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최영륜 대한신생아학회 2013 Neonatal medicine Vol.20 No.3
Although advances in neonatal intensive care have led to an improved survival rate of extremely low birth weight infants, prolonged hospitalization of these critically ill infants has rendered them to be vulnerable to fungal infection in NICU. Because the incidence of fungal infection with related mortality and morbidity is inversely related to gestational age and birth weight, preventive measure is imperative to improve the survival rate and the outcome. There are many evidence-based reports for antifungal prophylaxis with fluconazole target infants <1,000 g and/or ≤27 weeks, because this group has a high infection-related mortality and neurodevelopmental impairment among survivors. However, interventions should begin with prenatal initiatives,with women being treated for vaginal candidiasis, especially with preterm labor. Furthermore, policies for restrictive use of third-generation cephalosporins, H2-antagonists, proton pump inhibitors, and postnatal dexamethasone; follow of the guideline for central venous catheter care and removal; and feeding practices, with promotion of early feedings and breast milk, and supplementation with lactoferrin and or probiotics, may reduce the fungal infection. In conclusion, prophylactic systemic antifungal therapy along with comprehensive infection control measures,restrictive use of drugs and proper feeding practice reduce the incidence of invasive fungal infection in high risk very low birth weight infants in NICU. However, further study is needed for the routine use of prophylactic antifungal therapy because the effect on mortality rate was not significant and the data on the long-term neurodevelopmental consequences were limited. In addition, further data on the emergence of resistant organisms and Malassezia colonization are needed.
최영륜,Eun Song Song,김윤하,송태복 전남대학교 의과학연구소 2011 전남의대학술지 Vol.47 No.1
Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.
최영륜 대한의사협회 2008 대한의사협회지 Vol.51 No.8
Premature (gestational age < 37th week) and low birth weight (LBW, birth weight < 2,500g) infants are very sensitive to small changes in respiratory management, blood pressure, fluid administration, nutrition, and virtually all other aspects of care because of physiological immaturity. The most important principle in the care of those babies is the ‘maximum observation and minimum handling’ during their initial adaptation from intrauterine to extrauterine life. At birth, the measures needed to clear the airway, initiate breathing, care for the umbilical cord and eyes, and administer vitamin K are the same for term and normal weight infants. However, special care is required to maintain a patent airway and avoid potential aspiration of gastric contents. Additional considerations are needed for thermal control and monitoring of the heart rate, respiration, and nutrition. Safeguards against infection can never be relaxed. The effective care based on currently available evidence is best ensured through the implementation for standardized protocols for the care of those infants within individual nursery or neonatal intensive care unit (NICU). The need for regular and active participation by the parents in the infant's care during hospital stay, the need to instruct the monitor in at-home care of her infant, and the question of prognosis for later growth and development require special consideration. Effective discharge planning and follow-up visiting also promote continuity of care from hospital to home.
최영륜 ( Young Youn Choi ) 대한주산의학회 2010 Perinatology Vol.21 No.3
Fetal development is achieved under the influences of maternal environment, utero-placental function and the genetic growth potential which lead to development and maturation of tissues and organs. In the optimal condition, normal growth and development of the fetus will be achieved and process of labor and delivery will be easier. And also cardiopulmonary function and metabolic adaptation of the newborn in extrauterine environment will progress naturally. However, if there is unsatisfactory environmental condition such as maternal illness, problems including abnormal growth and development of the fetus, difficult labor and delivery and uneasy transition to extrauterine environment may occur. This article reviews the effects of noninfectious diseases of pregnancy such as hypertension, diabetes mellitus, thyroid and autoimmune diseases on the fetus and newborn.