activity of SCC 12 cell line.

Comparison of Clinical Outcomes in Late Preterm Infants between Born at 34+0 to 34+6 Weeks and at 35+0 to 36+6 Weeks of Gestation

Hyung-Joon Joo,Gyu Hong Shim,Myoung Jae Chey 대한신생아학회 2020 Neonatal medicine Vol.27 No.1

Purpose: We compared perinatal characteristics, clinical outcomes, and treatment between late preterm infants born at 34 weeks and 35 to 36 weeks of gestation. Methods: We reviewed the medical records of 254 neonates (gestational age 34+0 to 36+6 weeks) who were born at Inje University Sanggye Paik Hospital between July 1, 2013 and June 31, 2018. Late preterm infants were categorized into two groups: Group 1 (born at 34 weeks, n=88) and Group 2 (born at 35 to 36 weeks, n=162). We compared the clinical outcomes, treatment, and readmission within 12 months after birth between two groups. Results: Group 1 showed higher frequencies of antenatal steroid administration, premature membrane rupture, maternal antibiotic use, and histologic chorioamnionitis. Group 1 also had significantly more medical problems such as respiratory distress, feeding intolerance, gavage feeding, neonatal jaundice, apnea or bradycardia, and hypocalcemia. Treatment during hospital stay including respiratory support, nutritional support, and antibiotics use over 24 hours was also significantly higher in Group 1. In addition, delayed discharge was more frequent in Group 1. Conclusion: Late preterm infants born at 34 weeks gestation had significantly higher morbidity, required more aggressive management, and more often had delayed discharge compared to those in late preterm infants born at 35 to 36 weeks’ gestation.

Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia

Seo, Sun Young,Shim, Gyu Hong,Chey, Myoung Jae,You, Su Jeong The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.11

Purpose: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. Methods: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. Results: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. Conclusion: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.