최근 6년간 단일 신생아중환자실에서 발생한 패혈증 환자의 분석

천베드로,공섬김,변신연,박수은,이형두,Chun, Peter,Kong, Seom-Gim,Byun, Shin-Yun,Park, Su-Eun,Lee, Hyung-Du 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

Purpose : Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm. The objective of this study was to analyze the incidence rate, causative pathogens and clinical features of neonatal sepsis in one neonatal intensive care unit (NICU) for 6 years. Methods : This study was retrospectively performed to review the clinical and laboratory characteristics including sex, gestational age, birth weight, Apgar score, length of hospitalization, length of total parenteral nutrition, presence of central venous catheter, underlying diseases, laboratory findings, microorganisms isolated from blood culture, complications and mortality in 175 patients between January 2003 and December 2008. Results : 1) Sepsis was present in 175 of 3,747 infants for 6 years. There were more gram-positive organisms. 2) The gram-negatives were more prevalent in preterm. There were no significant differences of other clinical features between two groups. 3) Underlying diseases were found in 73.7%, and the most common disease was cardiovascular disease. The most common organisms of gram-positives and gram-negatives were methicillin resistant Staphylococcus aureus (MRSA) and Serratia marcescens. 4) There was statistically significant difference on platelet counts between two groups (P<0.05). 5) Complications were found in 18.3% and septic shock was the most common. MRSA was the most common pathogen in sepsis with complication. 6) The mortality rate was 7.4%. 7) There were differences in monthly blood stream infection/1,000 patient-days. Conclusion : The studies about the factors that can influence neonatal sepsis will contribute to decrease the infection rates in NICUs.

문제기반학습 교육과정 개편에 따른 과정 만족도 및 학생평가 결과 비교 분석 연구

김세진,김민정,공섬김,정호중,Kim, Sejin,Kim, Minjeong,Kong, Seom Gim,Jeong, Ho Joong 연세대학교 의과대학 2022 의학교육논단 Vol.24 No.2

The purpose of this study was to redesign a problem-based learning (PBL) curriculum and compare the differences between the previous and redesigned PBL based on the results of course satisfaction and student assessments. The PBL was redesigned using curriculum design guidelines (including revisions of curriculum objectives, learning components, learning environments, and assessment methods) that were developed based on previous studies and evaluation results. A comparative study was employed using course satisfaction surveys from the previous and redesigned curricula, and a total of 45 students participated. We also compared student assessment results from concept mapping, learning issue reports, modified essay questions, and reflection journals. We identified four key findings. First, we explored the possibility that the redesigned PBL could be implemented by student facilitators without professors as tutors. Second, the redesigned PBL fostered group dynamics that facilitated developing communication skills and collaborative learning through small-group discussions. Third, the new learning elements added in the redesigned PBL made a meaningful contribution to enhancing students' clinical reasoning based on hypothetico-deductive reasoning. Fourth, concept maps in redesigned PBL contained more complex and various nodes and connections, and the levels of the nodes were more appropriate. The implications of this study can provide meaningful preliminary information for redesigning PBL curricula for medical students to develop their essential competencies through PBL.

급성 뇌염의 초기 뇌파소견과 예후와의 관계

오재민(Jae Min Oh),공섬김(Seom Gim Kong),이윤진(Yun Jin Lee),남상욱(Sang Ook Nam) 대한소아신경학회 2011 대한소아신경학회지 Vol.19 No.1

목적 : 급성 뇌염 환자의 예후를 초기 뇌파검사로 예측할 수 있는가를 확인하고자 하였다. 방법 : 2007년 1월부터 2010년 3월까지 부산대 학교병원 및 부신대학교 어린이병원 소아청소년과에서 급성 뇌염으로 진단되어 치료받은 18세 이하의 환자를 대상으로 하였다. 총 31명의 환자를 완전히 회복된 군(A군, 20명)과 후유증이 남은 군(B군, 11명)으로 나누었다. 두 군 간에 초기 진단 시 뇌파 상 이상소견의 심한 정도 및 간질양파, 뇌파경련, 정상수면파, 외부자극에 대한 뇌파의 변화 등의 출현여부를 비교하였다. 뇌파 상 이상소견의 정도를 평가하는 데에는 Synek의 분류를 이용하였다. 결과 : A군에 비해 B군 환자들이 Synek의 분류 상 더 높은 단계의 뇌파 상 이상소견을 보였다(P=0.004) 간질양파의 출현(P=0.004), 뇌파경련(P=0.049) 등은 B군에서 더 높은 빈도로 나타났다. 외부자극에 대한 뇌파상의 변화는 완전히 회복된 A군에서 더 많이 나타났다(P=0.002). 정상 수면파는 통계학적인 유의성은 없으나 A군에서 더 많이 나타나는 경형을 보였다(P=0.081). 결론 : 초기 뇌파에서 이상소견의 심한 정도를 평가하는 것은 일반적인 혼수 환자에서 뿐만 아니라 급성 뇌염 환자의 예후를 예측하는 데 있어서도 유용한 수단이 될 수 있다. 또한, 간질양파가 나타나는 경우, 뇌파경란을 보이는 경우, 외부 자극에 대한 뇌파의 변화를 보이지 않는 경우 더 많은 후유증을 가지게 되는 것으로 나타났다. 정상수면파가 출현하는 경우는 통계적 유의성은 없으나 양호한 예후와 연관되는 경향을 보였다. Purpose : This study aimed to identify the usefulness of initial electroencephalograms (EEG) in the prediction of neurological outcomes of acute encephalitis. Methods : Thirty-one patients diagnosed with acute encephalitis between January 2007 and March 2010 were included in the study. all of whom were less than 18 years old. Patients were divided into two groups. Those who had recovered completely were designated group A, and those who had neurological sequalae were designated group B. We compared the severity of EEG background abnormalities according to the Synek classification, and the incidence of interictal epileptiform discharges, electrographic seizures, normal sleep features, and EEG reactivity to pain stimuli between the two groups upon initial EEGs. Results : Compared with group A, group B showed a higher grade of EEG background abnormalities (P=0.004). The incidence of interictal epileptiform discharge (P=0.004) and electrographic seizure (P=0.049) were also higher in group B. Further, Group A had more EEG reactivity (P=0.002) and the incidence of normal sleep features tended to be higher in group A (P=0.081). Conclusion : Initial EEG features including the severity of EEG background abnormalities are helpful in predicting the prognosis of acute encephalitis.

단일 병원에서 소아 기도 이물 흡인에 대한 30년의 임상 경험

김혜영 ( Hye Young Kim ),공섬김 ( Seom Gim Kong ),박희주 ( Hee Ju Park ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

목적: 소아 기도 이물 흡인은 치명적일 수 있는 응급질환이며 진단이 늦어진 경우 장기적인 합병증을 유발할 수 있다. 이에 기도 이물 흡인에 대한 임상 자료를 분석하여 진단과 치료에 기여하고자 하였다. 방법: 1980년부터 2009년까지 약 30년간 부산대학병원 소아 청소년과에서 기왕력,흉부 방사선검사,기관지 내시경 검사 등을 시행하여 기도 내 이물 흡인으로 진단 받은 15세 미만 206명을 대상으로 임상 경과를 후향적으로 분석하였다. 급성 중증 호흡기 폐색 증상이 있었던 16명의 임상 자료를 분석하여 위험도를 평가하였다. 또한 기도 내 이물 흡인 후 진단 및 치료까지의 기간을 기준으로 24시간 이내인 경우를 조기 진단,24시간 이상인 경우를 지연 진단으로 나누어 임상 자료를 비교 분석하였으며, 7일 이상 진단이 늦어진 환아들을 대상으로 지연된 진단의 원인을 조사하였다. 결과: 기도 이물 흡인 환아의 평균 연령은 22.3개월이며 3세 미만이 76.2%로 대부분이었고, 남녀 비는 2.12:1였다. 첫 내원시 임상증상은 기침이 67.9%, 진찰시 호흡음 감소가 43.6%로 가장 많았다. 흉부 방사선 소견에서 폐기종이 50.0%로 가장 흔하였다. 이물 종류는 식물성이 63.6%로 이중 땅콩이 45.6%로 가장 많았고,이물 위치는 주 기관지가 66.5%로 가장 흔하였다. 심한 급성 호흡곤란은 3세 미만이 어린 영아에서 더 흔하였다. 조기 진단 군에서 사래걸림 증상과 후두와 기관에 이물이 위치한 경우가 유의하게 많았고, 지연 진단 군은 발열, 반복적인 폐렴,기관지 확장증 증상이 유의하게 높았다. 7일 이상 진단이 지연된 환아들은 천식 및 기도 감염으로 오인된 경우가 흔하였다. 결론: 기도 이물 흡인은 3세 이하의 소아들에서 호발하며 어릴수록 호흡기 폐색 증상이 심각하게 나타날 수 있어 영아의 이물 흡인 예방을 위한 적극적인 보호자 교육이 필요하다. 또한 기왕력이 없고 흉부 방사선 소견이 정상이더라도 비특이적인 호흡기 증상들이 지속된 경우 기도 이물 흡인의 감별을 위해 기관지 내시경 검사를 적극적으로 고려해야 한다. Purpose: This study aimed to analyze the clinical spectrum of foreign body aspiration in children and explore the clinical features which could facilitate early diagnosis. Methods: We studied 206 pediatric patients who had aspirated foreign bodies in Pusan National University Hospital between 1980 and 2009. Age, sex, symptoms, signs, the type and location of foreign bodies, radiologic findings and clinical courses were investigated retrospectively. We compared these findings of children diagnosed within 24 hours (early-diagnosis group: EDG) with those of the delayed-diagnosis group (DDG). Results: The majority of patients (76.2%) were yonger than 3 years of age. Cough (67.9%) and decreased breathing sound (43.6%) were the predominant symptoms and signs. Obstructive emphysema (50.0%) was the most frequent radiologic finding. Peanut was the most common foreign body. Acute severe airway obstruction by aspirated foreign bodies tended to occur in younger children because of their small airway. Choking was more frequent in the EDG group than in the DDG group (P=0.018). For the location of foreign bodies, the larynx and trachea were more common in the EDG group (P=0.031). Fever (P=0.024), persistent pneumonia (P=0.011) and bronchiectasis (P=0.041) were more common in the DDG group than in the EDG group. Bronchial asthma, upper respiratory infection and pneumonia were the most common wrong diagnosis. Conclusion: Reducing the number of accidents associated with foreign body aspiration is the best way to promote public prevention policies. Physicians must consider the possibility of foreign body aspiration in children with chronic respiratory symptoms. [Pediatr Allergy Respir Dis(Korea) 2009;19:383-391]

2011-2012년 인플루엔자 국내 유행시기에 신생아 중환자실에서 발생한 A형 인플루엔자 바이러스 집단발병

손옥성 ( Ok Sung Son ),오지은 ( Chi Eun Oh ),공섬김 ( Seom Gim Kong ),정유진 ( Yu Jin Jung ),홍유라 ( Yoo Rha Hong ) 대한소아감염학회 2016 Pediatric Infection and Vaccine Vol.23 No.2

Purpose: An outbreak of influenza virus is uncommon in neonatal intensive care unit (NICU). The clinical presentation of influenza virus infection in neonates is diverse. This study was aimed to report an outbreak of influenza A in a NICU and to investigate the clinical characteristics of influenza virus infection in neonates especially preterm infants during the 2011-2012 influenza season in Korea. Methods: We reviewed the medical records of 29 patients who were evaluated by respiratory virus multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) at NICU of Kosin University Gospel Hospital during the 2011-2012 seasonal influenza outbreak in Korea. Results: Eleven patients (37.9%) were influenza A virus RT-PCR positive during the survey periods. They were all preterm infants and three of them had no symptoms. Eight patients had symptoms and it was fever (18%, 2/11), respiratory difficulty (72.7%, 8/11) without symptoms of upper respiratory infection, and gastrointestinal symptoms (27.3%, 3/11). The median duration of symptom was 5 days. There were differences of duration of admission at the test of respiratory RT-PCR, Clinical Risk Index for Babies (CRIB) score, use of mechanical ventilation, and use of dexamethasone before infection between influenza A virus RT-PCR positive and negative group. All 11 patients with influenza A were discharged without any complications. Conclusions: The symptoms of influenza A virus infection in the preterm infants is nonspecific. Influenza A virus should be considered as a possible cause of infection in NICU during the influenza season in the community.