Youngmee Ahn

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.

The Effects of Shallow versus Deep Endotracheal Suctioning on the Cytological Components of Respiratory Aspirates in High-Risk Infants

Background: The harmful effects of mechanical ventilation and suctioning are compounded if endotracheal suctioning (ETS) is inappropriately performed. Deep ETS involves catheter insertion into the endotracheal tube until resistance is met. Shallow ETS may be beneficial in lessening mechanical irritation to the first bronchial layers. However, clinical observation reveals wide variation in the length of the suction catheter for ETS in high-risk infants. Objective: The study was conducted to examine the effects of deep and shallow ETS on the cytological components of respiratory aspirates from high-risk infants. Methods: A cross-over experimental study was performed in 22 high-risk infants with a mean birth weight of 2,200 g. Whether deep or shallow ETS was conducted first was determined randomly. The numbers of (1) columnar cells [CC – ciliated (CCC) and nonciliated (NCC)], (2) fresh clustered columnar cells (CLCC), and (3) Curschmann’s spirals (CS), a mucus cast residing inside the lower terminal airways, in the respiratory aspirates were compared between the two ETS protocols. Results: No statistical differences were found in the quantities of CC, CLCC and NCC between shallow and deep ETS. However, greater quantities of CLCC were observed in the deep ETS aspirates than in the shallow ETS aspirates. Conclusions: Detachment of larger amounts of clustered columnar cells from the respiratory epithelium without the guarantee that lung secretions from the lower airways will be removed questions the justification of deep ETS in high-risk infants.

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.

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 Gestational Age Using an Extended New Ballard Examination in Korean Newborns

Introduction The New Ballard Examination (NBE) estimates gestational age (GA) through direct assessment on physical and neuromuscular maturity of newborns [1], and is particularly useful in clinical settings where sophisticated diagnostic tests are not common for GA estimation, such as in Korea. However, NBE is limited by its scoring system, with only 5-point intervals for total scores (i.e. 30, 35, 40), and 2-week intervals for corresponding GA (i.e. 38 GA, 40 GA), leading to inconsistencies in GA estimates, such as overestimation in both premature infants [2, 3] and full-term newborns [4], and underestimation for preterm newborns [5]. Little is known about whether this inconsistency is due to the scale itself, popula-tional variation, or other phenomena. The author therefore mathematically extended the scale of the NBE using an assumption of linearity between the NBE score and GA [6], and then evaluated the accuracy of the extended NBE in assessing the GA of Korean newborns, including premature newborns.

[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<r<.27, p<.010), and negative relation between hydration and pH in both areas (-.23<r<-.15, p<.010). Antibiotics may play a positive role in AM formation. CONCLUSION High-risk newborns may experience delay in acid mantle formation on SC, hypothermia and decreases in hydration on peripheral sites during the first 7 days of life.

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.

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

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 childrens 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 childrens 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.

[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.