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대한주산의학회> PERINATOLOGY (구 대한주산의학회잡지)

PERINATOLOGY (구 대한주산의학회잡지) update

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수록범위 : 1권1호(1990)~31권4호(2020) |수록논문 수 : 1,334
PERINATOLOGY (구 대한주산의학회잡지)
31권4호(2020년 12월) 수록논문
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1Overview of Malignancy in Pregnancy

저자 : Yung-taek Ouh , Geum Joon Cho , Sunghun Na

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 161-165 (5 pages)

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The incidence of cancer during pregnancy is increasing although it is relatively rare, which is expected to rise with an increase in the maternal age of the pregnancy. Due to the ambiguity of the symptoms, the diagnosis of cancer is often delayed. Diagnosis of cancer in pregnancy needs complex management issues that balance the benefit of treatment for the mother and harm for the fetus. Every patient should be personalized with a multidisciplinary system of obstetricians, gynecologists, oncologists, radiologists, and neonatal specialists and it should assist patients in making informed decisions about the best diagnosis and management for mother and fetus. Radiotherapy, chemotherapy, and surgery could be provided as a management option. In most cancer, pregnancy did not seem to have an adverse effect on maternal prognosis. In this article, we review various perspectives on the diagnosis and treatment of cancer during pregnancy as well as the prognosis of cancer in pregnancy.

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2Correlation between Capillary Blood-spotted Filter Paper Thyrotropin Results and Serum Thyroid Function Tests in Premature Neonates

저자 : Moon Bae Ahn , Shin Hee Kim , Won Kyoung Cho , Kyoung Soon Cho , So-young Kim , Byung-kyu Suh , Min Ho Jung

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 166-171 (6 pages)

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Objective: The interpretation of thyroid function test results in preterm infants is affected by various conditions. Neither a definite thyrotropin cut-off nor intercurrent conditions have been clearly determined for premature neonates. This study aimed to determine the specific considerations required in the interpretation of capillary blood thyrotropin concentration by comparing it to serum thyrotropin when screening for congenital hypothyroidism in preterm neonates.
Methods: A retrospective review was performed on 57 premature newborns who were screened for thyroid function test. The comparison of thyrotropin measured by two different methods, dried capillary blood-spotted filter paper using an immunofluorometric assay and serum radioimmunoassay, was performed. Clinical and biochemical factors affecting the difference between the two methods were investigated.
Results: Filter paper thyrotropin concentration showed a positive correlation with the serum thyrotropin concentration. In total, 50.9% of premature neonates had a difference in the concentration ≥3.0 mIU/L between the methods. In these subjects, the serum thyrotropin concentration was higher, whereas other factors, such as maternal factors, neonatal anthropometric parameters, Apgar score, and corrected age, were not different when compared to that in subjects with a difference of <3.0 mIU/L.
Conclusion: The filter paper thyrotropin concentration differed from the serum level in a substantial portion of premature neonates, and the degree of deviation may be affected by the serum thyrotropin concentration and gestational age at birth. Further investigations and longitudinal studies are warranted to establish clinical consensus guidelines for hypothyroidism screening in preterm neonates.

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3Clinical Experiences of Amplitude-integrated Electroencephalographic Monitoring in Neonatal Intensive Care Unit

저자 : Sangeun Lee , Sujin Choi , Yun Jeong Lee , Jisook Kim , Sook-hyun Park , Eun Joo Lee

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 172-178 (7 pages)

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Objective: The purpose of this study was to analyze the clinical experience of amplitude-integrated electroencephalogram (aEEG) in the neonatal intensive care unit (NICU) and to evaluate the usefulness of the aEEG and to determine whether an EEG could help to identify high risk infants with later epilepsy.
Methods: Clinical data of 200 newborn infants admitted to the NICU and monitored with aEEG were reviewed retrospectively. A single- or two-channel aEEG (electrode placement P3-P4 for single, C3-C4 and P3-P4 for two) was recorded continuously by using gold cups. Background activity was assessed based on voltage and pattern recognition methods. To assess for differences in later epilepsy among infants with abnormal versus normal results, chi-square test was employed with odd ratio.
Results: Overall, 200 newborn infants were included. About half showed abnormal findings on aEEG monitoring with 34.5% abnormal background activity, 30.0% abnormal cyclicity, and 30.0% with seizures. The odd ratio for an abnormal trace on aEEG to predict later epilepsy was 7.9 (95% confidence interval; 2.8-22.0; P<0.001).
Conclusion: aEEG monitoring is useful for cerebral monitoring in NICU. aEEG monitoring enabled to assess the cerebral integrity of infants by measuring background activities and detecting seizures and help to identify high-risk infant for later epilepsy.

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4Term Low Birth Weight or Macrosomia among Immigrant Mothers in Korea

저자 : Jung Eum Lee , Hyon Jee Yoon , Yu-ri Jang , Hyun Sun Ko

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 179-185 (7 pages)

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Objective: The aim of this study was to analyze the relationship between maternal origin and risks of term low birth weight (TLBW) or macrosomia in Korea.
Methods: Using Korean birth statistics from 2009 to 2015, we examined the association between maternal nationality and risks of TLBW (less than 2.5 kg) or term macrosomia (over 4.0 kg). Birth statistics included singleton live births in women, from 37 to 41 weeks' gestation, during the period 2009-2015. Immigrant mothers were defined as women born in any country other than Korea, and were grouped by economic level of maternal country of origin. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with multivariate logistic regression analysis.
Results: There were significant differences in neonatal birth weights between Korean mothers and immigrant mothers (3.28±0.38 kg vs. 3.24±0.39 kg, P<0.001). In multivariate logistic regression analysis, the risk of TLBW was significantly higher (OR: 1.268, 95% CI: 1.181-1.361, P<0.001) and the risk of macrosomia was significantly lower (OR: 0.607, 95% CI: 0.518-0.71, P<0.001), in mothers from low and lower middle income countries, compared to Korean mothers. The risk of macrosomia was significantly higher (OR: 1.387, 95% CI: 1.228-1.566, P<0.001) and the risk of TLBW was significantly lower (OR: 0.879, 95% CI: 0.81-0.954), in mothers from high and upper middle income countries, compared to Korean mothers.
Conclusion: After adjustment for relevant characteristics, the risk of TLBW was higher in immigrant mothers from low and lower middle income countries, but the risk of macrosomia was higher in immigrant mothers from high and upper middle income country. Prenatal care and education needs to consider the origin of immigrant mothers.

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5The Correlation between Maternal Ante- and Postpartum Depression and Mode of Delivery: Preliminary Study

저자 : Hwa Seon Koo , Young Ran Kim , Jin Young Park , Kyungun Jhung , Kyungmi Chung , Hee Young Cho

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 186-190 (5 pages)

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Objective: To investigate the relationship of prenatal and postnatal depression and mode of delivery.
Methods: The study population consisted of 35 pregnant women who underwent antenatal care in Bundang CHA Medical Center from October 2018 to September 2019. Among them, 20 women underwent cesarean section (c-sec) and 15 women underwent vaginal delivery (VD). The survey was conducted at 34 to 36 gestational weeks and at postpartum 4 weeks consecutively using Korean version of Edinburgh Perinatal/Postnatal Depression Scale (EPDS). To evaluate the association between maternal ante- and postpartum depression and mode of delivery, we analyzed the differences of EPDS according to mode of delivery and pre- and postpartum.
Results: The mean scores of EPDS before delivery was 7.2±5.0 in C-sec group and 5.8±4.7 in VD group, but it was not statistically significant (P=0.390). The EPDS scores at postpartum was significantly higher in women who underwent C-sec compared to VD group (9.2±4.9 vs. 7.6±5.4, P=0.010; respectively). Also when comparing the mode of delivery in fourteen women with EPDS 9 or above at postpartum, C-sec rate (64.3%) was significantly higher than VD rate (35.7%) (P=0.010). In both groups, the scores of EPDS were increased after delivery with statistical significance (P=0.039).
Conclusion: C-sec delivery could increase the EPDS at postpartum and delivery itself could result in maternal depressive symptoms during postpartum period regardless of mode of delivery.

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Objective: To determine the effects of patent ductus arteriosus (PDA) ligation, clinical characteristics of infants who need surgical ligation of PDA and risk factors of PDA ligation were evaluated.
Methods: Preterm infants with gestational age (GA) <30 weeks presenting with hemodynamically significant ductus arteriosus (HSDA) were enrolled. HSDA was closed with ibuprofen (medical group, n=55) or surgical ligation (surgical group, n=57).
Results: GA and birth weight were smaller in the surgical group (27.8±1.4 weeks in the medical group vs. 26.1±1.6 weeks in the surgical group, P<0.001; 959±241 g in the medical group vs. 815±193 g in the surgical group, P=0.001, respectively). There were no significant differences in gender, Apgar scores, antenatal steroids therapy, maternal gestational diabetes mellitus, pregnancy-induced hypertension, or chorioamnionitis between the two groups. In the surgical group, total duration of mechanical ventilation and duration of invasive ventilation were longer, although postnatal day of ductal closure was not delayed. Moderate to severe bronchopulmonary dysplasia, high-grade intraventricular hemorrhage (≥grade 3), retinopathy of prematurity (≥stage 2), necrotizing enterocolitis (≥stage 2), and mortality rate were also similar between the two groups. Low GA was a significant risk factor associated with surgical ligation of PDA (adjusted odds ratio 0.493, 95% confidence interval 0.366-0.666; P<0.001).
Conclusion: Although surgical ligation of PDA is inevitable in certain cases with large shunt and severe respiratory failure, clinicians should weigh the benefit of ductal closure and complications associated with surgery.

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7Clinical Characteristics and Outcomes of Mothers and Newborn Babies at an Integrated Perinatal Center for High-risk Pregnancy and Neonatal Care

저자 : Youna Park , Mi Hyeon Gang , Yong Wook Lee , Byung Hun Kang , Min A Lee , Mea-young Chang

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 199-208 (10 pages)

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Objective: The appropriate perinatal care and safe delivery of high-risk pregnant women have a significant impact on the prognosis of newborn. The purpose of this study is to analyze the characteristics and outcomes of high-risk pregnant women and their babies in a single integrated care center for high risk pregnancy and neonate care.
Methods: The subjects were babies born in Chungnam national university hospital, their mothers and transferred babies between January 1, 2018 and December 31, 2018. We analyzed the time of transfer, interval between transfer and delivery, clinical features in pregnant women and their babies. The clinical characteristics and outcomes of the babies were compared to those of outborn babies and analyzed according to the timing of the transfer and duration between time of the mother's transfer and delivery.
Results: Mean gestational age at first visit was 26.4 weeks. The average time to delivery after the first visit was 73.1 days. The main reasons for the mother's transfer were fetal problems (17.0%), obstetric and other underlying diseases of mothers (18.9%) and various problems related to pregnancy (52.4%). Babies born in hospital had lower gestational age and birth weight than transferred babies and their main reason for admission was prematurity (65.5%). The earlier transfer of mothers and longer interval between transfer and delivery were related to lower rate of emergency cesarean section in mothers, lower admission rate and larger gestational age and birth weight in babies.
Conclusions: The early transfer of high-risk pregnant women and their appropriate management can optimize the outcomes of babies as well as mothers.

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8Predictive Model for Motor Developmental Delay in Preterm Infants by Using Recurrent Neural Network

저자 : Seung Soo Kim , Jun Hwan Song , Ho Kim

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 209-215 (7 pages)

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Objective: The aim of this study is to develop the predictive model for motor developmental delay in Korean preterm infants beyond neonatal intensive care unit.
Methods: The authors retrospectively investigated the medical records of premature infants who had undergone developmental test and discharged from the single regional newborn intensive care center. We collected 30 independent variables and the motor scale of the Korean version of Bayley scale of infant and toddler development III (K-Bayley III). The predictive modeling was conducted by 3 steps: 1) data preprocessing, 2) training predictive models, and 3) evaluation of final performance of each model. We used sensitivity as a primary evaluation metrics, and F1 score and area under precision-recall curve (AUPRC) as a secondary metrics.
Results: Total 359 subjects were enrolled in the study. Ten percent of subjects were below 80 in the motor scale (coding as '1' in the dependent variable). Recurrent neural network model showed the best performance (sensitivity 1.00, F1 score 0.36, AUPRC 0.22). XGBoost model (sensitivity 0.71, F1 score 0.63, AUPRC 0.65) and ridge logistic regression model (sensitivity 0.71, F1 score 0.56, AUPRC 0.60) also showed good performance.
Conclusion: Machine learning approach showed good predictive value for motor delay in Korean preterm infants. The further research by using big data from multicenter is needed.

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9Tracheal Stenosis Successfully Treated without Surgery in Preterm Infant

저자 : Yae Eun Chung , Ran Lee , Jae Sung Son , Hye Won Park

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 216-219 (4 pages)

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Congenital tracheal stenosis is a rare disease that can be life threatening, especially when early identification is missed. A premature twin showed progressive respiratory symptoms at birth and tracheal stenosis, with difficulty intubating. Chest computed tomography scan revealed diffuse tracheal stenosis and left pulmonary artery (LPA) sling. Tracheal ballooning under fluoroscopic guide was successfully performed at 5 days old and maintained with endotracheal intubation until 7 months old. The patient underwent surgery for LPA sling and is doing well without any respiratory symptoms following extubation. Herein, we report the first case of congenital tracheal stenosis in a preterm infant who was successfully treated with tracheal ballooning and conservative management in Korea.

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10Necrotizing Enterocolitis Associated with Norovirus Infection in a Preterm Infant

저자 : Hae In Park , Hye Sun Yoon

발행기관 : 대한주산의학회 간행물 : PERINATOLOGY (구 대한주산의학회잡지) 31권 4호 발행 연도 : 2020 페이지 : pp. 220-225 (6 pages)

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In general, norovirus infection may cause epidemic acute gastroenteritis over all ages and may lead to self-limiting progression with typical clinical symptoms such as non-bloody diarrhea and vomiting. Premature infants diagnosed with norovirus infection have moderate to severe symptoms including a distended abdomen, apnea, hematochezia, and a rare radiologic finding called pneumatosis intestinalis. This infection is occasionally fatal in preterm infants because of their immature immune system and increased intestinal permeability to pathogens. Norovirus may cause severe illness such as hemorrhagic colitis, necrotizing enterocolitis, and colon ischemia. Outbreaks of necrotizing enterocolitis associated with norovirus infection have been reported in neonatal intensive care units. We report a case of a preterm infant diagnosed with necrotizing enterocolitis associated with norovirus.

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