Background: Even before coronavirus disease 2019 (COVID-19), unexpected new infectious diseases such as severe acute respiratory syndrome, novel influenza A and Middle East respiratory syndrome (MERS) affected the Korean healthcare systems. Nevertheless, during the COVID-19 period, we still experienced difficulties in systematic response. Especially in Ulsan Metropolitan City, which had no confirmed cases during the MERS, the response infrastructure was also very insufficient. Therefore, this study aimed to investigate in depth experiences of managers and practitioners of infectious disease management organizations with the COVID-19 response and identify areas for improvement in the response to future novel infectious diseases. Methods: We recruited participants through targeted and snowball sampling. Data were collected between March 27 and May 2, 2023, through in-depth interviews with 15 healthcare workers from Ulsan Metropolitan City, South Korea, including civil servants, physicians, nurses, and administrative staff, all of whom had experience with the COVID-19 response. Results: We extracted 1,496 semantic units, 16 subcategories, and 5 categories. The participants experienced confusion at being inserted into the infectious disease response without a thorough understanding of the work due to the sudden appearance of COVID-19.In the absence of precise manuals or designated consultancies, the participants’ confusion was exacerbated by frequent changes to guidelines and insufficient communication, and they felt despair by others’ passive attitudes, which contradicted their own feelings. They also felt bewildered that they were not supported by policy, despite having chosen to support a great cause in an emergency. Excessive workloads led to health problems. Nevertheless, the participants actively sought help, received support, made efforts to construct the response environment, and felt a sense of reward when they witnessed the results. The participants emphasized the need to build up the inadequate public healthcare system in Ulsan to prepare for future novel infectious diseases, to maintain a trained, professional workforce, and to secure a sufficient budget to provide support and compensation. Conclusion The findings indicate that local governments need to establish public healthcare systems and secure professionals for responding to novel infectious diseases.

Background: Even before coronavirus disease 2019 (COVID-19), unexpected new infectious diseases such as severe acute respiratory syndrome, novel influenza A and Middle East respiratory syndrome (MERS) affected the Korean healthcare systems. Nevertheless, during the COVID-19 period, we still experienced difficulties in systematic response. Especially in Ulsan Metropolitan City, which had no confirmed cases during the MERS, the response infrastructure was also very insufficient. Therefore, this study aimed to investigate in depth experiences of managers and practitioners of infectious disease management organizations with the COVID-19 response and identify areas for improvement in the response to future novel infectious diseases. Methods: We recruited participants through targeted and snowball sampling. Data were collected between March 27 and May 2, 2023, through in-depth interviews with 15 healthcare workers from Ulsan Metropolitan City, South Korea, including civil servants, physicians, nurses, and administrative staff, all of whom had experience with the COVID-19 response. Results: We extracted 1,496 semantic units, 16 subcategories, and 5 categories. The participants experienced confusion at being inserted into the infectious disease response without a thorough understanding of the work due to the sudden appearance of COVID-19.In the absence of precise manuals or designated consultancies, the participants’ confusion was exacerbated by frequent changes to guidelines and insufficient communication, and they felt despair by others’ passive attitudes, which contradicted their own feelings. They also felt bewildered that they were not supported by policy, despite having chosen to support a great cause in an emergency. Excessive workloads led to health problems. Nevertheless, the participants actively sought help, received support, made efforts to construct the response environment, and felt a sense of reward when they witnessed the results. The participants emphasized the need to build up the inadequate public healthcare system in Ulsan to prepare for future novel infectious diseases, to maintain a trained, professional workforce, and to secure a sufficient budget to provide support and compensation. Conclusion The findings indicate that local governments need to establish public healthcare systems and secure professionals for responding to novel infectious diseases.

Background: Even before coronavirus disease 2019 (COVID-19), unexpected new infectious diseases such as severe acute respiratory syndrome, novel influenza A and Middle East respiratory syndrome (MERS) affected the Korean healthcare systems. Nevertheless, during the COVID-19 period, we still experienced difficulties in systematic response. Especially in Ulsan Metropolitan City, which had no confirmed cases during the MERS, the response infrastructure was also very insufficient. Therefore, this study aimed to investigate in depth experiences of managers and practitioners of infectious disease management organizations with the COVID-19 response and identify areas for improvement in the response to future novel infectious diseases. Methods: We recruited participants through targeted and snowball sampling. Data were collected between March 27 and May 2, 2023, through in-depth interviews with 15 healthcare workers from Ulsan Metropolitan City, South Korea, including civil servants, physicians, nurses, and administrative staff, all of whom had experience with the COVID-19 response. Results: We extracted 1,496 semantic units, 16 subcategories, and 5 categories. The participants experienced confusion at being inserted into the infectious disease response without a thorough understanding of the work due to the sudden appearance of COVID-19.In the absence of precise manuals or designated consultancies, the participants’ confusion was exacerbated by frequent changes to guidelines and insufficient communication, and they felt despair by others’ passive attitudes, which contradicted their own feelings. They also felt bewildered that they were not supported by policy, despite having chosen to support a great cause in an emergency. Excessive workloads led to health problems. Nevertheless, the participants actively sought help, received support, made efforts to construct the response environment, and felt a sense of reward when they witnessed the results. The participants emphasized the need to build up the inadequate public healthcare system in Ulsan to prepare for future novel infectious diseases, to maintain a trained, professional workforce, and to secure a sufficient budget to provide support and compensation. Conclusion The findings indicate that local governments need to establish public healthcare systems and secure professionals for responding to novel infectious diseases.

Background: Even before coronavirus disease 2019 (COVID-19), unexpected new infectious diseases such as severe acute respiratory syndrome, novel influenza A and Middle East respiratory syndrome (MERS) affected the Korean healthcare systems. Nevertheless, during the COVID-19 period, we still experienced difficulties in systematic response. Especially in Ulsan Metropolitan City, which had no confirmed cases during the MERS, the response infrastructure was also very insufficient. Therefore, this study aimed to investigate in depth experiences of managers and practitioners of infectious disease management organizations with the COVID-19 response and identify areas for improvement in the response to future novel infectious diseases. Methods: We recruited participants through targeted and snowball sampling. Data were collected between March 27 and May 2, 2023, through in-depth interviews with 15 healthcare workers from Ulsan Metropolitan City, South Korea, including civil servants, physicians, nurses, and administrative staff, all of whom had experience with the COVID-19 response. Results: We extracted 1,496 semantic units, 16 subcategories, and 5 categories. The participants experienced confusion at being inserted into the infectious disease response without a thorough understanding of the work due to the sudden appearance of COVID-19.In the absence of precise manuals or designated consultancies, the participants’ confusion was exacerbated by frequent changes to guidelines and insufficient communication, and they felt despair by others’ passive attitudes, which contradicted their own feelings. They also felt bewildered that they were not supported by policy, despite having chosen to support a great cause in an emergency. Excessive workloads led to health problems. Nevertheless, the participants actively sought help, received support, made efforts to construct the response environment, and felt a sense of reward when they witnessed the results. The participants emphasized the need to build up the inadequate public healthcare system in Ulsan to prepare for future novel infectious diseases, to maintain a trained, professional workforce, and to secure a sufficient budget to provide support and compensation. Conclusion The findings indicate that local governments need to establish public healthcare systems and secure professionals for responding to novel infectious diseases.

Neonatal chylothorax is a potentially fatal respiratory condition caused by a congenital or traumatic etiology. Conventional therapies, such as fasting, total parenteral nutrition, and intravenous octreotide, are generally successful in such cases; however, more invasive therapeutic measures, such as pleurodesis, should be considered in refractory cases. This case report presents two preterm infants with refractory chylothorax who were non-responsive to conventional treatment but were successfully managed using hypertonic glucose pleurodesis. The first case was that of a female infant born at 24+5 weeks of gestation (585 g) and diagnosed with postsurgical chylothorax at 68 days of life. Even after the initiation of fasting and intravenous octreotide administration, pleural drainage did not reduce. Therefore, the patient underwent three intermittent procedures of 50% glucose pleurodesis, which resulted in the resolution of the chylothorax and subsequent chest tube removal after 37 days. The second case was a female infant born at 34+6 weeks (3,040 g), who was diagnosed with congenital chylothorax immediately after birth. Fasting and intravenous octreotide failed to show any clinical effects; therefore, the patient underwent pleurodesis for 3 consecutive days. After the procedure, the amount of pleural drainage substantially decreased, and the chest tube was removed after 14 days. In both cases, a temporal relation between pleurodesis and chylothorax resolution was observed, suggesting that hypertonic glucose pleurodesis may be an effective and safe alternative for treating refractory chylothorax in preterm infants with minimal side effects. Further studies are needed to establish the optimal protocol for this procedure and to compare its efficacy with that of other pleurodesis agents.

Neonatal chylothorax is a potentially fatal respiratory condition caused by a congenital or traumatic etiology. Conventional therapies, such as fasting, total parenteral nutrition, and intravenous octreotide, are generally successful in such cases; however, more invasive therapeutic measures, such as pleurodesis, should be considered in refractory cases. This case report presents two preterm infants with refractory chylothorax who were non-responsive to conventional treatment but were successfully managed using hypertonic glucose pleurodesis. The first case was that of a female infant born at 24+5 weeks of gestation (585 g) and diagnosed with postsurgical chylothorax at 68 days of life. Even after the initiation of fasting and intravenous octreotide administration, pleural drainage did not reduce. Therefore, the patient underwent three intermittent procedures of 50% glucose pleurodesis, which resulted in the resolution of the chylothorax and subsequent chest tube removal after 37 days. The second case was a female infant born at 34+6 weeks (3,040 g), who was diagnosed with congenital chylothorax immediately after birth. Fasting and intravenous octreotide failed to show any clinical effects; therefore, the patient underwent pleurodesis for 3 consecutive days. After the procedure, the amount of pleural drainage substantially decreased, and the chest tube was removed after 14 days. In both cases, a temporal relation between pleurodesis and chylothorax resolution was observed, suggesting that hypertonic glucose pleurodesis may be an effective and safe alternative for treating refractory chylothorax in preterm infants with minimal side effects. Further studies are needed to establish the optimal protocol for this procedure and to compare its efficacy with that of other pleurodesis agents.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Background: Extracorporeal membrane oxygenation (ECMO) is the only treatment option that can stabilize patients with congenital diaphragmatic hernia (CDH) with severe pulmonary hypertension. This study assessed the effects of a multidisciplinary ECMO team approach (META) as part of a quality improvement initiative aimed at enhancing the survival rates of neonates with CDH. Methods: The medical records of infants with CDH treated at a tertiary center were retrospectively reviewed. Patients were categorized into two groups based on META implementation. The META group (P2) were given key interventions, including on-site ECMO management within the neonatal intensive care unit (NICU), use of venoarterial modality, ECMO indication as a priority even before the use of inhaled nitric oxide, and preplanned surgery following ECMO discontinuation. These approaches were compared with standard protocols in the pre-META group (P1) to assess their effects on clinical outcomes, particularly in-hospital mortality. Results: Over a 16-year period, 322 patients were included. P2 had a significantly higher incidence of non-isolated CDH and higher rate of cesarean section compared with P1.Moreover, P2 had delayed time to surgical repair (9.4 ± 8.0 days) compared with P1 (6.7 ± 7.3 days) (P = 0.004). The overall survival rate at NICU discharge was 72.7%, with a significant improvement from P1 (66.3%, 132/199) to P2 (82.9%, 102/123) (P = 0.001). Among the 68 patients who received ECMO, P2 had significantly lower baseline oxygenation index and serum lactate levels before ECMO cannulation than P1. The survival rate of patients who received ECMO also remarkably improved from P1 (21.1%, 8/38) to P2 (56.7%, 17/30).Subgroups who could be weaned from ECMO before 2 weeks after cannulation showed the best survival rate. Conclusion META significantly improved the survival rate of newborn infants with CDH.Further interventions, including prenatal intervention and novel ECMO strategies, may help improve the clinical outcomes and quality of life.

Background: Extracorporeal membrane oxygenation (ECMO) is the only treatment option that can stabilize patients with congenital diaphragmatic hernia (CDH) with severe pulmonary hypertension. This study assessed the effects of a multidisciplinary ECMO team approach (META) as part of a quality improvement initiative aimed at enhancing the survival rates of neonates with CDH. Methods: The medical records of infants with CDH treated at a tertiary center were retrospectively reviewed. Patients were categorized into two groups based on META implementation. The META group (P2) were given key interventions, including on-site ECMO management within the neonatal intensive care unit (NICU), use of venoarterial modality, ECMO indication as a priority even before the use of inhaled nitric oxide, and preplanned surgery following ECMO discontinuation. These approaches were compared with standard protocols in the pre-META group (P1) to assess their effects on clinical outcomes, particularly in-hospital mortality. Results: Over a 16-year period, 322 patients were included. P2 had a significantly higher incidence of non-isolated CDH and higher rate of cesarean section compared with P1.Moreover, P2 had delayed time to surgical repair (9.4 ± 8.0 days) compared with P1 (6.7 ± 7.3 days) (P = 0.004). The overall survival rate at NICU discharge was 72.7%, with a significant improvement from P1 (66.3%, 132/199) to P2 (82.9%, 102/123) (P = 0.001). Among the 68 patients who received ECMO, P2 had significantly lower baseline oxygenation index and serum lactate levels before ECMO cannulation than P1. The survival rate of patients who received ECMO also remarkably improved from P1 (21.1%, 8/38) to P2 (56.7%, 17/30).Subgroups who could be weaned from ECMO before 2 weeks after cannulation showed the best survival rate. Conclusion META significantly improved the survival rate of newborn infants with CDH.Further interventions, including prenatal intervention and novel ECMO strategies, may help improve the clinical outcomes and quality of life.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.