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30일 이상 90일 미만의 발열 영아에서 경험적 항생제 사용에 영향을 미치는 요소
변정희,송보경,김영아,고훈,유석동,임택진,박수은,Byun, Joung-Hee,Song, Bo Kyung,Kim, Young A,Ko, Hoon,Yoo, Suk dong,Lim, Taek Jin,Park, Su Eun 대한소아감염학회 2018 Pediatric Infection and Vaccine Vol.25 No.2
Purpose: This study investigated the factors affecting the use of empirical antibiotics in febrile infants from 1 month to less than 3 months. Methods: We retrospectively reviewed the medical records of hospitalized previously healthy infants with fever in Pusan National University Children's Hospital from January 2010 to December 2016. Clinical features, laboratory findings and antibiotic therapy were analyzed. Respiratory viruses were identified by multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and were reported after 1-3 days. Enterovirus were identified by real time polymerase chain reaction (PCR) and were reported in several hours. Results: The 129 of 366 subjects used empirical antibiotics and 237 patients didn't used empirical antibiotics. Empirical antibiotics were used more frequently when the fever was longer before admission, respiratory symptoms and ill being appearances were present and C-reactive protein was elevated. The rate of readmission was low in the group not used empirical antibiotics. Most of the patients detected by enterovirus PCR in cerebrospinal fluid didn't used empirical antibiotics. The results of respiratory virus multiplex RT-PCR showed no difference in the use of empirical antibiotics. Conclusions: In our study, empirical antibiotic prescriptions were affected not respiratory virus multiplex RT-PCR but enterovirus PCR. If multiplex RT-PCR were reported more rapid turn around time, it will affect antibiotic use.
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변정희(Joung-Hee Byun),송지연(Ji-Yeon Song),공주현(Juhyun Kong),남상욱(Sang-Ook Nam),김영미(Young Mi Kim),연규민(Gyu Min Yeon),이윤진(Yun-Jin Lee) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.2
목적: 본 연구는 소아 중추 및 말초신경계의 급성 병합 탈수초 질환의 발병률과 임상적 특징을 조사하고, 중추 혹은 말초신경계의 단독 탈수초질환과의 비교 분석을 하고자 하였다. 방법: 부산대어린이병원에서 2010년부터 2015년 사이에 급성 탈수 초질환 소아들의 의무기록을 후향적으로 조사하였다. 임상증상, 자기 공명영상 및 신경전도검사 소견을 바탕으로 진단 기준에 합당한 96명을 선정하였다. 이들을 중추신경계 단독 탈수초질환군(A군, 60명), 말 초신경계 단독 탈수초질환군(B군, 30명), 그리고 병합 탈수초질환군 (C군, 6명)으로 분류하였다. 결과: 세 군 사이 비교분석을 하였고, 20132015년 동안의 발병율 (A군, 45.0%; B군, 43.3%; C군, 83.3%; P =0.024), 중환자실 입실 비율 (A군, 8.3%; B군, 26.7%; C군, 50.0%; P =0.027), 전체 입원 기간(A군, 9.7±11.2일; B군, 12.3±18.7일; C군, 48.3±51.2일; P =0.75), 스테로이 드 치료(A군, 88.3%; B군, 10.0%; C군, 100.0%; P =0.003), 면역글로불 린 투여(A군, 13.3%; B군, 100.0%; C군, 100.0%; P =0.002), 혈장교환술 시행(A군, 0.0%; B군, 3.3%; C군, 50.0%; P =0.037; P =0.037) 그리고 퇴원시 심각한 활동 장애 비율(A군, 3.3%; B군, 16.7%; C군, 33.3%; P =0.012)에서 의미 있는 차이가 있었다. 결론: 급성 탈수초질환 추정되는 경우에, 병합 탈수초질환군이 단독 탈수초질환군에 비해 불량한 경과를 보일 수 있으므로, 신경영상 및 신경전도검사 등의 광범위한 검사를 통해 병합 탈수초질환에 대한 정확한 진단과 신속한 치료를 함으로써, 비가역적인 신경학적 후유증 을 방지할 수 있겠다. Purpose: This study aimed to describe the clinical characteristics and outcomes of children with acute combined central and peripheral nervous system demyelination (CCPD); and compare with the children of isolated acute central or peripheral nervous system demyelination. Methods: A retrospective chart review of 145 children with acute demyelinating disease between 2010 and 2015 was undertaken in children with younger than 18 years old. Among these, 96 fulfilled criteria (clinical features and positive neuroimaging or electromyography/nerve conduction studies) for either acute central (group A, n=60, 62.5%) or peripheral (group B, n=30, 31.3%) nervous system demyelination, or a CCPD (group C, n=6, 6.3%). Results: Significant differences among the groups (A vs B vs C) were evident for occurrence of disease between 2013-2015 (45.0% vs 43.3% vs 83.3%; P=0.024), admission to intensive care unit (8.3% vs 26.7% vs 50.0%; P=0.027), length of hospitalization (median, 9.7 vs 12.3 vs 48.3 days; P<0.001), treatment with steroids (88.3% vs 10.0 vs 100.0%; P=0.003), immunoglobulins (13.3% vs 100.0% vs 100.0%; P=0.002) and plasmapheresis (0.0% vs 3.3% vs 50.0%; P=0.037) and severe disability at discharge (3.3% vs 16.7% vs 33.3%; P=0.012). Children of group C showed good response to simultaneous use of immunoglobulin and high-dose corticosteroids and earlier try of plasmapheresis, however, two patients had moderate degree of neurological disability. Conclusion: Systemic studies using neuroimaing and electromyography/nerve conduction studies in all patients with demyelinating disease will be necessary to verify the combined or isolated disease, because CCPD might have the poorer outcome than isolated disease.
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모유수유와 부모의 사회경제적 관계에 관한 연구: 2013-2017 국민건강영양조사자료
변정희 ( Joung-hee Byun ),이주석 ( Jusuk Lee ),김태홍 ( Taehong Kim ) 한국모자보건학회 2021 한국모자보건학회지 Vol.25 No.1
Purpose: The importance of breastfeeding is well known. Socioeconomic status is one of the factors affecting breastfeeding. We investigated the association between breastfeeding and parental socioeconomic status to help design future breastfeeding promotion projects. Methods: Data on demographic characteristics and socioeconomic status of parents of 1,220 children aged under 60months were extracted from the 2013-2017 Korea National Health and Nutrition Examination Survey. Results: Some socioeconomic factors were associated with breastfeeding. Maternal factors such as education level (≥13 years: odds ratio [OR], 2.79; 95% confidence interval [CI], 1.21-6.42), middle high income level (OR, 2.30; 95% CI, 1.18-4.49), no smoking status (OR, 3.07; 95% CI, 1.28-7.36) and body mass index (BMI) (<25 kg/m<sup>2</sup>: OR, 1.82; 95%CI, 1.12-2.95) were associated with breastfeeding (p<0.05). In addition, paternal factors such as age (30s: OR, 4.88; 95%CI, 1.82-13.04) and education level (≥13 years: OR, 7.94; 95% CI, 3.12-20.18) were associated with breastfeeding (p<0.05). After controlling for confounding factors, mother’s BMI, father’s age, and father’s educational level were found to be statistically significant predictors of breastfeeding. Conclusion: This study demonstrated that some parental socioeconomic factors were associated with breastfeeding in Korea.
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