Differences in perspectives of pediatricians on advance care planning: a cross-sectional survey

Background: The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Earlier, withdrawal of life-sustaining treatment was taboo in the medical society in South Korea due to the history of such practice being punishable by law, and physicians tended to pursue aggressive treatment. With changes in public opinion on end-of-life care, the Korean government enacted a new law that protect human dignity by respecting patients' self-determination and facilitating advance care planning. However, little is known about current state of advance care planning for pediatric patients. The study aimed to assess perceptions regarding advance care planning among South Korean pediatricians and clarify any differences in perception among pediatric subspecialties. Methods: This study was an observational cross-sectional survey that used a web-based self-report questionnaire. Participants comprised of pediatricians currently caring for children with life-limiting conditions in 2018. Results: Of the 96 respondents, 89 were included in the analysis. In a hypothetical patient scenario, more hemato-oncologists and intensivists than neonatologists and neurologists preferred to provide comfort care than aggressive treatment. While 72.2% of hemato-oncologists reported that they usually or always discuss advance care plans with parents during treatment, more than half of other pediatricians reported that they seldom do so. Furthermore, 65% of respondents said that they never discuss advance care planning with adolescent patients. Moreover, there were no notable differences among subspecialties. The most prevalent answers to factors impeding advance care planning were lack of systemic support after performing advance care planning (82.0%) and uncertain legal responsibilities (70.8%). Conclusions: The pediatricians differed in their experiences and attitudes toward advance care planning based on their subspecialty. Consequently, institutional support and education should be provided to physicians so that they can include children and families in discussions on prognosis.ope

Survival of children with trisomy 18 associated with the presence of congenital heart disease and intervention in the Republic of Korea

BACKGROUND: Trisomy 18 syndrome (T18) is the second most common autosomal trisomy and has a high risk of fetal loss and stillbirth. Aggressive surgical treatments for the respiratory, cardiac, or digestive systems of patients with T18 were previously futile, while the results of recent studies are controversial. Over the past decade, there have been approximately 300,000 to 400,000 births annually in the Republic of Korea; however, there have been no nationwide studies on T18. This nationwide retrospective cohort study aimed to determine the prevalence of T18 in Korea and its prognosis according to the presence of congenital heart disease and relevant interventions. METHODS: This study utilized NHIS-registered data between 2008 and 2017. A child was defined as having T18 if the ICD-10 revision code Q91.0-3 was reported. Subgroup analysis was performed for children with congenital heart diseases, and survival rates were compared based on the history of cardiac surgical or catheter interventions. The primary outcomes in this study were the survival rate during the first hospitalization period and the 1-year survival rate. RESULTS: Of the children born between 2008 and 2017, 193 were diagnosed with T18. Of these, 86 died, with a median survival of 127 days. The 1-year survival rate for children with T18 was 63.2%. The survival rate in the first admission of children with T18 who did and did not have congenital heart disease was 58.3% and 94.1%, respectively. Children with heart disease who underwent surgical or catheter intervention had a longer survival time than those who did not. CONCLUSIONS: We suggest these data could be used in ante- and postnatal counseling. Ethical concerns about the prolonged survival of children with T18 remain; however, the potential benefits of interventions for congenital heart disease in this population need further study. © 2023. The Author(s).ope

대한민국에 거주하는 이주 여성의 부정적 출산 결과 현황과 위험인자 분석

학위논문 (석사)-- 서울대학교 보건대학원 : 보건학과 보건정책관리학 전공, 2016. 2. 권순만.Background The Republic of Korea (Korea) experienced increases in births from immigrant women steadily over the last 20 years, accounting for a substantial proportion of total births (4.3 %). Nevertheless, little is known about birth outcomes of immigrant women in Korea. Methods This study compared the birth data of immigrant and native women in Korea and explored factors affecting birth outcomes of immigrant women. A total of 68,074 singletons from immigrant women and 1,644,956 singletons from natives were examined based on the National Birth Registration Database between 2010 and 2013. The outcomes included preterm births, low birth weight and small for gestational age (SGA). Adjusted proportions for the occurrence of preterm births, low birth weight and SGA were calculated, and performed subgroup analysis according to maternal original nationalities, maternal age, parity, and birth region. The birth outcomes of the immigrant group to a vulnerable group in Korea were compared. Add to that, the associated factors with those birth outcomes were assessed in multivariate analyses adjusted for demographic and socioeconomic factors. Results After adjusted for birth-related factors (infant sex, maternal age, marriage status, and parity) the adjusted proportions for preterm birth (4.9% vs. 4.6%, p < 0.001), low birth weight (4.2% vs. 3.6%, p < 0.001) and SGA (5.7% vs. 7.2%, p < 0.001) were significantly higher for immigrants than natives. However, after additionally adjusted for socioeconomic factors (birth region, parental education level, and occupation), preterm birth and low birth weight were significantly more favorable but SGA were still unfavorable in the immigrant group. The results were similar in the subgroup analysis for immigrants from Southeast Asia, but immigrants from China, Europe, or America revealed similar or more favorable outcomes compared to the native group. The results of stratified analyses showed that primiparous immigrant women and those between the ages of 20-34 had significantly higher proportions of adverse birth outcomes relative to native women. The results that compared to less educated parents or unemployed fathers in the native group revealed that the immigrant group had lower proportion of preterm birth and comparable proportion of low birth weight. Multivariate analysis showed that infant sex, parental ages and economic level of maternal original countries were related to preterm birth and low birth weight. After adjustment with all demographic and socioeconomic factors, the risks of preterm birth and low birth weight was lower, and that of SGA was higher in the immigrant group compared to the native group. Conclusions This study has provided evidence regarding the disparities in the risks of adverse birth outcomes among immigrant women and native women in Korea. However, to accurate assess the precise status of birth outcomes, and to identify the causes of adverse birth outcomes, additional information (e.g., health status of mothers and infants, monthly income, durations of residency in Korea) is needed. These data will be necessary to develop comprehensive policies that can reduce health disparities and support the successful settlement of immigrants in Korea.I. Introduction 1 A. Research Background 1 B. Research Purpose 3 C. Research Hypotheses 3 II. Literature review 4 A. Immigrant women in Korea 4 B. Factors related to preterm birth and low birth weight 5 C. Perinatal health of immigrants 7 D. Health problems of immigrant children in Korea 9 III. Methods 10 A. Data 10 1. Study design and data source 10 2. Variables 13 B. Statistical analysis 14 C. Ethics statement 15 IV. Results 16 A. Demographic and birth-related characteristics 16 B. Correlations among variables 19 C. Adverse birth outcomes among immigrant women in Korea 21 D. Subgroup analysis according to maternal original nationalities 23 E. Subgroup analysis according to demographic characteristics 33 F. Comparing outcomes among vulnerable populations 36 G. Factors that were associated with adverse birth outcomes 39 V. Discussion and Conclusion 48 A. Demographic characteristics of the study population 48 B. Correlation among variables 48 C. Adverse birth outcomes among immigrant women in Korea 49 D. Comparing the vulnerable immigrant and native Korean groups 53 E. Multivariate analyses of factors that were associated with birth outcomes 55 F. Limitations and implications 56 G. Conclusions 59 References 60 국문초록 65Maste

Looking into the life of technology-dependent children and their caregivers in Korea: lifting the burden of too many responsibilities

Background: The number of technology-dependent children (TDC) is increasing in South Korea, but available healthcare services after their discharge are poor. This study aimed to examine how TDC and caregivers live at home and identify their difficulties and needs regarding home care with few services to support them. Methods: This cross-sectional study was conducted in a tertiary hospital for children in South Korea. A self-reported questionnaire was completed by primary caregivers of TDC who were younger than 19 years and had been dependent on medical devices for more than 3 months. Technologies included home mechanical ventilation, oxygen supplementation, suction equipment, enteral feeding tube, and home total parenteral nutrition. Patterns of healthcare use and home care of TDC and caregivers' perception toward child were assessed. Results: A total of 74 primary caregivers of TDC completed a self-reported questionnaire. About 60% children were aged under 5 years. There were 31.1% children who required both respiratory and nutritional support. On average, caregivers took care of a child for 14.4 (±6.1) hours, slept for 5.6 (±1.6) hours, and spent 2.4 h per day on personal activities. Children used hospital services for 41.3 (±45.6) days in 6 months, and most (78.1%) were transported through private car/ambulance. Participants (75.6%) reported taking more than an hour to get to the hospital. More than 80% of caregivers responded that child care is physically very burdensome. The only statistically significant relationships was between economic status and financial burden (p = 0.026). Conclusions: Caregivers of TDC reported having significant time pressure regarding childcare-related tasks, insufficient time for personal activities, and inefficient hospital use because of inadequate medical services to support them in South Korea. Thus, it is necessary to support caregivers and develop a home care model based on current medical environment.ope

Association between birth weight and neurodevelopmental disorders assessed using the Korean National Health Insurance Service claims data

The risk of neurodevelopmental disorders in low birth weight (LBW) infants has gained recognition but remains debatable. We investigated the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-aged children according to their birth weight. We conducted a retrospective cohort study using the Korean National Health Insurance claims data of 2,143,652 children who were born between 2008 and 2012. Gestational age of infants was not available; thus, outcomes were not adjusted with it. Not only infants with birth weights of < 1.5 kg, but also 2.0-2.4 kg and 1.5-1.9 kg were associated with having ADHD; odds ratio (OR), 1.41 (95% confidence interval [CI] 1.33-1.50), and 1.49 (95% CI 1.33-1.66), respectively. The OR in infants with birth weights of 2.0-2.4 kg and 1.5-1.9 kg was 1.91 (95% CI 1.79-2.05) and 3.25 (95% CI 2.95-3.59), respectively, indicating increased odds of having ASD. Subgroup analysis for children without perinatal diseases showed similar results. In this national cohort, infants with birth weights of < 2.5 kg were associated with ADHD and ASD, regardless of perinatal history. Children born with LBW need detailed clinical follow-up.ope

Patent ductus arteriosus treatment trends and associated morbidities in neonates

To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.ope

Extrauterine growth restriction in extremely preterm infants based on the Intergrowth-21st Project Preterm Postnatal Follow-up Study growth charts and the Fenton growth charts

Growth charts are essential for monitoring the postnatal growth of preterm infants. The preterm postnatal follow-up study (PPFS) of the Intergrowth-21st Project provides new growth standards based on a longitudinal study. This study was conducted to investigate the prevalence of extrautrine growth restriction (EUGR) and the associated factors of EUGR in preterm infants, using the PPFS charts and the Fenton charts. Data of 1,356 infants with gestational age (GA) less than 28 weeks from the Korean Neonatal Network were analysed. The prevalence of small for gestational age (SGA) of weight and length was higher with the Intergrowth charts than with the Fenton charts. EUGR in weight and length was more prevalent when using the Fenton charts. Multivariate analysis showed that low GA, high birthweight z score, male, treated patent ductus arteriosus (PDA), necrotizing enterocolitis, intraventricular haemorrhage and duration of parenteral nutrition (PN) were associated with EUGR in weight by the Intergrowth charts. High birthweight z score, treated PDA and PN duration were associated with EUGR defined by the Fenton charts.Conclusion: Compared to the Fenton charts, SGA was more defined and EUGR was less prevalent in extremely low gestational infants, while EUGR defined by the Intergrowth charts categorized infants with adverse clinical courses more elaborately. What is Known: • Preterm infants are at risk of postnatal growth restriction (PGR), although optimal postnatal growth is important for the long-term outcomes. • Growth charts are essential tools to monitor the postnatal growth of preterm infants. What is New: • PGR of weight and length were less defined with the Intergrowth charts than the Fenton charts. • PGR defined by the Intergrowth preterm postnatal follow-up study (PPFS) chart categorized preterm infants with morbidities more elaborately than the Fenton charts.ope

황화물로 표면 개질된 나노영가철을 이용한 중금속오염 산성지하수 정화에 관한 연구

MasterHigh concentrations of Cd, Zn, Ni, and Al have been detected in the soil and groundwater near Yeongpoong zinc smelter in Seokpo, South Korea. The level of groundwater pollution was significant with pH 2.6, 315.5 mg/L of Cd, 1476.0 mg/L of Zn, 249.8 mg/L of Al, and 3.2 mg/L of Ni by a long-term unauthorized discharge of wastewater. Nanoscale zerovalent iron (nZVI) has been widely used to remediate various heavy metals in groundwater, but the sulfidation of nZVI can greatly improvea the reactivity toward Cd. In this study, a sulfidated nZVI (S-nZVI) was applied to remediate groundwater near the Yeongpoong zinc smelter. The batch tests confirmed the efficient removal of Ni and Al by the S-nZVI, but especially the sulfidation greatly enhanced the selective removal of Cd (99.8%) compared to that of nZVI (7.2%). The fate of heavy metals before and after treatments was predicted by MINEQL+ modeling and particle characterization indicated that Fe in FeS on S-nZVI simultaneously displaced with Cd and Zn and formed more stable CdS and ZnS. The additional NaHCO3 injection removed the remaining Zn and Fe after the S-nZVI treatment. The sequential S-nZVI and NaHCO3 treatments in column setup with Microtox toxicity test demonstrated the applicability of S-nZVI for the remediation of real acidic groundwater contaminated by high concentrations of heavy metals

Effects of short-term fine particulate matter exposure on acute respiratory infection in children

Background: Previous studies on the association between fine particulate matter (PM2.5) exposure and acute respiratory infection in children are scarce and present inconsistent results. We estimated the association between short-term PM2.5 exposure and acute respiratory infection among children aged 0-4 years using a difference-in-differences approach. Methods: We used data on the daily PM2.5 concentrations, hospital admissions for acute respiratory infection, and meteorological factors of the 15 regions in the Republic of Korea (2013-2015). To estimate the cumulative effects, we used a difference-in-differences approach generalized to multiple spatial units (regions) and time periods (day) with distributed lag non-linear models. Results: With PM2.5 levels of 20.0 μg/m3 as a reference, PM2.5 levels of 30.0 μg/m3 were positively associated with the risk of acute upper respiratory infection (relative risk (RR) = 1.048, 95% confidence interval (CI): 1.028, 1.069) and bronchitis or bronchiolitis (RR = 1.060, 95% CI: 1.038, 1.082) but not with the risk of acute lower respiratory infection and pneumonia. PM2.5 levels of 40.0 μg/m3 were also positively associated with the risk of acute upper respiratory infection (RR = 1.083, 95% CI: 1.046, 1.122) and bronchitis or bronchiolitis (RR = 1.094, 95% CI: 1.054, 1.136). Conclusions: We found the associations of short-term PM2.5 exposure with acute upper respiratory infection and bronchitis or bronchiolitis among children aged 0-4 years. As causal inference methods can provide more convincing evidence of the effects of PM2.5 levels on respiratory infections, public health policies and guidelines regarding PM2.5 need to be strengthened accordingly.restrictio