본 연구는 신생아 검사 중 포수클로랄(chloral hydrate)을 투여 후 진행되는 신생아 진정 검사 대비 진정 대체 방식 중 하나인 피드 및 랩(feed and wrap) 방식의 유용성을 평가한 연구이다. 본 연구에선 진정으로 진행한 신생아의 두뇌 T2 축면 영상과 피드 및 랩 방식으로 진행한 같은 영상 각 30개의 운동 허상(motion artifact)과 백질과 회백질의 구분 정도를 두 명의 영상의학과 전문의가 정성적으로 평가하였고, 운동 허상을 측정하기 위해서 위상부호화(phase encoding) 방향의 배경 영역(background area)의 평균 신호 강도(mean signal intensity)를 구하여서 정량적 방식으로 평가하였다. 또한 총검사 시간을 정리한 뒤 정량적 방식으로 평가하였고 투약 기록의 여부와 간호일지를 토대로 피드 및 랩 방식의 총 39건의 검사 건수 대비 성공률을 측정하였다. 운동 허상의 정량적 평가와 영상 품질의 정성적 평가 모두에서 두 집단은 유의미한 차이가 없었으나, 검사 시간의 정량적 평가에선 p값이 0.001로 유의한 차이가 있었다. 피드 및 랩 방식의 총검사 건수 대비 성공률은 100%였다. 결론적으로 본 논문에선 피드 및 랩 방식과 진정 방식의 영상 품질이 유의한 차이가 없고 성공률이 높기에 유용하다고 판단하였으나, 검사 시간이 더 지연되는 한계가 있다는 사실을 확인하였다.

Purpose: This study aimed to identify the current status and needs of nursing education for extremely low birth weight (ELBW) infants in Korea, and to obtain preliminary information to develop a simulation-based educational program on nursing care for nurses in the neonatal intensive care unit (NICUs). Method: Descriptive survey design was adopted in developing an ELBW infant nursing education program. Data were collected from 71 NICU nurses using a questionnaire survey. Statistical Package for the Social Science (SPSS) (version 23) for windows was used to analyze the frequency, percentage, mean, and standard deviation of the collected data. Results: Seventy-one nurses working in the NICU reported that majority of them (76.1%) had experience in ELBW infants’ nursing education. The following were highly recommended for simulated training by NICU nurses: nursing intervention immediately after birth in ELBW infants (69.0%), NICU‘ initial admission nursing (66.2%), and frequency response coping nursing (57.7%). Conclusion: The study revealed that there is a considerable need for the ELBW infants nursing education program. The results of this survey will ultimately provide a basis for developing simulation-based ELBW infants nursing training programs for NICU nurses.

Purpose: This study, as presented by Kern, Thomas, and Hughes , aims to verify the effectiveness of clinical inference education through digital storytelling programs based on Smith and Mann’s (2002) mobile education model in accordance with the six stages of the medical course development model. Based on the mobile education model of Smith and Mann (2002), the effectiveness of clinical reasoning education is verified through the mobile education program. Method: A single group pre-post test design that evaluates the clinical reasoning education effects of the mobile education program was used. Results: A statistically significant improvement was observed in clinical inference capacity from before intervention (t=-9.81, p<0.001); there was also a greater difference in the average value after intervention than before intervention in all of the results. Conclusion: This study suggests that while scenarios were constructed around five cases of high-risk Infant with respiratory and mechanical problems, in the future, additional scenarios should be developed to include different body systems.

목 적 : 신생아 혹은 미숙아의 뇌 MRI 검사 시 임상에서는 성인과 동일한 protocol을 사용하여 검사하고 있다. 하지만 신생아의 뇌는 성인과 달리 수초화가 완성되지 않아 물의 함량은 많고 단백질과 지질의 함량은 적어 각 조직의 T1 값이 성인보다 길다. 따라서 신생아의 뇌 특성을 고려한 최적의 T1 강조영상을 얻기 위해서는 기존에 적용되는 성인 TR: 450ms와 다른 적절한 TR 값이 요구된다. 이에 본 연구에서는 신생아 뇌 MRI 검사 시 진단가치 높은 T1 강조영상을 획득할 수 있는 최적의 TR 값을 찾고자 하였다. 대상 및 방법 : 신생아 중환자실에 입원한 생후 3개월 미만의 신생아 혹은 미숙아 총 10명(남6명, 여4명)을 대상으로 2014년 10월부터 2015년 1월까지 검사를 진행하였다. 장비는 1.5T Avanto (SIEMENS, Germany), MR Diagnostics Incubator System과 신생아 전용 Head coil인 LMT coil을 사용하였다. 대상 신생아에서 모든 parameters는 동일하게 하고, 조직 간의 T1 회복시간 차이에 큰 영향을 미치는 TR 값만을 450, 900, 1200, 1500 으로 달리하여 각각의 영상들을 얻었다. 영상분석방법은 정성적 분석과 정량적 분석으로 하였다. 정성적 분석을 위해 영상의학과 소아판독 전문의 2명과 방사선사 3명이 촬영한 영상에 대해 백질(white matter)과 회백질(gray matter)의 구별정도, 병변의 식별정도, Artifact, 전체적인 image quality에 관해 5 point scale (0=very poor, 1=poor, 2=fair, 3=good, 4=excellent)로 평가하였으며, 정량적 분석으로 신생아의 백질과 회백질 그리고 background의 신호강도(Signal intensity: SI)를 측정하여 신호 대 잡음비(signal to noise ratio: SNR)와 대조도 대 잡음비(contrast to noise ratio: CNR)를 계산해 비교분석 하였다. 통계적 분석을 위해서 SPSS 22.0(SPSS Incorporated, Chicago, IL, USA) 프로그램을 사용하였다. 결 과 : 본 실험에서 450, 900, 1200, 1500 TR 값으로 얻어진 영상들의 결과이다. 각 TR에 따른 백질과 회백질의 평균 SNR은 12.81/15.06, 23.58/27.39, 28.16/32.32, 35.52/40.26 이다. 각 영상들의 백질과 회백질 평균 CNR은 0.225, 0.371, 0.391, 0.454 이다. 정성적 분석으로 각 영상들의 평균값은 1.4±0.66, 2.56±0.49, 2.88±0.55, 3.46±0.49 이다. 통계분석은 Kruskal-Wallis 검정과 Mann-Whitney의 U 검정을 이용한 사후검정에서 근사유의확률 0.000~0.005로서 통계적으로 유의미한 차이가 있는 것으로 나타났다. 결 론 : 일반적인 검사방법인 성인 protocol의 TR 값을 신생아 뇌 MRI 촬영 시 적용하여 T1 강조영상을 얻을 경우, 신호 대 잡음비(SNR)와 대조도 대 잡음비(CNR)가 감소해 해부학적 분별력과 병변의 식별능력이 저하되는 문제점이 있었다. 하지만, 신생아 뇌의 특성을 고려하여 기존의 TR 값보다 2배 이상의 값을 선택하여 영상을 얻는다면 기존보다 향상된 SNR과 CNR을 가진 영상으로 신생아의 뇌 질환을 진단하는데 유용할 것으로 사료된다.

Purpose: This study was to develop a clinical competence scale to assess competence of nursing students in neonatal core nursing management after delivery in the simulation-based clinical situations. Methods: The assessment items developed with 14 items of 3 point scale. An expert panel of 4 professor and 1 nurse reviewed the scale for content validity by using the CVI(Content Validity Index). Following the establishment of content validity, 14 items of the checklist were developed. The simulation-based neonatal core nursing education that consisted of four sessions for 6 hours lecture and practice was provided to 26 small groups. Result: The total mean score of clinical competence in neonatal core nursing care was 20.04. Items with the highest mean score was 1.87 with 'apply clean gloves'. Items with lowest mean score was 1.15 with 'perform the body temperature management to the neonatal'. Reliability of between two evaluation using Cronbach's alpha was .86. Conclusion: This results show neonatal core nursing care assessment tool developed this study had reliability and validity. Further studies are needed to determine property of tool in neonatal core nursing care assessment tool.

Purpose: This study aimed to develop an algorithm-based simulation scenario for emergency measures for a high-risk newborn presenting apnea. Methods: A methodological study design was used to develop the algorithm-based simulation scenario. Expert evaluation was used to establish the developed algorithm’s content validity. Results: The simulation scenario was developed using several steps of algorithm development based on the Neonatal Resuscitation Program (NRP). The content validity was established. Based on the expert evaluation results, an eight-frame algorithm was selected for the final simulation scenario. The scenario courseware was composed of six major components: pre-learning activity simulation orientation, simulation operation, SBAR-format recording, watching the video-clip of their performance for self-evaluation and debriefing. After simulation, student’s clinical performance and communication skill were evaluated with the developed instrument. Conclusion: Considering that nursing students have limited access to high-risk newborns during their clinical experience and that newborns presenting apnea are common in the neonatal intensive care unit, the algorithm-based simulation scenario developed in this study can provide students with the opportunity to practice alternative emergency measures for high-risk newborns.

iarrheal diseases constitute one of the major causes of morbidity and mortality in infants and young children globally. One of the main microorganisms causing diarrheal diseases is Campylobacter jejuni. For treatment of these diseases, Portulaca oleracea has been widely used as a folk remedy for a long time. This study was performed to investigate the antimicrobial activity of P. oleracea against gastroenteritis pathogens including C. jejuni. P. oleracea was extracted with petroleum ether, chloroform, ethylacetate, methanol, and hot water. The antimicrobial activity of the P. oleracea extracts was determined using the paper disc method, minimum inhibitory concentration, and the liquid culture method. The 10 ㎎/㎖ ethylacetate extract showed the strongest antimicrobial activity against Salmonella typhimurium, Salmonella enteriditis, and Shigella spp.. The hot water extract from P. oleracea showed the highest anti-microbial activity against C. jejuni at 10～20 ㎎/㎖. The hot water extract of P. oleracea retarded the growth of C. jejuni for 36 hr at 42℃.

Transcutaneous bilirubinometer(TcB) has been performed in patients who visited the outpatient clinic with jaundice, and the major factors and natural course of long-term hyperbilirubinemia were investigated. From January 2011 to December 2016, a review was made based on 61 electronic medical records that conform to the conditions of patients who visited outpatient clinic with neonatal jaundice. TcB values were measured to confirm the natural progress data of jaundice in the study sub-jects. We collected information on gestational age, birth weight, mode of delivery, Apgar score, patient and maternal blood type, feeding type and perinatal problems at outpatient visits. Feeding type was classified into breastfeeding, formula feed-ing, and mixed feeding. Total of 61 patients, 31 were born by vaginal delivery, and 30 were delivered by Caesarean section. 32 patients were male, and 29 were female. The mean gestational age was 38.07 ± 1.52 weeks and the mean birth weight was 3.04 ± 0.45 kg. Most of the infants were supplied by breastfeeding (39.3%) or mixed feeding (44.3%). The TcB values of the patients ranged from 10.0 to 19.0 mg/dL, when they visited for the first time with jaundice. The mean age was 11.64 ± 7.52 days and the mean body weight was 3.27 ± 0.66 kg. The range of TcB values at the next outpatient visit was 7.0 to 18.0 mg/dL. Initially measured TcB value was divided by 15.0 mg/dL and analyzed using Pearson Chi-square method, and the TcB value was significantly lower only in the delivery through Caesarean section (p=0.03). The changes in TcB values tend-ed to decrease during the follow-up period. The proportion of breast-feeding or mixed breast milk was slightly higher at 90.6% in the previous method of breastfeeding compared to those in the group with higher TcB values (p=0.009) (Table 3). When patients with mild jaundice visit the outpatient clinic and check the birth method and the main feeding method at the time of the visit, it is considered to be possible to reduce the number of examinations and to provide accurate information to the parents, thereby reducing the excessive interruption of breastfeeding.

This study is to make a comparison between the one liquid emulsion with and without fish oil containing higher omega-3 fatty acid in parenteral nutrition (PN) of newborns. Serum chemistry and clinical complications from Medical Records of 76 newborns who had received PN with either SMOFlipidⓇ or ClinOleicⓇ for at least 7 days in NICU at Chosun Univeristy Hospital from January 2011 to December 2014 were reviewed retrospectively. Serum chemistry revealed no significant difference between the two groups except for total bilirubin (TB), glucose, blood urea nitrate (BUN), creatine (Cr), and cholesterol, but they even were not clinically significant as their values were within almost normal range. In terms of the difference in clinical complications, the incidence of cholestasis was higher in newborns given ClinOleicⓇ. However, there was no statistically significance. In this study, no significant difference between ClinOleicⓇ and SMOFlipidⓇ in their clinical efficacy was proven. But, considering the advantage of omega-3 fatty acid in reduction of cholestasis and infection risk, more studies may be needed using lipid emulsions containing higher content of fish oil with high omega-3 fatty acid, and they may be better if done with larger groups.

This study aimed to identify initial predictive factors of meningitis among the febrile neonates. Retrospective analysis was conducted on the clinical data of 147 cases who admitted the neonatal intensive care unit due to fever (temperature ≥ 38.0 ℃) from 2010 to 2014. Lumbar puncture was performed on every case before administration of antibiotics. 37 cases (25.2%) were diagnosed as meningitis, who included 7 cases of bacterial meningitis (4.8%). When we compared meningitis group with non-meningitis group (110 patients), moaning was statistically higher in meningitis group. In a comparison of bacterial meningitis with aseptic meningitis (30 patients), grunting, fever peak on admission day and C-reactive protein were significantly higher in bacterial meningitis group.

본 실험에 사용한 신생아 분변을 BL-NPNL 배지와 MRS(pH 5.4) 배지로 생균수를 조사한 결과, 각각 2.09×108 CFU/g feces와 1.06×109 CFU/g feces로 조사되었으며, 통성혐기성 유산균을 선발하여 내담즙산성과 내산성을 비교한 결과, SJ3, SJ6, SJ7, SJ-10균주들이 높은 활성을 보였다. 이들 유산균은 모두 E. faecalis로 동정되었으며, 향후 항생제 내성과 virulence factor에 대한 연구가 진행된다면 유산균 정장제와 사료 첨가제와 같은 probiotics 제품에 적용이 될 수 있을 것으로 판단되었다.