Han-Suk Kim

The associations of parental under-education and unemployment on the risk of preterm birth: 2003 Korean National Birth Registration database

ObjectivesThis study aimed to investigate the associations of combined parental low educational level and combined parental unemployment on the risk of preterm birth (PTB) in Korea.MethodsData on 427,857 singleton births were obtained from the National Birth Registration (NBR) database in 2003 and analyzed. Parental education and parental employment status were combined as exposure for analysis. Place of birth, sex, marital status, parental age and parity were included for analysis of unconditional multiple logistic regressions. PTB was defined as birth before a gestational age of 37 complete weeks.ResultsGroup of the lowest educational level, below high school, had the highest odds of PTB in both father and mother in multivariable analysis [odds ratio (OR) 1.15 and 1.16, respectively]. After combining parental educational status for the multivariable analysis, the highest probability of PTB was in families where both parents had below college level education (OR 1.22). As for paternal employment, the multivariable analysis showed an increased rate of PTB occurred where the father was unemployed (OR 1.11). After combining the employment status of both parents, the multivariable analysis revealed that PTB was only significant in families where both parents were unemployed (OR 1.09).ConclusionsWe found that combined parental low educational level and combined parental unemployment increased the likelihood of preterm birth.

Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success

INTRODUCTIONnThis study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.nnnMETHODSnThis study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.nnnRESULTSnOverall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person).nnnCONCLUSIONnUS-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.

Analysis of risk factors for lipid intolerance of intravenous fat emulsion in very low birth weight infants

In order to prevent fatty acid deficiency and to supply enough energy, intravenous fat emulsion is necessary for parenteral nutrition in preterm neonates. However, parenteral administration of intravenous fat emulsion can induce lipid intolerance. The purpose of this study was to analyze risk factors for lipid intolerance in very low birth weight infants. This retrospective study included 80 preterm neonates whose birth weight was less than 1,500xa0g. Subjects were divided into 2 categories: those with a serum triglyceride level ofxa0≥ 200xa0mg/dl (nxa0=xa033, 41xa0%) and those with a serum triglyceride level ofxa0< 200xa0mg/dl (nxa0=xa047, 59xa0%). We conducted logistic regression analysis using variables which were significant in univariate analysis. All statistical analyses were processed in SPSS version 19.0. Four risk factors for lipid intolerance were obtained through analysis of the electronic medical record. Lipid intolerance occurred more frequently in neonates with sepsis; those with a birth weight less than 1,000xa0g; those who was administered intravenous fat emulsion more than 2.6xa0g/kg/day; and those whose gestational age was less than 28xa0weeks. It is suggested that serum triglyceride levels should be closely monitored to prevent lipid intolerance in preterm neonates with the aforementioned characteristics.

Improved Regional Disparities in Neonatal Care by Government-led Policies in Korea

Background Although the number of high-risk neonates has increased in Korea, hospitals were reluctant to open or maintain neonatal intensive care unit (NICU) due to the low medical cost. Consequently, there were regional disparities in facilities, equipment, and neonatal health outcomes. For these reasons, the Korean government began to invest in neonatal care during the last decade. We identified the status of NICUs in Korea and assessed changes after the government-driven policies. Methods We surveyed 87 of 89 hospitals that operated NICUs in 2015. The questionnaire assessed the number of NICU beds, admission and mortality rates of very low birthweight infants (VLBWIs), personnel status, equipment and facilities, and available multidisciplinary approach. Current data was compared with the previous studies and changes in the status and function of the nationwide NICU from 2009 and 2011. Results During the last 7 years, there was an increase of 462 NICU beds, which met the required number estimated by the number of births and covered about 90% of regional VLBWI births. Status of facilities and equipment improved in all regions in Korea but there were still regional differences in multidisciplinary approach and human resources. The difference in odds ratios for mortality of VLBWI between regions decreased compared to 2009. Conclusion There was improvement in regional disparities of neonatal care and mortality of premature babies with the government investment in Korea. Further supports are required for human resources and referral system.

Characterization of Detailed Audiological Features of Cytomegalovirus Infection: A Composite Cohort Study from Groups with Distinct Demographics

Congenital cytomegalovirus (cCMV) infection is a common congenital infection that causes sensorineural hearing loss (SNHL). Despite its substantial impact on public health and cost burden, epidemiology and clinical features of CMV-related SNHL have never been reported in the Korean populations. This study investigated the detailed audiologic phenotypes of cCMV infection to see if a specific SNHL pattern is associated with a particular clinical setting. A total of 38 patients with cCMV infection were studied retrospectively. Patients were classified into three groups with distinct demographics: clinically driven diagnosis (n=17), routine newborn CMV screening according to the NICU protocols (n=10), or referral to ENT for cochlear implant (CI) (n=11). The incidence of cCMV infection was 3.6%, showing 33.3% of SNHL among cCMV patients, 38% of asymmetric hearing loss, 29% of late-onset hearing loss, and diverse severity spectrum in patients with CMV-related SNHL. CI recipients with CMV-related SNHL showed a significantly improved speech perception. Surprisingly, in 36.4 % of CI implantees, initial audiological manifestation was significant asymmetry of hearing thresholds between both ears, with better ear retaining significant residual hearing up to 50dB. CMV turns out to be a significant etiology of SNHL, first to date reported in the Korean pediatric population. Analysis of audiologic phenotypes showed a very wide spectrum of SNHL and favorable CI outcomes in case of profound deafness. Especially for the patients with asymmetric hearing loss, close surveillance of hearing should be warranted and CI could be considered on the worse side first, based on the observation of rapid progression to profound deafness of better side.

Birth outcomes of immigrant women married to native men in the Republic of Korea: a population register-based study

Objectives The Republic of Korea (Korea) has experienced a steady increase in the number of births from immigrant women over the last 20 years. However, little is known about the birth outcomes of immigrant women in Korea. This study compared Korean birth data from immigrant and native women who married native men, and explored the factors that affected birth outcomes among immigrant women. Design Observational cross-sectional study. Setting Nationwide registry-based study in Korea. Participants A total of 70u2009258 records from immigrant women and 1700 976 records from native women were examined using the National Birth Registration Database, from 2010 to 2013. Independent variable Native Korean women and immigrant women who married native men. Outcomes Proportion of preterm births, post-term births, low birth weights and macrosomia. Results Adjusted ORs (aOR) were calculated for the adverse birth outcomes, and subgroup analyses were performed according to parity and mothers from three Asian countries (China, Vietnam, the Philippines). Multivariate logistic regression analyses were also conducted to evaluate the association of these factors with birth outcomes among immigrant women. Immigrant women had higher OR of post-term births (aOR 1.62; 95% CI 1.44 to 1.83) and low birth weights (aOR 1.17; CI 1.12 to 1.22). Mothers from the Philippines had higher OR of preterm births (aOR 1.26; CI 1.12 to 1.52) and Chinese mothers had higher OR of macrosomia (aOR 1.55; CI 1.44 to 1.66). The OR of post-term births and low birth weights was significantly higher in the first pregnancies of immigrant women. Conclusions This study has demonstrated higher proportions of adverse birth outcomes among immigrant women who married Korean men, compared with native women in Korea. Policies reducing the gap in birth outcomes between native and immigrant women are needed.