Comparison of maternal and neonatal survival exposed to humidifier disinfectants during perinatal periods: a case-series study.

A humidifier disinfectant (HD) has been prohibited by the government due to its serious effects on the human body. Several studies on the relationship between HD and lung diseases have been performed independently on children and adults. However, there have been no reports on the effects of HD exposure on pregnant women and their foetuses. Therefore, the present study was conducted to investigate the effects of HD exposure on the foetuses of women who encountered HD during pregnancy. A total of 56 cases were recruited from 2017 to 2019 through the Korea Environmental Industry & Technology Institute, and data obtained from the medical records included maternal date of birth, maternal date of death, maternal start and end date of HD exposure, maternal date of symptom onset, neonatal birthday, neonatal birthweight, gestational age, and neonatal survival status within 28 days. All data were retrospectively investigated through medical records. Of the 47 mothers, 20 (42.6%) mothers survived, and 27 (57.4%) mothers died. In the group of survivors, there was a shorter period of total HD use, period of HD use before pregnancy and period of HD use to onset of symptoms. Shorter durations of HD use resulted in higher survival rate of mothers. HD use caused an increase in gestational age surviving foetuses, and foetal mortality increased when clinical symptoms developed before birth.

Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study.

OBJECTIVE: To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database. METHODS: From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples. RESULTS: Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons. CONCLUSIONS: Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.

Efficiency analysis by training sequence of high-fidelity simulation-based neonatal resuscitation program (NRP).

OBJECTIVE: This study was conducted to find a more effective education method in a neonatal resuscitation program (NRP) using a high-fidelity simulation that has recently shown positive results in terms of its effectiveness. STUDY DESIGN: A single-blind prospective cohort study was performed. The high-fidelity simulation model was used in a formal NRP training course for trainees caring for neonatal patients. The trainees were divided into a group that conducted the scenario after the lecture (Group A) and a group that attended the lecture after the scenario (Group B) and they both took the test before, during, and after the training. RESULTS: The increase in score after theory training was statistically significant in both groups, but the final score did not differ between the two groups. However, when compared by career, in Group A, trainees under 24 months tended to be more effective, and in Group B, trainees over 24 months tended to be more effective. CONCLUSION: The difference in short-term memory of trainees according to the order of education identified by the test score was not prominent, but it was found that the degree of difference in test scores for the order of education tended to be different according to the career. It is thought that the effectiveness of the training might be increased by changing the education order according to the degree of experience of each trainee. More effective educational methods should be introduced by continuously developing lectures for repeated education of various trainees in the future.

Relationship Between Rotavirus P[6] Infection in Korean Neonates and Histo-Blood Group Antigen: a Single-Center Study.

BACKGROUND: Rotaviruses are a major cause of pediatric gastroenteritis. The rotavirus P[6] genotype is the most prevalent genotype isolated from Korean neonates but has rarely been reported in other countries. Histo-blood group antigen (HBGA) is known to play an important role in rotavirus infection. We investigated the relationship between rotavirus genotype and HBGA-Lewis blood type in Korean children and explored the reasons for the predominance of rotavirus P[6] strain in Korean neonates. METHODS: Blood and stool samples were collected from 16 rotavirus-infected patients. Rotavirus G (VP7) and P (VP4) genotyping was performed using reverse transcription-PCR and sequencing. Lewis antigen phenotypes (Lea/Leb) were tested, and HBGA-Lewis genotype was determined by sequencing the secretor (FUT2) and Lewis (FUT3) genes. Deduced amino acid sequences and three-dimensional structures of the VP8* portion of the rotavirus VP4 protein were analyzed. RESULTS: All P[6] rotaviruses were isolated from neonates under one month of age, who were negative or weakly positive for the Leb antigen. However, 10 of the 11 non-P[6] rotaviruses were isolated from older children who were Leb antigen-positive. The VP8* amino acid sequences differed among P[6], P[4], and P[8] genotypes. Korean P[6] strains showed a unique VP8* sequence with amino acid substitutions, including Y169>L169, which differed from the sequences of P[6] strains from other countries. CONCLUSIONS: The predominance of the rotavirus P[6] genotype in Korean neonates may be related to the interaction between HBGA-Lewis antigen and the VP8* portion of the VP4 protein, and this information will be helpful in future neonatal vaccine development.

Metabolic syndrome and lung function in Korean children and adolescents: A cross-sectional study.

This study aimed to investigate whether obesity and metabolic syndrome (MetS) are associated with pulmonary function in Korean children and adolescents. Data from the 2009-2011 Korea National Health and Nutrition Examination Survey which is cross-sectional, nationwide, and representative survey were used. Adjusted regression analysis was performed to evaluate the association of obesity and MetS with lung function in children and adolescents. A total of 763 children and adolescents aged 10-18 years were evaluated. We found no significant difference in FEV1% predicted, FVC% predicted, and FEV1/FVC ratio among the obesity groups. Subjects with MetS showed a significantly lower FEV1 predicted (91.54 ± 0.74% vs 94.64 ± 0.73%, P = 0.004), lower FVC% predicted (91.86 ± 0.63% vs 95.20 ± 0.63%, P < 0.001), and lower FEV1/FVC ratio (76.76 ± 0.43% vs 80.13 ± 0.43%, P < 0.001) than those without MetS. Elevated waist circumference (WC), systolic blood pressure, fasting glucose, and lower high-density lipoprotein cholesterol (HDL-C) were independently associated with lower FEV1/FVC ratio (all P < 0.05, respectively). Among MetS components, increased WC was the most important factor influencing lower FEV1/FVC ratio. In conclusion, lung function in MetS patients was significantly lower, and the MetS component was independently associated.

Whole-genome analysis of rotavirus G4P[6] strains isolated from Korean neonates: association of Korean neonates and rotavirus P[6] genotypes.

BACKGROUND: Group A rotaviruses are the major causative agents of pediatric gastroenteritis worldwide. Several studies have reported the predominance of G4P[6] rotavirus genotypes in Korean neonates, which is uncommon in other countries. Therefore, the purposes of this study were to determine the genotype constellations of complete genomes of G4P[6] rotavirus strains isolated from Korean neonates using next-generation sequencing, to compare these sequences with other G4P[6] strains in other countries, and to determine the reason for the predominance of G4P[6] genotypes in Korean neonates. RESULTS: Twenty rotavirus G4P[6] strains, isolated from January 2013 to January 2016, were selected for whole-genome sequencing. Eleven rotavirus genes were amplified using specific primer sets, and sequencing was carried out using an Ion S5 XL next-generation sequencing platform. Genotypes of each gene were determined, and phylogenetic analyses were performed to investigate genetic distances between genes of rotaviruses in this study and those of other rotavirus G4P[6] strains whose whole-genome sequences were previously published. All 20 rotavirus strains in this study had the same genotype: G4-P[6]-I1-R1-C1-M1-A1-N1-T1-E1-H1, representing the Wa-like genotype constellation. BLAST searches of 20 G4P[6] rotavirus strains revealed that all G4 sequences in this study showed the highest nucleotide identity to G4 sequences of G4P[6] rotavirus strains isolated in Korea in 2008 (GenBank accession number: FJ603447). Additionally, P[6] gene sequences in this study showed the highest nucleotide identity to P[6] sequences of G4P[6] strains detected in Korea in 2002 (AY158093). Phylogenetic and nucleotide sequence analyses showed that G4P[6] strains in this study and previously reported G4P[6] strains in Korea were mostly detected in neonates and had similar G4 and P[6] sequences compared with other G4P[6] strains detected in other countries. CONCLUSIONS: This study showed that the whole-genome constellation of rotavirus G4P[6] strains from Korean neonates resembled a Wa-like genotype constellation. Additionally, rotavirus genotypes detected in Korean neonates had unique P[6] sequences, which may be the cause of Korean neonatal rotavirus infection.

Emergence of G8P[6] rotavirus strains in Korean neonates.

BACKGROUND: Rotaviruses are the major causes of pediatric gastroenteritis worldwide. The genotypic distribution of rotavirus strains shows temporal and geographical fluctuations, and knowledge of the molecular epidemiology of rotaviruses is important for the development of vaccines and diagnostic reagents. We investigated VP4 and VP7 capsid genotypes of rotaviruses isolated from 211 stool specimens collected from Korean neonates in a neonatal intensive care unit from September 2017 to March 2018. RESULTS: Of 211 stool specimens, 15 specimens (7.1%) were rotavirus-positive. Eleven specimens (73.3%) were G8P[6] type and 4 (26.7%) were G4P[6] type. Sequence analysis revealed that all G8 sequences in this study showed the highest nucleotide identity to G8 sequences of G8P[8] rotavirus strains isolated in Vietnam in 2014, and P[6] gene sequences showed the highest nucleotide identity to P[6] sequences of G4P[6] strains detected in Korea in 2012. Only one amino acid difference in VP7 was found in 3 of the 11 G8P[6] strains in this study, but multiple amino acid substitutions in VP7 were detected between these G8P[6] strains and the commonly used vaccine strains. CONCLUSIONS: This study showed that rotavirus G8P[6] strains were firstly detected at high frequency in Korean neonates from September 2017 to March 2018. These new rotavirus G8P[6] strains were estimated to be derived from reassortment events between the G8 of G8P[8] strains in Asian region and the P[6] of G4[6] in Korea. Whether the emergence of this unusual G8P[6] strain reflects continuous prevalence or transient occurrence will require continuous monitoring of rotavirus epidemiology.

Association between depression and asthma in Korean adults.

PURPOSE: Asthma is a one of the most common allergic diseases, and depression is an important comorbidity with asthma. However, little is known about the prevalence of depression in Korean adults with asthma. This study was performed to find the association between asthma and depression in Korean adults and to investigate the demographic and socioeconomic characteristics in Korean adults with asthma and with depression. METHODS: Data were acquired from 47,351 men and women, ages >19 years, who participated in the Korea National Health and Nutrition Examination Survey, which was conducted from 2007 to 2014. The presence of asthma and depression was based on self-reported physician diagnosis in the Health Interview Surveys. RESULTS: The prevalence of asthma was 2.8% and of depression was 4.1%. Logistic regression analysis showed that single marital status (separated or divorced) (adjusted odds ratio [aOR] 1.291 [95% confidence interval {CI}, 1.077-1.547]), unemployment (aOR 1.226 [95% CI, 1.061-1.417]), under middle school graduated education level (aOR 2.433 [95% CI, 1.867-3.171]), middle school graduated education level (aOR 1.759 [95% CI, 1.330-2.327]), obesity (aOR 1.403 [95% CI, 1.196-1.647]), and depression (aOR 1.796 [95% CI, 1.422-2.267]) were significantly associated with adult asthma; however, sex, age, monthly family income, residential area, smoking status, hypertension, and diabetes mellitus were not associated with adult asthma. Compared with individuals without asthma and with depression, patients with asthma and with depression were prone to be single (separated or divorced) and to have a lower education level (p < 0.01) Conclusion: The present study showed that depression was associated with asthma in Korean adults.