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Abstract This study investigated neurodevelopment and risk factors in children surgically treated for congenital gastrointestinal anomalies (CGIA), excluding those with known high-risk factors such as low birth weight or chromosomal anomalies. Data of children born between 2008 and 2015 who underwent surgical treatment for CGIA were retrieved from the Korean National Health Insurance Database. CGIA included esophageal atresia, duodenal atresia, jejunoileal atresia, anorectal malformations, and congenital megacolon. Neurodevelopmental impairment (NDI) was defined as Korean Ages and Stages Questionnaire scores below the determined cut-off or Korean Developmental Screening Test scores

Background Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years.Methods This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality.Results In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk.Conclusion Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.

During the last several decades, the number of preterm infants has increased, and their survival rate has improved owing to advances in perinatal care. As more preterm infants survive, many studies examine their neurodevelopmental outcomes. This study aimed to summarize the neurodevelopmental outcomes of preterm infants according to gestational age at birth using a recently published meta-analysis. The prevalence of neurodevelopmental impairment and behavioral disorders decreased as gestational age and birth weight increased. Recent studies reported that proactive neonatal treatment of periviable preterm infants (gestational age, 22–24 weeks) could improve their prognosis. Moderate and late preterm infants reportedly have less severe disease than very preterm infants; nonetheless, they still experience adverse neurodevelopmental outcomes compared to term infants. Neonatal morbidities such as bronchopulmonary dysplasia and retinopathy of prematurity are associated with poor neurodevelopmental outcomes. Despite improvements in neonatal care, prematurity is still associated with poor neurodevelopmental outcomes. To ensure timely intervention, the establishment of a follow-up system for premature infants is necessary.

Background Dexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and analyse the factors associated with the response to dexamethasone in very low birthweight infants using a nationwide database.Methods We included very low birthweight infants born between January 2013 and December 2020 with a gestational age of 23–31 weeks using data from the Korean Neonatal Network registry. Patients were grouped based on their dexamethasone use into ‘Dex’ or ‘No Dex’ groups. Clinical variables and data were collected, and the annual trends of dexamethasone use and the proportion of patients who received dexamethasone according to gestational age were analysed. Respiratory outcomes were compared between the groups. Univariate and multivariate analyses were performed to analyse factors associated with the response to dexamethasone in BPD.Results Of 11 261 eligible infants, 2313 (20.5%) received dexamethasone, and 1714 (74.1%) of them were diagnosed with moderate-to-severe BPD. The 8-year annual prevalence of dexamethasone use was 17.7–22.3%. The ‘Dex’ group had more moderate-to-severe BPD, more frequent invasive ventilation use at a postmenstrual age of 36 weeks and longer ventilator duration. Birth weight, 5-minute APGAR score, pulmonary hypertension within the first 28 days, surgical treatment of patent ductus arteriosus, medical treatment of patent ductus arteriosus, pathological chorioamnionitis, hydrocortisone or budesonide use, surgical management of necrotising enterocolitis and fungal sepsis were associated with BPD after dexamethasone use.Conclusions Approximately 20.5% of preterm infants received dexamethasone, and the frequency increased as gestational age decreased. Poor response to dexamethasone was associated with antenatal and postnatal inflammation, low birth weight and early pulmonary hypertension.

Abstract Background Trisomy 18 syndrome (T18) is the second most common autosomal trisomy and has a high risk of fetal loss and stillbirth. Aggressive surgical treatments for the respiratory, cardiac, or digestive systems of patients with T18 were previously futile, while the results of recent studies are controversial. Over the past decade, there have been approximately 300,000 to 400,000 births annually in the Republic of Korea; however, there have been no nationwide studies on T18. This nationwide retrospective cohort study aimed to determine the prevalence of T18 in Korea and its prognosis according to the presence of congenital heart disease and relevant interventions. Methods This study utilized NHIS-registered data between 2008 and 2017. A child was defined as having T18 if the ICD-10 revision code Q91.0–3 was reported. Subgroup analysis was performed for children with congenital heart diseases, and survival rates were compared based on the history of cardiac surgical or catheter interventions. The primary outcomes in this study were the survival rate during the first hospitalization period and the 1-year survival rate. Results Of the children born between 2008 and 2017, 193 were diagnosed with T18. Of these, 86 died, with a median survival of 127 days. The 1-year survival rate for children with T18 was 63.2%. The survival rate in the first admission of children with T18 who did and did not have congenital heart disease was 58.3% and 94.1%, respectively. Children with heart disease who underwent surgical or catheter intervention had a longer survival time than those who did not. Conclusions We suggest these data could be used in ante- and postnatal counseling. Ethical concerns about the prolonged survival of children with T18 remain; however, the potential benefits of interventions for congenital heart disease in this population need further study.

Abstract The risk of neurodevelopmental disorders in low birth weight (LBW) infants has gained recognition but remains debatable. We investigated the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-aged children according to their birth weight. We conducted a retrospective cohort study using the Korean National Health Insurance claims data of 2,143,652 children who were born between 2008 and 2012. Gestational age of infants was not available; thus, outcomes were not adjusted with it. Not only infants with birth weights of

Background: To investigate postnatal growth patterns and their relationship with the neurodevelopment of preterm infants born small for gestational age (SGA). Methods: This retrospective cohort study analyzed 90 infants born SGA with a birthweight

With improvements in the survival rate of high-risk newborns, the need for ethical considerations is increasing. In the event of a conflict of opinion between the parents and the medical staff about the treatment decision, often there are concerns about who needs to make the decision that would be in the best interest of the baby. In this article, focusing on the guidelines for neonatal resuscitation revised in 2020, ethical issues that may arise before and soon after birth are reviewed. In addition, the considerations in determining the treatment direction for neonates with poor prognosis and the care required for babies and their families during the neonatal period have been investigated. Decisions about withholding or discontinuing neonatal resuscitation are often time-pressed since they are often made when labor is imminent or are needed shortly after the baby’s birth. The recommendations put forth by the American Heart Association in 2020 may be referred toward decision making. Since the medical condition of high-risk newborns also often change rapidly following admission, it becomes necessary to review the treatment goals periodically. Though principles suggested by the American Academy of Pediatrics regarding the treatment decision of high-risk newborns are available, in Korea, it is also essential to consider the country’s law while discussing life-sustaining treatment. Improving the patient's quality of life is equally important as deciding treatment plans and approaches for sustaining life. Toward this, it becomes necessary that the medical staff treating high-risk newborns be educated on palliative care and build a support system.

Abstract Background Adverse metabolic outcomes later in life have been reported among children or young adults who were born as preterm infants. This study was conducted to examine the impact of very preterm/very low birth weight (VP/VLBW) birth and subsequent growth after hospital discharge on cardiometabolic outcomes such as insulin resistance, fasting glucose, and systolic and diastolic blood pressure (BP) among children at 6–8 years of age. Methods This retrospective cohort study included children aged 6–8 years and compared those who were born at

Abstract Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.

Abstract Background The number of technology-dependent children (TDC) is increasing in South Korea, but available healthcare services after their discharge are poor. This study aimed to examine how TDC and caregivers live at home and identify their difficulties and needs regarding home care with few services to support them. Methods This cross-sectional study was conducted in a tertiary hospital for children in South Korea. A self-reported questionnaire was completed by primary caregivers of TDC who were younger than 19 years and had been dependent on medical devices for more than 3 months. Technologies included home mechanical ventilation, oxygen supplementation, suction equipment, enteral feeding tube, and home total parenteral nutrition. Patterns of healthcare use and home care of TDC and caregivers’ perception toward child were assessed. Results A total of 74 primary caregivers of TDC completed a self-reported questionnaire. About 60% children were aged under 5 years. There were 31.1% children who required both respiratory and nutritional support. On average, caregivers took care of a child for 14.4 (±6.1) hours, slept for 5.6 (±1.6) hours, and spent 2.4 h per day on personal activities. Children used hospital services for 41.3 (±45.6) days in 6 months, and most (78.1%) were transported through private car/ambulance. Participants (75.6%) reported taking more than an hour to get to the hospital. More than 80% of caregivers responded that child care is physically very burdensome. The only statistically significant relationships was between economic status and financial burden (p = 0.026). Conclusions Caregivers of TDC reported having significant time pressure regarding childcare-related tasks, insufficient time for personal activities, and inefficient hospital use because of inadequate medical services to support them in South Korea. Thus, it is necessary to support caregivers and develop a home care model based on current medical environment.

Abstract Background The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Earlier, withdrawal of life-sustaining treatment was taboo in the medical society in South Korea due to the history of such practice being punishable by law, and physicians tended to pursue aggressive treatment. With changes in public opinion on end-of-life care, the Korean government enacted a new law that protect human dignity by respecting patients’ self-determination and facilitating advance care planning. However, little is known about current state of advance care planning for pediatric patients. The study aimed to assess perceptions regarding advance care planning among South Korean pediatricians and clarify any differences in perception among pediatric subspecialties. Methods This study was an observational cross-sectional survey that used a web-based self-report questionnaire. Participants comprised of pediatricians currently caring for children with life-limiting conditions in 2018. Results Of the 96 respondents, 89 were included in the analysis. In a hypothetical patient scenario, more hemato-oncologists and intensivists than neonatologists and neurologists preferred to provide comfort care than aggressive treatment. While 72.2% of hemato-oncologists reported that they usually or always discuss advance care plans with parents during treatment, more than half of other pediatricians reported that they seldom do so. Furthermore, 65% of respondents said that they never discuss advance care planning with adolescent patients. Moreover, there were no notable differences among subspecialties. The most prevalent answers to factors impeding advance care planning were lack of systemic support after performing advance care planning (82.0%) and uncertain legal responsibilities (70.8%). Conclusions The pediatricians differed in their experiences and attitudes toward advance care planning based on their subspecialty. Consequently, institutional support and education should be provided to physicians so that they can include children and families in discussions on prognosis.

OBJECTIVES The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents. METHODS We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants. RESULTS A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls. CONCLUSIONS Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.

Purpose This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. Methods We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children’s Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. Results Hypophosphatemia (phosphorus level

Necrotizing enterocolitis (NEC) is a devastating condition of hospitalized preterm infants. Numerous studies have attempted to identify the cause of NEC by examining the immunological features associated with pathogenic microorganisms. No single organism has proven responsible for the disease; however, immunological studies are now focused on the microbiome. Recent research has investigated the numerous bacterial species residing in the body and their role in diseases in preterm infants. The timing of initial microbial colonization is a subject of interest. The microbiome appears to transfer from the mother to the newborn, as well as to the fetus. Cross-talk between the fetus and fetal microbiome takes place continuously to generate a unique immune system. This review examined the transfer of the microbiome to the human fetus, and its potential relationship with NEC.

PurposeFollowing legal reform in 2013, the annual number of asylum seekers entering South Korea has increased from 1,143 in 2012 to 5,711 in 2015. We interviewed six African refugee mothers of young children regarding their health needs and barriers to access maternal child health services.MethodsWe recruited mothers who had visited a clinic for immigrants between July 2013 and August 2015. Participants were African refugee women, aged over 18 years, who had given birth in Korea within the previous 5 years and had come to Korea over a year before recruitment. Interview questions examined participants' experiences in pregnancy and childbirth and concerns regarding their child's health status. Initial data analysis involved all researchers' immersion in the entire collection of transcripts. We then noted recurrent topics and themes and identified similar issues.ResultsAt the time of giving birth, 5 participants were asylum seekers and one had undocumented status. The following barriers impeded their access to maternal child healthcare: socioeconomic factors (unstable social identity, low economic status, difficulty obtaining health insurance), language barriers (lack of linguistically appropriate health information, limited access to translation services), and cultural barriers (religious and cultural differences). Weak social support also hindered access to healthcare soon after migration; however, social links with the community emerged as a key coping strategy following settlement.ConclusionWe identified barriers to maternal and child healthcare and coping strategies among African refugee mothers in Korea. Future research should assess refugees' health status and improve health access and literacy among refugee mothers.

# Background In this study, we aim to analyze the association between different types of cohabitation status and obstetric outcomes of preterm births (PTB), low birthweight (LBW), small for gestational age (SGA) and achieve a manifestation of social marginalization among varied marital status of women in South Korea. # Methods The study compared the birth outcomes of legally unmarried women with record of cohabitation (cohabited single), legally unmarried women with no record of cohabitation (non-cohabited single), legally married women and explored factors affecting birth outcomes of women in South Korea. A total of 790 842 singletons from married and 7788 singletons from unmarried women were examined based on the National Birth Registration Database of 2014-2015. Adjusted proportions for the occurrence of preterm births, low birth weight, and SGA were calculated and subgroup analyses were performed according to various factors like maternal age, parity, area of birth and maternal education. # Results Adjusted proportions of PTB (7.1%; 95% confidence interval (CI)=6.3-8.0, *P*-trend \

It is known that some groups of immigrants can have low health literacy and it may affect their health. Although the number of North Korean defectors in the Republic of Korea has increased, little is known about their health literacy and health behavior. Adult North Korean defectors (n = 399) in this study were surveyed on health literacy, using the Korean Health Literacy Scale, and on the use of preventive services. Those with better health literacy scores were more likely to have vaccination than the lower scoring group (adjusted OR = 2.44; 95% CI, 1.19-5.00). However, undergoing medical check-up may not be associated with health literacy. In subgroup analysis, among defectors who lived alone (P = 0.032) or who had longer time in other countries before entering (P = 0.007), the vaccination coverage was associated with their health literacy scores. This study provides evidence for an association between health literacy and influenza vaccination coverage among North Korean defectors even though they may have fewer language barriers than other immigrants. Further research is needed to develop interventions for improving health literacy and their preventive health behavior.

The discomfort caused by whole-body vibration (WBV) has long been assessed using subjective surveys or objective measurements of body acceleration. However, surveys have the disadvantage that some of participants often express their feelings in a capricious manner, and acceleration data cannot take into account individual preferences and experiences of their emotions. In this study, we investigated vibration-induced mental stress using the electroencephalogram (EEG) of 22 seated occupants excited by random vibrations. Between the acceleration and the EEG signal, which contains electrical noise due to the head shaking caused by random vibrations, we found that there was a strong correlation, which acts as an artifact in the EEG, and therefore we removed it using an adaptive filter. After removing the artifact, we analyzed the characteristics of the brainwaves using topographic maps and observed that the activities detected in the frontal electrodes showed significant differences between the static and vibration conditions. Further, frontal alpha asymmetry (FAA) and relative band power indices in the frontal electrodes were analyzed statistically to assess mental stress under WBV. As the vibration level increased, EEG analysis in the frontal electrodes showed a decrease in FAA and alpha power but an increase in gamma power. These results are in good agreement with the literature in the sense that FAA and alpha band power decreases with increasing stress, thus demonstrating that WBV causes mental stress and that the stress increases with the vibration level. EEG assessment of stress during WBV is expected to be used in the evaluation of ride comfort alongside existing self-report and acceleration methods. [ABSTRACT FROM AUTHOR]

Abstract Background Rheumatoid arthritis (RA) is known to be associated with coronary artery diseases (CAD). Previous studies of the association between RA and CAD were reported mainly in non-Asian groups. We aimed to examine the prevalence of RA and the relationship between RA and CAD in South Korea. Methods We conducted a nationwide cross-sectional study by using the Korea National Health and Nutrition Examination Survey, which collected data for four years between 2008 and 2012. A total of 25,828 eligible participants were included. To balance the distribution of baseline characteristics, we used propensity score-matching. A multivariable logistic regression model was employed and we calculated the odds ratios (ORs) and 95% confidence intervals (CI) for the odds of the participants with RA on CAD prevalence. Results The prevalence of RA in Korea from 2008 to 2012 was 0.6% and RA was predominant among elderly women. The prevalence of CAD in patients with RA was significantly higher than in general population. After propensity score-matching to balance the confounding factors, RA was significantly associated with CAD (OR 2.97, 95% CI 1.15–7.68, P = 0.02). Conclusions The prevalence of RA in South Korea was comparable to the worldwide data, and the presence of CAD in RA patients was more than two-fold.

Quercetin is an active nutraceutical element that is found in a variety of foods, vegetables, fruits, and other products. Due to its antioxidant properties, quercetin is a flexible functional food that has broad protective effects against a wide range of infectious and degenerative disorders. As a result, research is required on food-contact surfaces (rubber (R) and hand gloves (HG)) that can lead to cross-contamination. In this investigation, the inhibitory effects of quercetin, an antioxidant and antibacterial molecule, were investigated at sub-MIC (125; 1/2, 62.5; 1/4, and 31.25; 1/8 MIC, μg/mL) against Salmonella Typhimurium on surfaces. When quercetin (0–125 μg/mL) was observed on R and HG surfaces, the inhibitory effects were 0.09–2.49 and 0.20–2.43 log CFU/cm2, respectively (p < 0.05). The results were confirmed by field emission scanning electron microscopy (FE-SEM), because quercetin inhibited the biofilms by disturbing cell-to-cell connections and inducing cell lysis, resulting in the loss of normal cell morphology, and the motility (swimming and swarming) was significantly different at 1/4 and 1/2 MIC compared to the control. Quercetin significantly (p < 0.05) suppressed the expression levels of virulence and stress response (rpoS, avrA, and hilA) and quorum-sensing (luxS) genes. Our findings imply that plant-derived quercetin could be used as an antibiofilm agent in the food industry to prevent S. Typhimurium biofilm formation.

Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction. [ABSTRACT FROM AUTHOR]