Flora colonization and oral care in high-risk newborns.

PURPOSE: A randomized intervention study was conducted to explore the impact of oral care with sterile normal saline to oral flora colonization of high-risk newborns at the third day after birth. DESIGN AND METHODS: Ninety-two newborns were allocated to either intervention or control group. After obtaining oral secretion for prepoint data, the intervention group received oral care with sterile normal saline only. Oral secretions for postpoint data were obtained 8 hr after the prepoint. Total 179 specimens were obtained during the study period. RESULTS: Among the total 92 newborns, 44.6% were female and 57.6% were premature. Mean gestational age and weight was 35.9 ± 3.2 weeks and 2,545 ± 697.5 g. The most common colonized flora included Streptococcus (26.3%), methicillin-resistant Staphylococcus aureus (MRSA, 16.2%), and coagulase-negative Staphylococci (CNS, 13.4%). The oral care with normal saline did not change the number of flora type of newborns. The statistic results were not significant by group (F = 0.918, p = 0.514), time (F = 0.322, p = 0.672), and the interaction between time and group (F = 0.519, p = 0.472). PRACTICE IMPLICATIONS: Oral care with sterile saline did not change oral flora colonization among high-risk newborns at early period of life. This intervention can be safely delivered to high-risk newborns when they are at risk of infection and particularly breast milk is not available.

Family quality of life among families of children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) may cause emotional distress and impairs the quality of life (QoL) in children and their families. OBJECTIVE: We examined family QoL of children with AD and explored associated factors such as disease severity and psychosocial factors among parents of children with AD. METHODS: Study participants were 78 children (1 month to 16 years old) diagnosed with AD and their parents visiting an outpatient clinic of the Department of Pediatrics in Inha University Hospital. Data were collected using structured questionnaires and medical record review. Parents completed the Dermatitis Family Impact questionnaire (DFI), the Positive Affect and Negative Affect Schedule, the Satisfaction with Life Scale, and the Korean Parenting Stress Index. For children aged below 6-year-old, parents were asked to complete the Infants' Dermatologic Quality of Life. SCOring Atopic Dermatitis (SCORAD), Children's Dermatology Life Quality Index, and the Pediatric Quality of Life Inventory version 4.0 Generic Core Scale were also completed. RESULTS: The mean age of parents and children were 37.4 ± 5.3 years and 65.1 ± 45.7 months, respectively. Among them, 87.2% of parents were mothers and 60.3% of children were boys. The mean score of DFI was 11.2 ± 6.0. The mean SCORAD score was 28.3 ± 16.1. Family who experienced strong negative emotionality had a 3.8 times higher probability of experiencing a lower QoL than parents who did not (odds ratio [OR], 3.82; p = 0.041). Family of children with higher severity of AD had a 6.6 times (OR, 6.55; p = 0.018) higher probability of experiencing a low family QoL than their less-severe counterparts. Families of girls with AD had a lower QoL (OR, 8.40; p = 0.003) than families of boys. CONCLUSION: Family QoL among parents of children with AD was low and associated with parent's psychosocial characteristics as well as disease severity of the children. Considering parental involvement in AD management for children, emotional support for parents can be helpful in long journey of disease management.

Development of a simulation-based assessment to evaluate the clinical competencies of Korean nursing students.

OBJECTIVES: To describe a simulation-based assessment (SBA) to evaluate the clinical competencies of nursing students in children's health and to compare its results with grade point average (GPA), self-efficacy, topic-specific knowledge, and self-reported clinical competency using the Six-D Scale. METHODS: This cross-sectional, descriptive study recruited nursing students from a children's health clinical practicum. Students were assigned to either an asthma (n=55) or a type 1 diabetes (n=48) care scenario conducted on a high-fidelity simulator. Clinical competencies were assessed using the global rating scale (GRS) and a checklist. RESULTS: Data on 103 students were analyzed. The SBA-GRS indicated that 64.6%-87.3% of students passed. The SBA-GRS showed a statistically significant positive association with the SBA checklist in both the asthma (rho=.763, p<.001) and the type 1 diabetes (rho=.475, p=.001) group. In the asthma group, the SBA-GRS and checklist showed statistically significant associations with GPA (rho=.413, p=.002 vs. r=.508, p<.001) and the Six-D Scale (rho=.266, p=.049 vs. r=.352, p=.008); in the diabetes group, only the SBA checklist showed a statistically significant association with self-efficacy (r=.339, p=.018) and the Six-D Scale (r=.373, p=.009). Four groups by SBA-GRS had statistically significant differences in scores on the SBA checklist in both groups (F=25.757, p<.001 in the asthma group; F=4.790, p=.006 in the diabetes group) and GPA only in the asthma groups (F=6.095, p<.001). CONCLUSION: SBA was found to be feasible for nursing students. The GRS and checklist were reasonably correlated with other evaluation methods of student competency, but correlations were better with easier scenarios.

Diabetes-Specific Quality of Life of Korean Children and Adolescents With Type 1 Diabetes.

PURPOSE: The purpose of this study was to explore the quality of life of children in Korea with type 1 diabetes and related factors. METHODS: Children were recruited from a diabetes camp. Data were collected using four instruments: the PedsQL™ 3.2 Diabetes Module, Self-Efficacy for Diabetes Self-Management, the Center for Epidemiological Studies Depression Scale for Children, and the Diabetes Management Behavior Scale. RESULTS: Children who were older (t = 2.197, p = .041), male (t = -3.579, p = .002), and less depressed (t = -2.859, p = .010) were more likely to have better quality of life. CONCLUSION: Further research is needed in children with type 1 diabetes in countries where this disease is rare, and governmental support and public awareness are limited.

Two methods of cord care in high-risk newborns: their effects on hydration, temperature, pH, and floras of the cord area.

This randomized clinical study explored the effects of two cord care methods on hydration, temperature, pH, and floras at the cord area in high-risk newborns. One group used the water method; and the other group used the alcohol method. Seventy-two newborns, including premature newborns, in the neonatal intensive care unit (NICU) of a university-affiliated hospital in South Korea were enrolled from August 2011 to May 2012. Hydration, temperature, pH, and floras were measured daily until the cords fell off. The results showed no difference between the groups in hydration, temperature, pH, and the colonization of floras, but cord detachment in the alcohol group took 2 days longer (12.8 [5.7] days) than in the water group (10.9 [4.1] days). Our findings suggest that the clean-and-dry method of cord care, which uses water, could be sufficient, possibly even better than alcohol in maintaining the physiologic surface milieu of the cord area with less chance of infection and manipulation in NICUs with optimal infection control.

Growth of Korean preterm infants in a family-centered tradition during early infancy: the influence of health risks, maternal employment, and the sex of infants.

AIM: The physical growth of mild preterm infants (<32 weeks of gestation at birth) needs to be explored in terms of bio-sociocultural factors considering the sociocultural aspects of child-care practice. METHODS: A retrospective cohort study was conducted with 238 Korean mild preterm infants from birth up to 6 months of corrected age regarding four of the biological and sociocultural factors such as health risks (at birth and discharge), maternal employment status, and the infant sex. RESULTS: There were four noteworthy findings on growth variation in Korean mild preterm infants during early infancy: (i) the secular trend of intrauterine growth; (ii) the cumulative adverse effects of four risk factors; (iii) the possible burden of maternal employment if insufficient support; and (iv) the possibility of the cultural favoritism to male infants regardless of the modern industrialized society. CONCLUSION: The study suggests that, in a modern society, while mild preterm infants could sustain typical fetal growth, the early postnatal growth may vary based on health risks and sociocultural circumstances related to child-bearing and -rearing practices surrounding them.

[pH, temperature, hydration of the stratum corneum of the dorsal hand and the cord area, and acid mantle formation during early days of life in high-risk newborns].

PURPOSE: The study was done to explore variations in physiologic parameters of the stratum corneum (SC) of the dorsal hand and cord area during early days of life in high-risk newborns. METHODS: In this longitudinal study, a total of 77 high-risk newborns were assessed for pH, temperature and hydration of the SC of the dorsal hand and the cord area on the 1st, 2nd, 3rd, 5th and 7th days of life. RESULTS: Results showed that an acid mantle (AM) was formed in 57.1% for dorsal hand and 35.1% for cord area, implying significant delay regardless of decrease in pH (F=103.60, p<.001), and hydration (F=4.00, p=.003) across days in both areas. Peripheral hypothermia with low hydration level was also observed in both areas. There was a positive relation between hydration and temperature (.14

Growth patterns and their implications for preterm infants in a culture of rapid modernization.

This prospective longitudinal study explored the growth patterns of preterm infants and the implications of rearing them in an advancing culture. The study measured the weight, length, and head circumference of 343 Korean preterm infants over 12 months corrected age. Data were analyzed using a generalized estimation equation for growth patterns of preterm infants by the degree of prematurity (mild, moderate, or severe). Results showed that the early 'catch-up phenomenon', accelerated growth rate, occurred around 11 months corrected age, although the mild preterm group weighed less, was shorter, and had a smaller head circumference than the moderate and severe preterm groups. This may reflect the Asian culture's preference for big babies and draws special attention to the influence of cultural values and childrearing practices in the growth of preterm infants. Pediatric nurses should be alert to accelerated growth in preterm infants in societies in cultural transition.

Adiposity of Korean school-age children measured by national and international growth charts.

The study was conducted to explore adiposity levels of Korean children using body mass index (BMI) and comparing how three BMI charts define adiposity. The charts used were the growth standard of the Korean Centers for Disease Control and Prevention and the growth references of the World Health Organization and the International Obesity Task Force. The percentage of children at different adiposity levels varied depending on which chart was used. These discrepancies arose from the different cut-offs for adiposity and the different characteristics of the populations that were used to develop the charts. Research is needed to identify which growth charts and cut-offs for children are most associated with health risks in later life.

Simulation-based smoking cessation intervention education for undergraduate nursing students.

Smoking is one of the most important preventable risk factors that contributes to premature death from many tobacco-related diseases. Clinicians should offer and provide effective smoking cessation interventions to their smoking patients. Yet, few clinicians receive training in smoking cessation intervention. This one-group, quasi-experimental study was conducted to describe a simulation-based training of smoking cessation intervention and to evaluate its effectiveness on nursing students' self-efficacy in performing smoking cessation intervention, based on 5-As recommended by the United States Department of Health and Human Services. In addition, nursing students' experience, attitude and perceived barriers of smoking cessation intervention were also described. Among the 21 students (mean age: 21.6 ± 2.0 years), 86% were female, 62% were in their third year and 1% were current smokers. Most of students believed the health benefits of smoking cessation (100.0-66.7%) and were well educated about health risks of smoking (81.0-61.9%). However, few were taught (33.3-14.4%) and practiced (28.6-0.0%) smoking cessation intervention. Students reported that they should be actively involved in smoking cessation for patients (100.0-95.2%), but lack of knowledge and skills were the main barriers (90.5-85.7%). The simulation-based training of smoking cessation intervention improved nursing students' self-efficacy in seven out of nine skills of smoking cessation intervention (mean scores of pre- vs. post-intervention: 30.86 ± 3.80 vs. 34.05 ± 5.10; paired t=2.298, p=.027). These findings indicate that simulation could be effectively used in teaching smoking cessation intervention education delivered to nursing students.

[Growth patterns of premature infants up to 40th term week of corrected age].

PURPOSE: Study purpose were to describe growth patterns of premature infants in weight, length and head circumference from birth to 40th week of corrected ages (CA) and to explore factors affecting patterns. METHODS: A longitudinal descriptive study was conducted with 267 premature infants. They were categorized into 2 groups; GA group with measurements at birth and the CA group with measurements at CA, which was categorized into 3 groups (group 1-3) by WHO guideline for gestational age (GA) at birth. RESULTS: GA group presented greater measures in all than CA group at same week of life. Among CA groups, group 3 showed the highest measurements, up to 37 weeks of life, though this disappeared at 38-40 weeks. Reversely, group 1 revealed the highest growth rates in all measures, followed by group 2 and group 3. Significant interaction was observed in all measures between week of life and any type of groups. CONCLUSION: Higher measures in GA group, as well group 3 among CA groups, supported the superiority of intra-uterine environment overriding quality of regimen from NICU. Regardless of growth acceleration, smaller infants remain smaller, indicating that intra-uterine thrifty phenotype may continue at least up to the 40th week of CA.

Assessment of Primitive Reflexes in High-risk Newborns.

BACKGROUND: Assessment of primitive reflexes is one of the earliest, simplest, and most frequently used assessment tools among health care providers for newborns and young infants. However, very few data exist for high-risk infants in this topic. Among the various primitive reflexes, this study was undertaken particularly to describe the sucking, Babinski and Moro reflexes in high-risk newborns and to explore their relationships with clinical variables. METHODS: This study is a cross-sectional descriptive study. Sixty seven high-risk newborns including full-term infants required intensive care as well as premature infants were recruited in a neonatal intensive care unit using convenient sampling method. The sucking, Babinski and Moro reflexes were assessed and classified by normal, abnormal and absence. To explore their relationships with clinical variables, birth-related variables, brain sonogram results, and behavioral state (the Anderson Behavioral State Scale, ABSS) and mental status (the Infant Coma Scale, ICS) were assessed. RESULTS: The sucking reflex presented a normal response most frequently (63.5%), followed by Babinski reflex (58.7%) and Moro reflex (42.9%). Newborns who presented normal sucking and Babinski reflex responses were more likely to have older gestational age, heavier birth and current weight, higher Apgar scores, shorter length of hospitalization, better respiratory conditions, and better mental status assessed by ICS, but not with Moro reflex. CONCLUSIONS: High risk newborns presented more frequent abnormal and absence responses of primitive reflex and the proportions of the responses varied by reflex. Further researches are necessary in exploring diverse aspects of primitive reflexes and revealing their clinical implication in the high-risk newborns that are unique and different to normal healthy newborns. KEYWORDS: Primitive reflex; High risk infants; Korean; Moro reflex; Sucking reflex; Babinski reflex; The Anderson Behavioral State Scale; Infant Coma Scale.

Implementation of a clinical pathway in primary spontaneous pneumothorax patients treated by wedge resection surgery.

PURPOSE: This study was conducted to develop a clinical pathway for primary spontaneous pneumothorax (PSP) patients treated by wedge resection surgery. The authors also aimed to evaluate the effects of the implementation of the PSP clinical pathway on (1) complication occurrence rates, (2) self-efficacy with respect to PSP recurrence prevention, (3) patient-perceived quality of life, and (4) patient treatment satisfaction. DESIGN: This study was conducted using a quasi-experimental, nonequivalent study design. SAMPLE: The study subjects were 60 PSP patients admitted to the thoracic surgery departments at 2 university hospitals located in Seoul, South Korea. METHODS: A retrospective medical record review was conducted to develop a PSP clinical pathway, and the developed clinical pathway was then applied to the treatment group (n = 30). Complication occurrence rates, self-efficacy with respect to PSP recurrence prevention, perceived quality of life, and patient treatment satisfaction were measured. FINDINGS: The developed PSP clinical pathway is comprehensive and includes self-care and recurrence prevention education in addition to common protocols, such as medication and diagnostic tests. The pathway significantly improved self-efficacy with respect to preventing PSP recurrence, health-related quality of life, and patient treatment satisfaction, but did not reduce complication rates. IMPLICATIONS: The present study offers a new comprehensive clinical pathway for PSP patients who have undergone wedge resection surgery. This study may be useful in the clinical nursing field by providing guiding standards for PSP-related education with respect to diet, exercise, self-supervision, complication, stress control, and recurrence prevention.

[Evaluation of mental status in high-risk neonates using infants coma scale].

PURPOSE: This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea. METHODS: After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records. RESULTS: Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (+/-3.50) weeks and the mean birth weight was 1,842 (+/-728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status. CONCLUSION: Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.

Formula and scale for body surface area estimation in high-risk infants.

Advances in medical technology and the health sciences have lead to a rapid increase in the prevalence and morbidity of high-risk infants with chronic or permanent sequels such as the birth of early preterm infants. A suitable formula is therefore needed for body surface area (BSA) estimation for high-risk infants to more accurately devise therapeutic regimes in clinical practice. A cohort study involving 5014 high-risk infants was conducted to develop a suitable formula for estimating BSA using four of the existing formulas in the literature. BSA of high-risk infants was calculated using the four BSA equations (Boyd-BSA, Dubois-BSA, Meban-BSA, Mosteller-BSA), from which a new calculation, Mean-BSA, was arithmetically derived as a reference BSA measure. Multiple-regression was performed using nonlinear least squares curve fitting corresponding to the trend line and the new equation, Neo-BSA, developed using Excel and SPSS 17.0. The Neo-BSA equation was constructed as follows: Neo-BSA = 5.520 x W(0.5526) x L(0.300). With the assumption of the least square root relation between weight and length, a BSA scale using only weight was fabricated specifically for clinical applications where weight is more available in high-risk infant populations than is length. The validity of Neo-BSA was evaluated against Meban-BSA, the best of the four equations for high-risk infants, as there is a similarity of subjects in the two studies. The other formulas revealed substantial variances in BSA compared to Neo-BSA. This study developed a new surface area equation, Neo-BSA, as the most suitable formula for BSA measurement of high-risk infants in modern-day societies, where an emerging population of newborns with shorten gestational ages are becoming more prevalent as a result of new advances in the health sciences and new development of reproductive technologies. In particular, a scale for 400-7000 g body weight babies derived from the Neo-BSA equation has the clinical advantage of using only weight as a measurement, since length is often not feasible as a measurement due to the newborn's body posture. Further studies are required to confirm our findings for the application of Neo-BSA and the BSA scale (based on weight) for various populations and ethnicities under different clinical conditions.

[Comparison in weight, height, degree of obesity and body mass index among different methods for body shape classification in school-age children].

PURPOSE: The study was conducted to describe body shapes of school age children using the degree of obesity index (DOI) and body mass index obesity index classified by the Ministry of Education, Science and Technology (M-BOI) and Seoul Metropolitan Office of Education (S-BOI). METHODS: In this cross sectional descriptive study health screening data for school children collected in 2007 was used. RESULTS: Data were analyzed for 2,193 4th-6th grade boys (52%) and girls who attended 4 schools in rural areas. DOI determined that only 44.3% of students had average weight. This proportion was much lower than the results of other methods (74.3-77.6%). All three methods defined girls (51.3-61.8%) as skinnier than boys. Skinny and average body shaped children classified by DOI and obese children classified by S-BOI were heavier and taller and presented higher degrees of obesity (DO) and BMI scores than by other methods. M-BOI and S-BOI presented statistically significant positive correlations with weight, height, DO and BMI, while DOI was not correlated with height. CONCLUSION: BMI based body shape classifications provide a more rigorous classification of body shape which are favorable for school health professionals with limited resources and policy makers for internationally comparable references.

Breast functions perceived by Korean mothers: infant nutrition and female sexuality.

The descriptive cross-sectional study of 2,235 Korean postpartum women was conducted to explore (a) feeding types with related factors, (b) the perceived benefits of each feeding type, (c) the perceived sexuality-related barriers to breast-feeding, and (d) the perceived relative significance of breast functions. The most frequently utilized feeding type was breast-feeding only. The gender of infants, vaginal delivery, not being employed, having a nuclear family, previous breast-feeding experience, and previously receiving breast-feeding education were statistically significant factors of breast-feeding. Breast-feeding and mixed feeding mothers indicated that their feeding choices were based on nutritional benefits, convenience, and improving family relationships. Only breast-feeding mothers reported changes in breast shape as a perceived sexuality-related barrier to breast-feeding. All mothers reported that infant feeding was a more significant concern than female sexual functioning, but post hoc Schéffe revealed that the breast-feeding mothers appreciated infant feeding function more than female sexual functioning.

Estimations of body surface area in newborns.

AIM: To explore the suitability of existing formulas to estimate the body surface area (BSA) of newborns when direct measurement of surface estimation is not practical. METHODS: In 589 term-newborns of normal weight and height, the five estimations (in cm2) were performed using four known BSA formulas by Boyd, Meban, Mosteller and Dubois, and the fifth arithmetic mean of these four formulas (BSA-Mean). RESULTS: BSA-Meban was most similar to the BSA-Mean with a mathematically perfect correlation and the least dissimilarity using Euclidean distance (ED), followed by the Mosteller estimate. The estimations by both Boyd and Dubois showed about a 5% deviation above and below the BSA-Mean, respectively, with a consistent dissimilarity using ED regardless of the same goodness of fit. The degree of deviation increased with the weight and decreased with height. CONCLUSIONS: The formula by Meban is possibly the best BSA estimate for newborns among the existing formulas today, followed by the Mosteller formula. Due to either overestimation or underestimation, two formulas (Boyd and Dubois) are not recommended for surface estimation of newborns. A nomogram for surface estimation is needed for paediatric use especially with increasing preterm birth in modern society.

[Assessment of hydration on the stratum corneum and the influencing factors in neonates].

PURPOSE: The study was conducted to investigate the skin hydration level in various body sites and identify the influencing factors in neonates. METHODS: An exploratory comparison study was designed to measure the stratum corneum hydration, using a National DM-R2 on the forehead, abdomen, buttocks, and the back of the hands and feet of 198 neonates including 92 premature infants. RESULTS: The results showed 32.7%-36.5% of stratum corneum hydration for all sites. Premature infants revealed a higher hydration level on the peripheral sites (dorsal hand and feet) than those of the full-term infants, possibly resulting from therapeutic regimens including an incubator or radiant warmer. Infants in an incubator showed a higher hydration level than those in radiant warmers, suggesting more attention to fluid management for infants in the open environment. In addition, all stratum corneum hydration measurements except one, from the forehead, showed a positive correlation with postnatal age in full-term infants while showing no relation to any measurements in premature infants. CONCLUSION: The study demonstrated the very low skin hydration levels in hospitalized neonates, particularly in premature neonates with more susceptible skin hydration instability despite therapeutic interventions for fluid balance. More vigilant fluid management is imperative in neonates, particularly those in the open environment.