Currently, three different automated objective refractors are available commercially and are being used throughout the world. The most recently developed objective refractor. Dioptron, is an electro-optical instrument for measuring the refractive state of the eyes. The computer in this instrument takes the measurements and calculates automatically his objective refraction in term of sphere, cylinder and axis corrected for 12mm vertex distance. The motivation for this investigation was the need for a quantitative evaluation of Dioptron to determine how it may be utilized most effectively in clinical practice. The results in this study are based on comparisions of differences between Dioptron and streak retinoscopy which were examined the random samples of 800 eyes. In this analysis, authors found that the Dioptron proved to be more accurate in the cylinder and axis and equivalent in sphere findings when compared to streak retinoscopy although Dioptron could not replace physician's judgement.
Axis, Cervical Vertebra ; Evaluation Studies as Topic ; Motivation ; Retinoscopy*

We undertook a multi-hospital collective study to evaluate outcomes of neonatal respiratory distress syndrome (RDS) patients treated with pulmonary surfactant (PS) over 17 yr in Korea (Group I; 1990/91, Group II; 1996, Group III; 2002, and Group IV; 2007). There were 60 neonates in Group I (16 hospitals), 1,179 in Group II (64), 1,595 in Group III (62), and 1,921 in Group IV (57). We adopted Bomsel's classification to evaluate initial chest radiographic findings, categorized RDS severities, and classified response types to PS therapy. Almost all cases were treated using a single dose in Groups I and II, but 19.5% received multiple-dose therapy in Group IV. In Group IV, Bomsel's stages III and IV composed 62.9% and initial severities of mild, moderate, and severe RDS were 23.0%, 42.0%, and 35.0%. More infants showed good response in Groups II, III, and IV than in Group I (71.7%, 66.8%, and 69.2% vs. 58.3%). Complications and mortality rate were lower in Group IV than in Groups I, II, and III (mortality rate: 14.3% vs. 40.0%, 30.0%, and 18.7%). We conclude that PS therapy in neonates with RDS had a remarkable impact on improving clinical course and outcomes over 17 yr in Korea.
Birth Weight ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature, Diseases/epidemiology/mortality/pathology/*therapy ; Korea/epidemiology ; Longitudinal Studies ; Pregnancy ; Pulmonary Surfactants/*therapeutic use ; Questionnaires ; Radiography, Thoracic ; Respiratory Distress Syndrome, Newborn/epidemiology/mortality/pathology/*therapy ; Treatment Outcome

PURPOSE:To evaluate the neonatal statistics on a national basis, data for birth characteristics and neonatal mortality were collected and analyzed from 57 hospitals in Korea. METHODS:Questionnaires were distributed to determine the characteristics of neonatal births and mortality rates in 57 hospitals in Korea during 2007. We analyzed the characteristics of all inborn births and hospitalized neonates in the neonatal care units (NICUs) and compared the results with published Korean data from 1996 and 2002. RESULTS:A total of 40,433 inborn live births were reported from the 57 hospitals during 2007. Pre-term, term, and post-term births comprised 24.2%, 75.6%, and 0.2% of the neonates, respectively. Low birth weight infants (LBWIs), very low birth weight infants (VLBWIs), and extremely low birth weight infants (ELBWIs) made up 22.0%, 4.6%, and 1.7% of the neonates, respectively. A total of 21,957 (collected by gestational period) and 21,356 (collected by birth weight) neonates were hospitalized in the 57 NICUs. Pre-term, term, and post-term neonates comprised 39.8%, 59.8%, and 0.4% of the neonates, respectively. LBWIs, VLBWIs, and ELBWIs made up 37.3%, 9.5%, and 3.3% of the neonates, respectively. Pre-term, term, and post-term neonates had mortality rates of 4.5%, 0.7%, and 3.7%, respectively, while the mortality rates of LBWIs, VLBWIs, and ELBWIs were 4.7%, 15.3%, and 32.2%, respectively. In comparison with prematurity data from 1996 and 2002, LBWIs, and ELBWIs had a marked increase in birth frequency and a decreased mortality rate in Korea during 2007. CONCLUSION:The number of live births and the survival rate of pre-term neonates, especially VLBWIs and ELBWIs, are increasing. Even though the outcomes of neonatal care are improving, further efforts to manage these premature infants are needed.
Birth Rate ; Humans ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Korea ; Live Birth ; Parturition ; Survival Rate

PURPOSE: Recently, Forkhead box M1 (FoxM1) was reported to be correlated with lung maturation and expression of surfactant proteins (SPs) in mice models. However, no study has been conducted in rabbit lungs despite their high homology with human lungs. Thus, we attempted to investigate serial changes in the expressions of FoxM1 and SP-A/B throughout lung maturation in rabbit fetuses. MATERIALS AND METHODS: Pregnant New Zealand White rabbits were grouped according to gestational age from 5 days before to 2 days after the day of expected full term delivery (F5, F4, F3, F2, F1, F0, P1, and P2). A total of 64 fetuses were enrolled after Cesarean sections. The expressions of mRNA and proteins of FoxM1 and SP-A/B in fetal lung tissue were tested by quantitative reverse-transcriptase real-time PCR and Western blot. Furthermore, their correlations were analyzed. RESULTS: The mRNA expression of SP-A/B showed an increasing tendency positively correlated with gestational age, while the expression of FoxM1 mRNA and protein decreased from F5 to F0. A significant negative correlation was found between the expression levels of FoxM1 and SP-A/B (SP-A: R=-0.517, p=0.001; SP-B: R=-0.615, p<0.001). CONCLUSION: Preterm rabbits demonstrated high expression of FoxM1 mRNA and protein in the lungs compared to full term rabbits. Also, the expression of SP-A/B was inversely related with serial changes in FoxM1 expression. This is the first report to suggest an association between FoxM1 and expression of SP-A/B and lung maturation in preterm rabbits.
Animals ; Blotting, Western ; Female ; Fetus/*metabolism ; Forkhead Transcription Factors/*metabolism ; Lung/*metabolism ; Pregnancy ; Pulmonary Surfactant-Associated Protein A/genetics/*metabolism ; Rabbits

In Korea, pulmonary surfactant (PS) replacement therapy in respiratory distress syndrome (RDS) was started in 1991 since when Surfacten(R) was imported from Japan. At the present time, Surfacten(R), Newfactan(R), Curosurf(R), and Infasurf(R) are available in Korea. The governmental health insurance covers the expense for multiple dose treatment since 2002 and the early prophylactic treatment (BW: <1,250 g or GP: <30 wks) since 2011. We undertook a multi-institutional collective study to evaluate the outcomes of PS over past 20 years in Korea (Period-I; 1990/91, P-II; 1996, P-III; 2002, and P-IV; 2007, P-V; 2010). There were 60 RDS neonates with PS treatment in P-I (16 hospitals), 1,179 in P-II (64), 1,595 in P-III (62), 1,921 in P-IV (57), and 3,160 in P-V (72). Decreased mortality rate, defined as the percentage of neonates who died within 28 days of birth, was seen between periods, P-V vs P-I, II, III, and IV (mortality rate: 10.1% vs. 40.0%, 30.0%, 18.7%, and 14.3%). We conclude that PS therapy contributed to improve remarkable outcome in RDS neonates over the last 20 years in Korea. However, more efforts should be made to optimize PS therapy for better outcome. Multiple PS doses for relapse and poor response, early prophylactic use, and better supportive care for pre-term infants are mandatory.
Humans ; Infant ; Infant, Newborn ; Insurance, Health ; Japan ; Korea ; Parturition ; Pulmonary Surfactants ; Recurrence

Umbilical venous catheter (UVC) insertion is a life-saving procedure in neonates who require neonatal intensive care unit (NICU). It is a relatively easy procedure and it is routinely performed on the NICU. This life-saving yet relatively easy procedure, however, can yield some undesirable complications if it is not administered correctly. One of them is a liver abscess. This is a case report of a preterm infant who developed a liver abscess after UVC insertion. We inserted UAC and UVC to a preterm of 35 weeks of gestational age and birth weight of 2,720 g for treatment of respiratory distress syndrome, patent ductus arteriosus, and sepsis. A liver abscess associated with UVC was suspected on screening abdominal sonogram performed for evaluation of infection at 8 days of life. UAC was removed at 5 days of life, however, UVC was still being used. The patient recovered after 4 weeks of antibiotic treatment with prompt elimination of UVC. This case along with a brief review of literature illustrates an importance of proper maintenance and casuistic use of UVC for preterm infants.
Birth Weight ; Catheterization ; Catheters ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Liver ; Liver Abscess ; Mass Screening ; Sepsis

With regard to the outcome of intensive neonatal care, one of the most important concerns in neonatology is the mortality rate of very low birth weight infants (VLBWI; birth weight < 1,500 g) and extremely low birth weight infants (ELBWI; birth weight < 1,000 g). The present study was conducted to analyze and compare the mortality of VLBWI and ELBWI and neonatal care among Korean, Japanese, and American newborns. In Korea, the survival rates of VLBWI have increased significantly; they were 31.8% in the early 1960s, 65.8% in the early 1990s, 77.5% in 2002, 84.7% in 2007, and 85.7% in 2009. The survival rates of ELBWI have also increased; they were 8.2% in the early 1960s, 37.4% in the early 1990s, 56.1% in 2002, 67.7% in 2007, and 71.8% in 2009. The survival rates of VLBWI and ELBWI have significantly improved over the past 50 yr in Korea. However, the Korean survival rates of VLBWI and ELBWI are still lower than for similar groups in Japan and the USA. To achieve better outcomes that reach the level of these countries, the organization of perinatal care centers, nationwide neonatal perinatal research networks, and regionalization are needed in Korea.
Female ; Humans ; Infant Mortality/*trends ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Japan/epidemiology ; Perinatal Care/trends ; Pregnancy ; Republic of Korea/epidemiology ; Survival Rate ; United States/epidemiology

PURPOSE: The aim of our study is to identify the demographic changes of maternal age distribution in live births and incidence of low birth weight infants in advanced maternal age (> or =35 years of age) group at the time of birth in Korea. METHODS: Birth statistics in 1995, 2000, 2005, and 2008 were collected from Korean Statistical Information Service. Based on the data, total births in each group were 715,000, 634,000, 435,000, and 465,000, respectively. Maternal age distribution ranged from the age of 15 to 50, which were all fertile women. Infants were divided into groups according to birth weight. After maternal age distribution of each year and proportion of advanced maternal age group were examined, a retrospective analysis was conducted on incidence of low birth weight infant (LBWI) in advanced age pregnancy. RESULTS: Number of live births was constantly decreasing during the period of investigation. There was a shift in maternal age distribution; fertile women of the age of 25 to 29 accounted for 54.2% and 51.7% in 1995 and 2000 respectively, whereas those of the age 30 to 34 accounted for 40.8% and 42.7% in 2005 and 2008, respectively. Rate of delivery in elderly gravida were 4.8%, 6.9%, 10.8%, 14.5% in 1995, 2000, 2005 and 2008 respectively, showing a rapid increase. Of the live births, LBWI accounted for 3.0%, 3.8%, 4.3%, 4.9%, thus being increased by about 1.5 times. Overall, with rates of 7.8%, 10.3%, 15.2%, 19.0%, respectively, the proportion of advanced maternal age group with resultant LBWI was higher than that of elderly gravida alone. CONCLUSION: While there has been a constant decrease in number of live births in the last decade in Korea, proportion of advanced maternal age group is rapidly increasing and incidence of LBWI is also gradually increasing. Furthermore, considering that the incidence of LBWI among elderly gravida was increased by a higher degree than proportion of elderly gravida in maternal age distribution, maternal age can be one of the factors causing LBWI.
Aged ; Birth Weight ; Delivery, Obstetric ; Female ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Information Services ; Korea ; Live Birth ; Maternal Age ; Parturition ; Reproductive History ; Retrospective Studies

PURPOSE: Recently, the incidence of preterm and low birth weight infants (LBWI) is increasing, even though the birth rate is continuously low in Korea. Despite that change, there continues to be a deficit of beds in the neonatal intensive care unit (NICU). This study is based on the 2009 Korean Statistical Information Service that examined the development of a Korean NICU service and the survival rate of preterm infants by regionally analyzing the rate of total live births, preterm infants, LBWI, and NICU beds in Korea. METHODS: Data were obtained from the Korean Health Insurance Review and Assessment Service and Korean Statistical Information Service. We confirmed the regional total live birth rate, number of LBWI, and preterm infants and NICU numbers, and all of the results were compared to the average value to determine deficient areas of NICU beds. RESULTS: There were 25,374 (5.7%) preterm infants and 21,954 (4.9%) LBWI in the total number of live births (444,849) in 2009, and regions of high proportion compared to the mean value were Busan, Daegu, and Ulsan. Total NICU beds totaled 1,284, and regions of high rates preterm infants and LBWI per 1 NICU bed compared to the mean value were Incheon, Daegu, Ulsan, etc. The NICU holding rate was 87.5% (1,284/1,468), which was increased from 2005. However, there were still shortages of 184 NICU beds (12.5%), especially in Gyeonggi-do, which lacked 157 beds. CONCLUSION: High risk neonates difficult to transfer, and they need immediate and continuous treatment. As a result, a foundation of well-balanced, national NICU regionalization is necessary. This study suggested that more NICU facilities must be implemented, and clinicians should realize the continuing deficiency of NICU beds in cities and provinces.
Birth Rate ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Information Services ; Insurance, Health ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Korea ; Live Birth ; Survival Rate

Adult ; Aged ; Anti-Anxiety Agents ; therapeutic use ; Benign Paroxysmal Positional Vertigo ; Dizziness ; drug therapy ; etiology ; Female ; Humans ; Male ; Middle Aged ; Otolithic Membrane ; Semicircular Canals ; Vertigo ; therapy