Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors.

BACKGROUND: The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. OBJECTIVE: In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. METHODS: Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. RESULTS: The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). CONCLUSIONS: The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users' requirements should be accommodated in future developments of patient transfer information systems.

Comparison of sodium ion levels between an arterial blood gas analyzer and an autoanalyzer in preterm infants admitted to the neonatal intensive care unit: a retrospective study.

BACKGROUND: The difference in sodium ion levels determined with direct and indirect methods often exceeds the permissible limit clinically. Additionally, no previous study has assessed the difference in the sodium ion levels between direct and indirect methods in premature infants. Therefore, the present study aimed to compare sodium ion levels obtained using an arterial blood gas analyzer (ABGA; direct method) and an autoanalyzer (indirect method) to determine whether they are equivalent in premature infants. METHODS: The present retrospective study included 450 preterm infants (weight, <2500 g) who were admitted to the neonatal intensive care unit (NICU) of our hospital between March 2012 and April 2014. We compared sodium ion levels in 1041 samples analyzed using an ABGA (Stat Profile® CCX Series, Nova Biomedical, Waltham, MA) and an autoanalyzer (ADVIA® 2400 Clinical Chemistry System, Siemens, Tarrytown, NY). The data were evaluated using Spearman's correlation coefficient analysis, Bland-Altman plot, Deming regression analysis, and multivariate logistic regression analysis. RESULTS: The mean sodium ion levels were 134.6 ± 3.5 mmol/L using the ABGA and 138.8 ± 4.7 mmol/L using the autoanalyzer (P < 0.001). Among the 1041 samples, 957 (91.9 %) showed lower sodium ion levels with the ABGA than with the autoanalyzer and 74 (7.1 %) showed lower sodium ion levels with the autoanalyzer than with the ABGA. The incidence of hyponatremia identified using the ABGA was 51.9 % (541/1041), while the incidence of hyponatremia identified using the autoanalyzer was only 14.0 % (146/1041). The Deming regression analysis of the sodium ion levels between the ABGA and the autoanalyzer yielded the following formula: autoanalyzer Na (mmol/L) = 20.7 + (0.9 × ABGA Na [mmol/L]). In the multivariate logistic regression analysis, low plasma protein level (<4.3 g/dL) was found to be an independent risk factor for a sodium ion level difference of >4 mmol/L between the two methods (odds ratio = 2.870, P < 0.001). CONCLUSION: The sodium ion levels determined using the ABGA and the autoanalyzer might not be equivalent in premature infants admitted to the NICU. Therefore, clinicians should be careful when diagnosing sodium ion imbalance in premature infants and providing treatment.

Increased white matter connectivity in traumatized children with attention deficit hyperactivity disorder.

To distinguish between the consequences of trauma exposure and those of attention deficit hyperactivity disorder (ADHD), we compared brain diffusion tensor imaging (DTI) of children according to the diagnosis and the presence of a potentially traumatic event (PTE). The Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used for the assessment of PTEs. Subjects who experienced any traumatic event were placed in the PTE group, and subjects who did not experience such a traumatic event were placed in the non-PTE group. We examined the interactions between ADHD and PTEs in brain [fractional anisotropy (FA) values and mean diffusivity (MD) values] in 54 children with ADHD (29 with PTEs and 25 without PTEs) and 41 controls (18 with PTEs and 23 without PTEs). Analysis of covariance (ANCOVA) revealed main effects of ADHD for FA and MD values in several white matter tracts in the absence of main effects for PTEs. In addition, there was a significant ADHD-PTEs interaction in relation to FA and MD values in several white matter tracts. Further longitudinal studies in a larger sample are warranted to evaluate the neurobiological sequelae related to childhood trauma, ADHD, and interaction between the two.

Predictors of growth in children based on 2007 Korean National Growth Charts.

BACKGROUND: Postnatal growth patterns in children are associated with various factors within the birth and infancy periods. The aim of the present study was to examine the correlation between growth patterns and parameters including gestational age (GA), birthweight (BW), sex, and feeding method in the records of 61,631 children aged 6-72 months. METHODS: The data were obtained from the 2007 Korean National Growth Charts provided by the Korean Centers for Disease Control. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple linear regression. RESULTS: BW and sex were highly correlated with weight and height by 72 months (P < 0.01), with BW being the primary predictor (P < 0.001). Sex was the second predictor of weight and height in children by 66 months (P < 0.01). Feeding method was the predictor of weight in children aged 12-48 months and 60 months (P < 0.05), and was also influential in the height of children by 48 months (P < 0.05). GA was the predictor of weight at 12 months and from 30 to 42 months (P < 0.05). CONCLUSION: GA, BW, sex and feeding method were the predictors of weight and height among children at different times. Therefore, the present population-based study strengthens the consideration of these factors for routine monitoring of growth patterns in Korean children.

Stress responses of neonates related to maternal characteristics.

PURPOSE: To investigate the pre- and post-heelstick stress response patterns of infants and to identify related maternal factors. MATERIALS AND METHODS: Fifty-two mothers and their 57 infants were studied. Stress response patterns in neonates were collected by measurements of pulse rate, oxygen saturation, and salivary cortisol. Maternal demographic factors and awakening saliva were collected. RESULTS: Median level of pulse rate of infant increased from 132.1 to 140.4 beats per minute and salivary cortisol was elevated from 0.41 µg/dL to 0.70 µg/dL during the periods of discomfort, while oxygen saturation decreased from 97% to 95%. Infant's pulse rate change was negatively correlated with gestational age (GA) (r = - 0.37, p < 0.05), whereas the change of infants' salivary cortisol was correlated positively with maternal age (r = 0.29, p < 0.05). GA was the only independently significant predictor of pulse rate responses (R(2) = 0.15, p < 0.05). Influence of maternal age on infants' salivary cortisol changes (R(2) = 0.09, p < 0.05) was observed in a stepwise multiple regression. CONCLUSION: These findings suggest that maternal age and gestational period can be influential factors for stress responses in infants. Therefore, it would be important to consider the demographic characteristics of mother-infant pairs to evaluate these influential factors.

The effect of sucrose on infants during a painful procedure.

PURPOSE: The purpose of this study was to test the efficacy of treating the pain among newborn infants associated with a medical procedure with sucrose with regard to overall physiological and behavioral stability. METHODS: 103 newborn infants were enrolled in this study. The control group (n=63) did not receive any treatment. The experimental group (n=40) received 2 mL of 24% sucrose solution two minutes before a routine heel stick. The pain was assessed by measurements of physiological changes [e.g. pulse rate, oxygen saturation, salivary cortisol (hydrocortisone)] and behavioral changes [e.g. crying time, and the neonatal infant pain scale (NIPS) for neonates]. RESULTS: There were no differences among the groups with respect to physiological changes associated with the pain from the procedure. However, there were significant group differences in behavioral changes to the pain. In the control group, the median crying time was 13 seconds, while in the experimental group, the median crying time was 3.5 seconds (P=.000). In the control group the median NIPS score was 4, while in the experimental group the median NIPS score was 2 (P=.000). CONCLUSIONS: These findings suggest that sucrose can be an effective method for the management of stress responses in infants with regard to behavior. However, this treatment had no significant physiological effects.

L-carnitine-supplemented parenteral nutrition improves fat metabolism but fails to support compensatory growth in premature Korean infants.

We have previously shown that pregnant Korean mothers often have especially poor carnitine status, which may be responsible for the suboptimal carnitine levels of newborn Korean infants. This study tested the hypothesis that carnitine obtained from premature infant formula alone is adequate in sustaining optimal lipid metabolism and growth in premature infants. Accordingly, we investigated the effects of parenteral carnitine supplementation on carnitine status, growth parameters, and lipid metabolism in premature infants by measuring serum lipid profiles, carnitine and beta-hydroxybutyrate concentrations, and body weight, size, and length. Twenty-five low-birth weight Korean infants were randomly assigned to control (LCNS, n = 12) or L-carnitine-supplemented (10 mg/[kg d], LCS, n = 13) groups. On day 9, the triacylglycerol concentration was lower in the LCS group; but the high-density lipoprotein cholesterol concentration and free, acyl, and total carnitine and beta-hydroxybutyrate were significantly increased compared with the LCNS group. The ratio of acyl carnitine to free carnitine was significantly lower on day 5 in the LCS compared with the LCNS group. Body weight, height, Apgar score (1 and 5 minute), head circumference, and chest circumference were recorded on day 0; and body weight was measured again on days 5 and 9. Infant formula intake was recorded every day. There was no significant difference in body weight or growth parameters between the groups from days 0 to 9.Therefore, we concluded that, in low-birth weight infants, the addition of 10 mg/(kg d) supplemental carnitine significantly improves lipid profiles and serum carnitine level but does not enhance growth.

Blunted hypoxic pulmonary vasoconstriction in experimental neonatal chronic lung disease.

RATIONALE: Neonatal chronic lung disease (CLD), caused by prolonged mechanical ventilation (MV) with O(2)-rich gas, is the most common cause of long-term hospitalization and recurrent respiratory illness in extremely premature infants. Recurrent episodes of hypoxemia and associated ventilator adjustments often lead to worsening CLD. The mechanism that causes these hypoxemic episodes is unknown. Hypoxic pulmonary vasoconstriction (HPV), which is partially controlled by O(2)-sensitive voltage-gated potassium (K(v)) channels, is an important adaptive response to local hypoxia that helps to match perfusion and ventilation in the lung. OBJECTIVES: To test the hypothesis that chronic lung injury (CLI) impairs HPV. METHODS: We studied preterm lambs that had MV with O(2)-rich gas for 3 weeks and newborn rats that breathed 95%-O(2) for 2 weeks, both of which resulted in airspace enlargement and pulmonary vascular changes consistent with CLD. MEASUREMENTS AND MAIN RESULTS: HPV was attenuated in preterm lambs with CLI after 2 weeks of MV and in newborn rats with CLI after 2 weeks of hyperoxia. HPV and constriction to the K(v)1.x-specific inhibitor, correolide, were preferentially blunted in excised distal pulmonary arteries (dPAs) from hyperoxic rats, whose dPAs exhibited decreased K(v)1.5 and K(v)2.1 mRNA and K(+) current. Intrapulmonary gene transfer of K(v)1.5, encoding the ion channel that is thought to trigger HPV, increased O(2)-sensitive K(+) current in cultured smooth muscle cells from rat dPAs, and restored HPV in hyperoxic rats. CONCLUSIONS: Reduced expression/activity of O(2)-sensitive K(v) channels in dPAs contributes to blunted HPV observed in neonatal CLD.

Serum carnitine, triglyceride and cholesterol profiles in Korean neonates.

This study evaluated carnitine and lipid status of fifty Korean newborns. Each subject was assigned to two groups: one according to body weight at birth and the other according to gestational age. Serum total, HDL- and LDL-cholesterol were significantly lower and triacylglycerols were significantly higher, by 14 %, in the low birth weight infant (LBWI, 1310-2490 g) group compared with the normal birth weight infant (NBWI, 2570-4420 g) group. Neither birth weight nor gestational age affected serum total carnitine concentrations. However, serum ASAC (acid-soluble acylcarnitine) concentrations were 43 % higher (P < 0.001) in the LBWI group compared with the NBWI group, and approximately twice as high (P < 0.05) in the 28-32 gestational age group compared with the other gestational age groups. NEC (non-esterified acyl carnitine) fractions were significantly higher in the NBWI and 28-32 week groups (P < 0.001 and P < 0.05); consequently serum acyl/NEC carnitine ratios were four times higher in the LBWI group compared with the NBWI group and 2-3 times higher in the 25-32 week age group compared with the more advanced gestational age groups. Urinary carnitine excretion, including the NEC fraction and total carnitine, was significantly higher (P < 0.001) for LBWI than for NBWI. By gestational age, NEC excretion of the 28-32 week group was significantly (P < 0.05) higher than that of the other two groups, but total carnitine excretion was not different among the groups. This study demonstrated that Korean immature and preterm newborns have higher serum triacylglycerol concentrations but lower carnitine status than NBWI. Therefore, the lower carnitine status and moderately higher triacylglycerols may suggest that LBWI in Korea might be at risk for poor carnitine status and decreased capacity to utilise fatty acids for energy.