Kangaroo 관리(피부접촉 관리)가 미숙아와 부모에 미치는 생리적 영향

김행미,김수영 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.3

Purpose : Kangaroo care is the practice of holding a small premaure infant, naked except for a diaper and hat, against a parent's chest. The purpose of this study is to determine the safety and feasibility of kangaroo care in a NICU as defined by physiological variables. Methods : Ten stable, spontaneously breathing preterm infants, weighing less than 2,000gm were included in this 60-min. Kangaroo care(kc) study. Physiological variables, including heart and respiratory rates, blood pressure, skin and core temperature, pulse oximetry oxygen saturation and maternal serum prolactin were measured before, during and after kc. Results : Kc did not significantly affect any of these infants' physiological variables before and during kc. Maternal core temperature rose significantly during kc(36.7■0.4■ vs 37.0■0.2■, P< 0.05). After kc, the mean prolactin level(233.3■240.6ng/ml) of mothers was higher than the preceding day(81.9■94.2ng/ml) and before kc(71.2■96.3ng/ml)(P<0.05). Conclusion : For stables preterm infants weighing less than 2,000gm, 60min of kc is safe and well tolerated. The beneficial effects of kc such as stability of the preterm infants receiving kc and increase of maternal prolactin after kc suggest the need to incorporate it into standards of care. 목 적 : Kangaroo 관리는 본래 보육기 보급이 충분하지 못한 의료 환경에서 미숙아를 보육하기 위한 방법으로 고안되었으나 보온 외에 환아의 안정 및 부모-환아의 정서적 유대관계 성립 등 좋은 효과를 얻을 수 있다. 신생아 집중치료실 입원아에서는 이러한 효과를 얻기 위해 단시간 시행되기도 하나 우리나라에서는 아직 보고된 바가 없다. 이에 저자들은 신생아 집중치료실 입원 미숙아에게 단시간의 kangaroo 관리를 시도하여 시행중의 환아 및 부모의 활력 징후와 어머니의 prolactin 변화를 살펴 보았다. 방 법 : 대상 환아는 경북대학교병원 신생아집중치료실에 입원한 보육기 관리중인 2,000g 미만의 미숙아로 상태가 안정되고 부모가 이의 시행에 동의한 경우로 하였다. 시행시 부모의 앞가슴 피부와 아기의 가슴, 복부 피부가 최대한 접촉하게끔 아기를 수직으로 안게 한 후 포를 덮은 상태에서 활력 징후를 추적 관찰하였다. 어머니가 시행하는 경우에는 시행 전날, 시행 직전과 시행 후에 혈청 prolactin을 측정하였다. 결 과 : 조사 미숙아는 10명으로 출생시 체중은 995- 1,980g, 재태연령은 29-36주, 시행 일령은 12-68일이었다. 시행 전후 부모의 호흡수, 심박수, 혈압, 피부온도에는 변화가 없었으나 구강온도는 시행 전 36.7± 0.4℃에서 시행 후 37.0±0.2℃로 상승하였다(P<0.05). 미숙아는 시행 전후 호흡수, 심박수, 혈압, 경피 산소포화도, 항문 및 피부 온도는 모두 정상 범위에 있었고 전후 의의있는 차이를 보이지 않았다. 어머니의 prolactin은 시행전 71.2±96.3ng/ml에서 시행후 233.3±240.6ng/ml로 의의있게 증가하였다(P<0.05). 미숙아의 수유량은 시행 전후 의의있는 차이를 보이지 않았다.

편마비를 가진 뇌성마비 환아에서 확산 텐서강조영상을 Erythropoietin의 투여가 신생백서 저산소허혈뇌손상에 미치는 영향

김행미,최병호,권순학,손윤경 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.1

Purpose : Perinatal asphyxia is an important cause of neonatal mortality and subsequent lifelong neurodevelopmental handicaps. Although many treatment strategies have been tested, there is currently no clinically effective treatment to prevent or reduce the harmful effects of hypoxia and ischemia in humans. Erythropoietin (Epo) has been shown to exert neuroprotective effects in various brain injury models although the exact mechanisms through which Epo functions are not completely understood. This study investigates the effect of Epo on hypoxic-ischemic (HI) brain injury and the possibility that its neuroprotective actions may be associated with iron-mediated metabolism. Methods : HI brain injury was produced in 7-day-old rats by unilateral carotid artery ligation followed by hypoxia with 8% oxygen for 2 h. At the end of HI brain injury, the rats received an intraperitoneal injection of 5,000 units/kg erythropoietin. Random premedication with iron, deferoxamine, iron-deferoxamine, or saline were performed 23 d before HI brain injury. The severity of the brain injury was assessed at 7 d after HI. Results : Single Epo treatment post-HI brain injury reduced the gross and histopathological findings of brain injury. Iron premedication did not increase the incidence or severity of the injury as measured by the damage score. Deferoxamine administration before HI brain injury improved the brain injury as compared to no treatment or Epo treatment. Conclusion : These findings indicate that Epo provides neuroprotective benefits after HI in the developing brain. These findings suggest that Epos neuroprotective actions may involve reducing iron in tissues that mediate the formation of free radicals. 목 적 : 신생 백서의 저산소 허혈 뇌손상에 있어서의 erythropietin (Epo) 투여의 손상 예방 효과와 보호 기전에 철 대사가 관여하는지를 조사하고자 하였다. 방 법 : 신생 백서를 암수 구별 없이 생후 7일째에 편측 온목동맥 결찰 후 산소 농도 8%인 환경에 2시간 노출시켜 저산소 허혈을 유도하였으며 저산소 노출 직후 Epo 5,000 u/kg를 복강내 투여하였다. 이들은 저산소 허혈 유도 전 투여한 생리식염수, 철, deferoxamine 등에 따라 Epo군, Iron+Epo군, Def+Epo군, Iron+ Def+Epo군, 대조군으로 나누어 저산소 허혈 유도 후 7일에 뇌손상 정도를 비교하였다. 결 과 : Epo 투여시 뇌손상의 빈도와 정도는 대조군에 비해 감소하였다. 뇌손상의 빈도와 손상 점수로 뇌손상 정도를 비교한 결과 철 투여는 Epo의 뇌손상 예방 효과를 감소시키지 않았다. Deferoxamine 투여는 Epo 단독 투여군에 비해 뇌손상의 빈도와 정도가 경감하였으나 통계적 유의성은 없었다. 결 론 : Epo는 저산소 허혈 뇌손상에 있어 뇌손상 보호 효과를 보인다. 철 투여는 뇌손상을 악화시키지 않았으나 deferoxamine 동시 투여는 Epo 단독 투여에 비해 뇌손상의 빈도와 손상 점수가 감소하여 뇌손상 보호 효과에 철 대사가 관여할 가능성을 제시하였다.

小兒特發性痙攣에 對한 臨床的 考察

金幸美,趙南根,李相範,具滋薰 慶北大學校 醫科大學 1978 慶北醫大雜誌 Vol.19 No.2

성과정보 전주기 기반 성과관리체계 효율화 연구

김행미 한국과학기술기획평가원 2023 KISTEP InI Vol.- No.-

1979年 慶北地方 優良兒 選拔大會에 參加한 영유아의 成長發育에 對한 考察

金幸美,李康一,李相範,宋斗洪 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.1

1979年 慶北方地 優良兒選拔大會에 參加하던 영유아(10-24個月兒) 126名을 對象으로 하여 이들의 各種 身體計測値 및 血淸蛋白量, 血色素値, 비타민D 缺乏症狀을 살펴본 結果 다음과 같은 結論을 얻었다. 1. 體重에 있어서 韓國標準値 및 日本平均値와 比較하여 男女 모두 2.05~3.58㎏과 1.43~2.59㎏ 우위에 있었고 身長 역시 1.67~6.31㎝ 및 0.9~4.4㎝ 優位에 있었으며 胸圍 및 頭圍에 있어서도 各 3.14~5.29㎝, 2.50~4.70㎝ 및 0.39~2.04㎝, 0.1~2.8㎝씩 優位임이 測定되었다. 2. 皮膚두께 測定値에서 Triceps skin fold thickness가 洪等의 計測値에 비해 男兒는 3.10~4.06㎜, 女兒는 3.33~3.58㎜, Scapular thickness에서는 男兒 0.81~2.23㎜, 女兒가 1.87~2.23㎜ 優位에 있었다. 3. 上腕둘레는 洪等의 計測値보다 男兒 1.90~2.24㎝, 女兒 1.53~1.61㎝ 各各 優位에 있었다. 4. Hand refractometer를 使用하여 測定한 血淸蛋白量은 男兒 平均 8.30gm%, 女兒 8.18gm%로서 年齡別 差異는 없었다. 5. Kaup指數 20以上은 男兒에서 9.1%, 女兒 12.5%로 나타났다. 6. 授乳方法에서는 母乳가 가장 많아 39.7%였으며 다음이 混合營養, 人工營養의 순서였다. 7. 離乳時期는 50%가 4-6個月에 始作하여 1年以內에 大部分(86.5%)이 始作한 것으로 나타났고 이 때 사용한 離乳食品으로는 3/4이 암죽으로, 여기에 야채, 과일을 添加한 경우가 많았으며 商品化된 離乳食品 使用은 昨年에 比해 다소 增加했다. 8. 血色素値 10.5gm 미만은 貧血로 잡았을 때 5.1%가 여기 해당했고 이들은 鐵分投與時 4%, 投與하지 않은 경우 5.88%였다. 9. 비타민 D 缺乏症狀의 頻度는 23%였으며 비타민 D 投與群에서 20.7%, 투여않은 群에서 25%였고 授乳方法에 따르면 混合, 母乳, 人工營養의 차례로 나타났다. 10. 過法 3年間과 比較해 볼 때 매년 鐵分投與가 增加함에 따라 貧血은 減少하고 있으나, 비타민 D 投與가 增加하고 있음에도 그 缺乏症狀에 있어서는 뚜렷한 好轉이 없었다. Authors have conducted a study on 126 infants participated in Kyungpook regional well baby contest, held in 1979. After throughout investigation of the several parameters including physical development and nutritional status such as serum protein, Kaup index, hemoglobin and signs of possible vitamin D deficiency, the following results were obtained. Comparing the body weight, height, chest and head circumferences with Korean Children's Growth Standard (K.S.) and Japanese Children's Growth Standard (J.S.), their body weight were superior to those of, K.S. (2.05-3.58㎏) and J.S. (1.43-2.59㎏), their body length also superior to those of K.S.(1.67-6.31㎝) and J.S.(0.9-4.4㎝). Triceps skin fold thickness and Scapular thickness were superior to those of Hong(3.10-4.06㎜, 0.81-2.23㎜), the arm circumference was superior to those of Hong(1.53-2.24㎝), too. The Kaup index was above 20, considered to be overweight, in 9.1% in boys and 12.5% in girls. Breast feeding was the most common form of infant feedings, comprising 39.7%, followed by mixed feeding and bottle feeding. Weaning was started within 4-6 months of age in 50% of infants and the majority within 12 months of age (86.5%). The total mean serum protein was 8.3gm%, in boys 8.18gm% in girls and no difference was found between various age groups. 5.1% of these infants showed anemia, using the criteria of anemia as being hemoglobin less than 10.5gm%. They were found in 4% on iron supplementation group, and 5.88% on infants group without iron supplementation. In about one fourth of infants(23%), there were signs of possible vitamin deficiency including Harrison's groove, rhachitic rosary and pigeon chest. The prevalence rate of those physical findings on infants with vitamin D supplementation was 20.7%, infants without supplementation 25% and infants with mixed feeding showed somewhat higher rate than those with breast or bottle feeding. Compared to the results of last 3 years, the incidence of the anemia was decreased in accordance with increasing rate of the iron supplementation. However, the incidence of the vitamin D deficiency was not decreased inspite of the increasing rate of vitamin D supplementation.

미숙아 관리의 질 향상을 위한 방안 : Kangaroo식 아기 돌보기

김행미,현명철,한귀자,이경희,김정옥,박선민,최희정 한국의료QA학회 2005 가을학술대회 Vol.2005 No.2

신생아 저산소 허혈 뇌증의 약물 치료적 접근

김행미 대한신생아학회 2013 Neonatal medicine Vol.20 No.3

Despite marked improvements in perinatal practice, neonatal hypoxic-ischemic encephalopathy (HIE) remains one of the major causes of acute mortality and chronic neurologic disability in infants and children. Several new therapeutic approaches aiming at this condition have been used in the last decade, including therapeutic hypothermia and many pharmacological agents. Therapeutic hypothermia remarkably reduces death and neurological impairment, and has therefore rapidly become the standard therapy for full-term newborn infants with moderate-to-severe HIE. However, despite these promising outcomes of therapeutic hypothermia, approximately 50% of the infants treated with hypothermia have an adverse outcome. Therefore, there exists an urgent need for other treatment options. A mechanistically driven approach to HIE has resulted in the development of many drugs that are potent antagonists of specific steps in cascades of molecular reactions in HI injury. This review provides an overview of promising pharmacological approaches of neuroprotection that may be used in clinical practice. Although several drugs have been found to be effective in preclinical evaluations, such antagonists have been ineffective in human trials. Failure has been attributed to many factors such as the complex pathology of HIE in neonates, the inevitable delays in initiation of therapy in clinical practice, and the side effects of the drugs. Moreover, many of these drugs interfere with only one step of the cascades, while multiple biochemical cascades are put in motion simultaneously. Therefore, neuroprotective strategies such as hypothermia have to deal with multiple cascades. Research is now being focused on drugs that may act synergistically or additively with hypothermia, with the hope that combination therapy might augment neuroprotection.

小兒腎症候群에 關한 臨床的 觀察

金幸美,李昌浩,具滋薰,安斗洪 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

著者는 지난 3年間 慶北醫大 附屬病院小兒科에 入院하였던 特發性腎症候群 患兒 38名을 對象으로 臨床症狀, steroid療法에의 反應度, 豫後에 영항을 미치는 要因, 再發樣狀等을 觀祭하였으며 steroid 療法에 不良한 反應을 보인 17名에서는 經皮的腎生檢을 시행하였다. 또한 9名에서는 methylprednisolone의 "pulse" therapy, 5名에서는 cytoxan을 使用하여 아래와 같은 結果를 얻었다. 發病年齡은 3~7歲가 16名(42%)으로 가장 많았고 男兒 28各, 女兒 10名으로 男女比 約 3:1로 男兒가 많았다. 初發 및 再發時의 臨床症狀은 심한 全身浮腫이 71.1%, 腹水 및 胸腔渗出液이 65.8%, 胃腸障碍가 47.4%에서 觀察되었으며, 初期 steroid療法으로 完全寬解를 보인 경우는 14名(37.8%), 部分的寬解 17名(46%), 不良한 反應을 보인 경우는 6名(16.2%)였으며 20名(57.1%)에서 2週以內에 利尿의 招來 및 蛋白尿 消失을 보였다. 腎炎所見은 全例에 있어서 血尿 21.6%, 高血壓 10.8%. 및 窒素血症 24.3%로서 steroid 療法에 不良한 反應을 보인 患兒들에게서 높은 頻度를 나타내었으며, 1年以上 追跡觀察된 21各中 9名(43%)에서 첫 1年以內에 再發이 있었고 再發例의 約 半數에서 上氣道感染이 동반되었다. 17名에서 施行한 腎組織檢査 所見은 minimal change 8例, membranoproliferative glomeruloneph ritis 및 membranous glomerulopathy 各 3例, focal segmental sclerosis 1例 및 focal proliferative glomerulonephritis 2例로서 男女比는 13:4였다. 이 중 steroid 療法에 反應이 좋지 않았던 9各에 있어서 methylprednisolone의 "pulse" therapy를 시행한 結果 5名에게는 檢査所見의 현저한 好轉 및 再發이 없어지는 등의 成果를 얻었으며, 또한 cytoxan을 使用한 5名中 2名에서 完金寬解가 있었다. 같은 期間 동안 入院하였던 急性絲球體腎炎 患兒 54名中 6名에서 二次性腎症候群이 병발되었으며, 또한 1日 2gm/㎡ 以上의 多重의 蛋白尿는 急性絲球 體腎炎 6名 및 心不全症 2名에서 觀察되었다. A clinical observation was done on 38 children with idiopathic nephrotic syndrome, who had been admitted to our pediatric department during 2 years and 9 months period, from January 1978 to September 1980. The following results were obtained: At the beginning of illness. 42% were in the age group of 3-7 year, and male to female ratio was approximately 3:1 of male preponderance. During initial attack and subsequnt relapses, pitting edema on extremities was noticed in all cases, followed in frequency by generalized edema in 71%, ascites and/or pleural effusion in 65.8% and GI trouble in 47.4%. Response to initial continuous steroid therapy showed complete remission(group 4) in 37.8%, partial remission (group 2&3) in 46% and no response (group 1) in 16.2%. Within 2 weeks after institution of steroid therapy, both diuresis and disappearance of proteinuria were noted in 57.1%. Nephritic manifestations, eg. hematuria, hypertension & azotemia, were seen in 21.6%, 10.8%, 24.3% respectively, and the majority of children with these manifestation showed poor response to steroid therapy. Nine out of 21 patients in whom follow-up could be done over 1 year, experienced one or more relapses, giving 43% relapse rate during the 1st year, and URI was accompanied in about half of these episodes. Percutaneous renal biopsy done on 17 patients who showed steroid dependency, or no response to poor response toward steroid therapy showed the following results: Minimal change nephrotic syndrome in 8, membranous nephropathy in 3, membranoproliferative glomerulonephritis in 3, focal segmental sclerosis in 1 and focal proliferative glomerulonephritis in 2. And male to female ratio was 13:4. "Pulse therapy" with bolus dosage of methylprednisolone was tried on 9 patients, resulting in disappearance of relapse, or significant improvement in blood chemistry & urinary finding in 5. And 2 out of 5 patients in whom immunosuppressant therapy with cytoxan was given due to poor response to steroid, experienced complete remission. During the same study period, secondary nephrotic syndrome was observed in 6 out of 54 patients with acute glomerulonephritis, and heavy proteinuria alone, defined as proteinuria over 2gm/㎡ day, was seen in 6 patients with acute glomerulonephrits and 2 patients with congestive heairt failure.

신생아 황달질환에서의 RDW의 진단적 의의

김행미,신채옥,현명철,이건수,이상범,구자훈 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.3

목적 : 신생아 적혈구는 그 모양이 불규칙하여 여러 측정치가 성인 및 소아와 다르다, 저자들은 국내에서 보고된 바 없는 신생아의 Red cell distribution width(RDW)를 조사하여 신생아 정상 측정치를 제시하는 동시에 신생아 시기의 적혈구에 손상을 미치는 질환의 RDW를 분석하여 진단상 의의를 조사하였다. 대상 및 방법 : 신생아 집중치료실에 입원한 만삭아중 감염소견이 없었던 78명과 ABO부적합증 및 패혈증 환아에서 hemoglobin, hematocrit, MV, RDW 및 망상적혈구를 측정하였다. 결과 : 생후 1일부터 7일까지의 만삭신생아의 RDW 17.4±1.5로 소아 정상치 13.4±1.2%에 비해 증가되어 있었으나 출생후 7일까지 hemoglobin, hematocrit는 의의있게 감소한 반면 RDW는 변동이 없었다. 같은 연령의 ABO 부적합증 및 패혈증 환아군은 대조군에 비해 의의있게 hemoglobin과 hematocrit가 낮았으나 RDW는 대조군과 질병군 및 각 질병군 사이에 차이를 보이지 않았다. RDW와 망상적혈구는 ABP 부적합증에서만 상관계수 0.91 (p<0.001)의 상관관계를 보였다. 결론 : 출생후 7일까지 계측한 정상 신생아의 RDW는 소아에 비해 증가되어 있으나 출생후 변화는 없었다. ABO 부적합증 및 패혈증 환아군의 RDW는 대조군과 질병군 및 각 질병군 사이에 차이를 보이지 않아 이들 질환의 진단적 의의가 없었다. ABO 부적합증에서 RDW가 망상적혈구 수와 높은 상관관계를 나타내므로서 자동 분석기로 측정된 RDW로서 망상적혈구 수를 추정할 수 있었다. The RBC distribution width(RDW) has been reported to be of value in the early and differential diagnosis of several RBC disorders, with no sufficient studies on the newborn population. Seventy-eight normal fullterm newborns were studied to establish normal values for RDW of 1st week of life. The RDW of 43 patients with ABO incompatibility or sepsis was then evaluated for the usefulness of the RDW in diagnosis of Jaundice. The RDW was 17.7 ± 1.2 and 17.5 ± 0.8 at 1st and 4-7th days of life, revealing no differences de pending on the postnatal age. The RDW of newborns with ABO incompatibility, sepsis with and without jaundice were 18.4 ± 2.2, 18.2 ± 1.1 and 17.3 ± 0.9 respectively. The RDW was found to be consistently elevated in all these newborn infants-the normal newborns and the newborns with ABO incompatibility or sepsis-when compared with normal older children at our hospital. That reveals a physiologic state of anisocytosis in the newborn, showing no significant differences between these infants. Our results suggest that RDW alone cannot be used as an indicator to distingish between jaundice induced by hemolysis and by other causes. In this study all parameters examined except the reticulocyte counts of ABO incompatibility, which showed, by regression analysis, no correlation with the RDW. High RDW in ABO incompatibility is consistent with high reticulocyte count. One clinical value of the RDW therefore may lie in its capacity for reflecting active erythropioesis in ABO incompatibility. Thus the study has confirmed that red blood cell anisocytosis, as determined by RDW, has no value to differentiate the etiology of jaundice in the newborn period but it seems that RDW plays a role in determining the reticulocyte count in newborns with ABO incompatibility.

新生兒出血性 및 혈액질환

金幸美 藥業新聞社 1991 (月刊) 醫藥情報 Vol.1991 No.7