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.

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.

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.

Measurement of pain-like response to various NICU stimulants for high-risk infants.

BACKGROUND: Infants during neonatal intensive care are invariably exposed to various procedural and environmental stimuli in which the pain-like responses may vary depending on the nature of the stimuli and the infants' condition. AIM: To examine firstly the pain-like responses to frequent stimulants in the neonatal intensive care unit (NICU) using CRIES, FLACC and PIPP, and secondly the clinical feasibility and validity of using these pain measurements for high-risk infants. STUDY DESIGN AND SUBJECTS: In a correlational study of 110 premature infants receiving neonatal intensive care, the pain-like responses to 274 observations of 8 types of frequently applied stimulant, classified into three categories according to the degree of invasiveness, were observed using CRIES, FLACC and PIPP. RESULTS: There was a significant difference in response scores among the three categories for CRIES and PIPP. In post-hoc Scheffé test, category A had the highest response scores. The response scores from CRIES and FLACC were lower for the premature infants than for the full-term infants in both categories A and B, whereas the PIPP scores were higher for the premature infants than for the term infants in category C. CONCLUSIONS: Full-term infants tended to express more distinct pain-like responses to invasive procedures or direct contacts than premature infants did. However, PIPP may be more sensitive to evaluate the negative effects of environmental auditory stimulants, particularly for premature infants receiving neonatal intensive care. Further study to refine these instruments may increase the clinical feasibility of pain measurements in high-risk infants.

Weight variation by sex and nature of risk factors in high-risk infants: an evolutionary perspective.

A retrospective cohort study was conducted to explore growth variation during the intrauterine and early postnatal period by sex and nature of high-risk factors (i.e. physiological and pathological) in 831 Korean infants at a University hospital. The results showed that infants with a physiological risk showed a more congruent intrauterine growth pattern compared to those with a pathological risk. Particularly with a physiological risk, female infants experienced more compatible intrauterine and postnatal growth than males, although male infants were heavier than female infants at a given gestational age. In conclusion bigger may not necessarily be better for prenatal growth in humans. A more confluent intrauterine growth in infants with physiological risk can be beneficial for early postnatal catch-up growth. From an evolutionary perspective, female infants with a physiological risk may keep their advantageous edge over male infants during the early postnatal period although such an advantage may not be present with a pathological condition.

[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.

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.

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.

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.

[Concept analysis of endotracheal suctioning (ETS)].

PURPOSE: Concept analysis was performed on the behavioral concept of endotracheal suctioning (ETS), to identify the goal, to develop a standardized clinical protocol, to identify the antecedents and consequences, and to differentiate the improper use of ETS. METHOD: Walker & Avant's concept analysis was employed using clinical guidelines, books and review articles in which the procedures of ETS were written in detail and published in Pubmed within the last 20 years. RESULT: The macro-goal of ETS was to remove accumulated respiratory secretions. Three defining attributes of ETS were identified; catheter, suctioning and asepsis. Each attribute involved empirical referents, such as the size and depth of the catheter, the suction pressure, duration and method for suctioning. The antecedents of ETS were identical to the clinical evidences for the need of ETS such as the nursing assessment data. The consequences of ETS serve as an evaluation criteria on the effects of ETS based on the goal of ETS. CONCLUSION: The concept analysis of ETS demonstrates an example of considering a specific nursing protocol of ETS as a behavioral concept, applying concept analysis to it to identify it's key behavioral components as defining attributes and empirical referents and then developing and applying the standard ETS protocol.

[Pain assessment using CRIES, FLACC and PIPP in high-risk infants].

PURPOSE: Infants at neonatal intensive care units (NICU) are invariably exposed to various procedural and environmental stimuli. The study was performed to compare the pain responses in three NICU stimulants and to examine the clinical feasibility for NICU infants using CRIES, FLACC and PIPP. METHOD: In a correlational study, a total of 94 NICU stimulants including angio-catheter insertions, trunk-rubbings and loud noises, was observed for pain responses among 64 infants using CRIES, FLACC and PIPP. RESULTS: A significant difference was identified among the mean scores in CRIES (F(2, 91)=47.847, p=.000), FLACC (F(2, 91)=41.249, p=.000) and PIPP (F(2, 91)=16.272, p=.000) to three stimulants. In a Post-hoc Scheff test, an angio-catheter insertion showed the highest scores in CRIES, FLACC and PIPP compared to the other two stimulations. A strong correlation was identified between CRIES and FLACC in all three stimulations (.817 < r < .945) while inconsistent findings were identified between PIPP and CRIES or FLACC. CONCLUSIONS: The results of the study support that CRIES and FLACC are reliable and clinically suitable pain measurements for NICU infants. Further studies are needed in data collection time-point as well as clinical feasibility on PIPP administration to assess pain response in infants, including premature infants.

[The relationship between early neo-maternal exposure, and maternal attachment, maternal self-esteem and postpartum depression in the mothers of NICU infants].

PURPOSE: This study was performed to investigate the quantities of three neo-maternal exposures; visiting frequency, auditory contact and physical contact, and to examine the relationship between the quantities of each exposure and maternal attachment, maternal self-esteem and postpartum depression in 40 mothers of NICU babies during the first week in the NICU. METHOD: Each neo-maternal exposure was counted at every mother's visit to the newborn and maternal attachment, maternal self-esteem and postpartum depression were measured using the maternal attachment inventory, the maternal self-report inventory and Edinburgh Postpartum Depression Scale (EPDS) on the first and seventh day in the NICU. RESULT: The Mean of each neo-maternal exposure was 8.77(2.81) for the visiting frequency, 5.82(3.66) for the auditory contact and 5.60(2.89) for the physical contact during 7 days in the NICU. No significant changes were found in the scores of maternal attachment, maternal self-esteem and postpartum depression between the first and the seventh day in the NICU. The quantities of neo-maternal exposures were positively related to the scores of maternal attachment and maternal self-esteem but not related to postpartum depression. CONCLUSION: The results of the study suggest the lack of early neo-maternal exposure in cases of NICU hospitalization negate its beneficial effects on maternal psychological well-being in increasing maternal attachment and self-esteem. More efforts are needed for the neo-maternal interaction and the reevaluation of NICU visitation hours in order to promote maternal-infant interaction.

[Coincidence analysis of keywords of the Journal of Korean Academy of Nursing with MeSH].

PURPOSE: We try to disclose how much the keywords of the papers from the Journal of the Korean Academy of Nursing coincide with MeSH terminologies and to understand the major subjects of the recent nursing research in Korea from keywords. METHODS: Keywords of journals were extracted and compared with MeSH terms. The frequency of the appearance of each keyword was sorted by a descending order. RESULTS: Coincidence rate of 1,235 keywords with MeSH terms was 51.6%. Out of them, depression, elderly, stress, self efficacy, quality of life, exercise, middle-aged women, and women appeared most frequently in descending order. CONCLUSION: Coincidence rate of the keywords with MeSH terms was at an acceptable level, however to improve it, the education of submitters and editorial board members are required, as well as the copy editor, to take a role in checking keywords. To infer the subjects of the research from keywords might well represent the recent topics of research work.

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.

[The effects of the systemic follow up health care program on the health promotion and the risk reduction in premature infants and their mothers].

PURPOSE: This research was conducted to evaluate the effects of a systemic follow-up care program on health promotion and risk reduction in 64 high-risk infants (HRI) including premature infants and their mothers. METHOD: The intervention consisted of systemic NICU education, tele-counseling and 3 home visits in 6 months. The subjects were divided into either the intervention group or the control group receiving the conventional education without the tele-counseling and home visiting. Infant health promotion was measured using physical assessment, types of health problems, reflexes, OPD visiting history, DDST, immunization, feeding assessment, Infant death rate, etc. Maternal self-esteem, postpartum depression and family function were measured using the maternal self-report inventory (MRI), EPDS, and family apgar score (Fapgar), retrospectively. RESULT: All premature infants in the intervention group were in the normal range of growth and development, and the regular vaccination schedule. The health problems in the intervention group were addressed early so not to develop into adverse effects. The follow-up program for 6 months showed beneficial effects on MRI, EPDS, and Fapgar. CONCLUSION: A systemic follow-up health care program is beneficial on health promotion and risk reduction in 64 HRI including premature infants and their mothers.

[Comparison of maternal self-esteem, postpartal depression, and family function in mothers of normal and of low birth-weight infants].

PURPOSE: The study investigates the degree of maternal self-esteem, postpartal depression, and family function in mothers of normal and of low birth-weight infants. METHOD: A retrospective cohort design was applied to compare the variables of interest between a group of 73 mothers with normal birth weight infants and a group of 45 mothers with low birth-weight infants, using the maternal self-report inventory(MSRV), Edinburgh Postnatal Depression Scale(EPDS) and Family APGAR(FAPGAR). RESULT: The total mean score was 82.57 for MSRV, 8.45 for EPDS, and 6.83 for FAPGAR with no differences between two groups. A positive correlation was found between MSRV and FAPGAR, while a negative correlations between MSRV and EPDS, and FAPGAR and EPDS. Regardless of the direction of the relationship, the degrees of the correlations were stronger in low birth-weight mothers group than in normal group. CONCLUSION: No differences in MSRV, EPDS and FAPGAR between the normal and the low birth-weight group considered as beneficial effects of the follow-up management which low birth-weight group was engaged in. This suggested the early intervention(follow-up) for the family with risk factor(low birth-weight) could reduce negative outcomes such as the impaired maternal self-esteem and family function, and the occurrence of postpartal depression, retrospectively.

The effects of a home-visiting discharge education on maternal self-esteem, maternal attachment, postpartum depression and family function in the mothers of NICU infants.

PURPOSE: A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. METHODS: Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1 week after the discharge by mail. RESULTS: The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. CONCLUSION: These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.

[Assessment of neonatal hyperbilirubinemia using a transcutaneous bilirubinometry].

PURPOSE: The purpose of the study is to investigate the relationship between total serum bilirubin(TSB) and transcutaneous bilirubinometry(TcB) in neonates with jaundice. METHOD: TcB from various sites(forehead, sternum, abdomen, buttock, hand, dorsalis-pedia) was measured using a JM-102 in a total of 102 neonate, 42 female and 60 male, with the mean 37.5 gestational week and the mean 2,903 gram of birth weight, as well as TSB from capillary punctures. RESULT: The mean bilirubin was 11.73 in serum, 20.55 on the forehead, 17.23 on the sternum, 16.19 on the abdomen, 18.22 on the buttock, 15.83 on the hand and 15.49 on the dorsalis-pedia. The relationship between TSB and TcBs were formulated by simple regression with 0.406 < r < 0.668(p <.000). A higher relationship was revealed between TSB and TCB at the forehead in infants of full-term, ABO incompatibility, and Hb greater than 16 mg/dl(r = 0.725, 0.790, and 0.717, retrospectively). Phototherapy altered the measurement of TcB per site. CONCLUSION: TcB on the forehead is a reliable, noninvasive and convenient measurement of TSB in normal infants(Institutions need to establish quantitative equations representing the specific relationship between TSB and TCB according to the hemodynamic problems of infants such as ABO incompatibility, or low Hb).

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.