Background:The prevalence of obesity is increasing in South Korea. We aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care in South Korea. Methods: The Awareness, Care, and Treatment In Obesity maNagement-an International Observation (AC-TION-IO) study was a cross-sectional survey conducted in 11 countries. Respondents were people with obesity (PwO; body mass index ≥25 kg/m 2 in South Korea from self-reported height/weight) and healthcare professionals (HCPs) primarily involved in direct care with PwO. Results: The survey was completed by 1,500 PwO and 200 HCPs in South Korea. PwO (78%) and HCPs (81%) agreed that obesity is a chronic disease, but more PwO (84%) believed that obesity has an extreme impact on their overall health compared with HCPs (65%). Most PwO felt completely responsible for their own weight loss (81%), and 78% reported at least one serious weight loss attempt in the past. In contrast, HCPs reported that, on average, only 35% of their patients with obesity had made a serious attempt at losing weight. Only 31% of PwO had discussed weight with their HCP in the past 5 years; of those, 78% appreciated that HCPs initiated these conversations. Short appointment times restricted weight loss discussions for 70% of HCPs, and 29% of HCPs expressed complete comfort with such conversations. Conclusion: South Korean PwO are motivated to lose weight and have expressed interest in HCPs being more active in their weight management. Further nationwide efforts may be required to lower the barriers to education about obesity and effective weight loss discussion and management.
Purpose: Extremely preterm infants are prone to brain injury and underdevelopment. Intraventricular hemorrhage (IVH) is the most common cause of brain injury and a significant risk factor for neurodevelopmental delay in preterm infants. Severe IVH is known to have a poor outcome; however, the outcomes of low-grade IVH remain controversial. This study aimed to evaluate neurodevelopmental outcomes and brain segmental volumes of preterm infants with low-grade IVH.Methods: This retrospective cohort study included 109 extremely preterm infants who underwent term equivalent age-magnetic resonance imaging and neurodevelopmental evaluation at a corrected age of 18 to 24 months. We compared infants with and without low-grade IVH.Results: Among the 109 extremely preterm infants, 25 had low-grade IVH and 84 had no IVH. There were no significant differences in the neurodevelopmental outcomes between the low-grade and no IVH groups. In multivariate analysis, low-grade IVH was associated with a smaller medullary volume (adjusted odds ratio, 0.575; 95% confidence interval, 0.346 to 0.957; <i>P</i>=0.034).Conclusion: We found no significant differences in the neurodevelopmental outcomes of extremely preterm infants at a corrected age of 18 to 24 months between those with low-grade IVH and those without IVH. Low-grade IVH was associated with a smaller medullary volume.
Purpose: Premature infants are prone to impaired neurodevelopmental outcomes due to brain injury or underdevelopment. However, these outcomes may be present without any brain lesions. The association between neonatal morbidities and the volume of segmentalbrain structures is not fully understood. Therefore, we analyzed the association between brain structure volumes, neonatal morbidities, and neurodevelopmental outcomesin extremepreterm infants. Methods: This retrospective cohort study included 158 extreme preterm infants, in whom brain magnetic resonance imaging at term equivalent age (TEA-MRI) and neurodevelopmental evaluation wereperformed at a corrected age of 18–24 months.Patients with congenital anomalies or significant brain lesions, such as high-grade intraventricular hemorrhage and periventricular leukomalacia were excluded. Medical records, including the Bayley Scales of Infant and Toddler Development 3rd Edition (BSID-III), of preterm infants were reviewed and analyzed. FreeSurfer infant software was used to evaluatebrain structures, while volumes of specific brain regions were adjusted for gestational age and postmenstrual age on MRI using multivariate regression analysis. Results: Preterm infants with neurodevelopmental impairment had smaller midbrain (aOR 0.804, 95% CI 0.647–0.998). Neonatal morbidities of preterm infants included respiratory distress syndrome (RDS), which was associated with a smaller volume of the medulla (aOR 0.593, 95% CI 0.387–0.908), ventral diencephalon (aOR 0.730, 95% CI 0.572–0.932), and putamen (aOR 0.874, 95% CI 0.788–0.969). Patent ductus arteriosus (PDA) requiring surgery was associated with a smaller volume of the pons (aOR 0.727, 95% CI 0.594–0.889) and vermis (aOR 0.766, 95% CI 0.646–0.907). Retinopathy of prematurity (ROP) requiring surgery was associated with a smaller pons volume (aOR 0.729, 95% CI 0.600–0.886). Necrotizing enterocolitis (NEC) requiring surgery was associated with a smaller volume of the pons (aOR 0.751, 95% CI 0.661–0.854), vermis (aOR 0.832, 95% CI 0.745–0.930), and cerebellum (aOR 0.974, 95% CI 0.960–0.989). Conclusions: Among preterm infants without significant brain injuries, smaller volume of midbrain was associated with impaired neurodevelopment. RDS and morbidities requiring surgery such as PDA, ROP, and NEC were associated with reduced segmental volumes of the brain in preterm infants.
Perinatal outcomes of twin pregnancies are determined by several factors, such as gestational age (GA), chorionicity, and discordance at birth. This retrospective study aimed to investigate the association of chorionicity and discordance with neonatal and neurodevelopmental outcomes in preterm twin infants from uncomplicated pregnancy. Data of very preterm twin infants who were both live-born between 2014 and 2019 on the chorionicity of the twin, diagnosis of the twin-to-twin syndrome (TTTS), weight discordance at birth, and neonatal and neurodevelopmental outcomes at 24 months of corrected age (CA) were collected. Of the 204 twin infants analyzed, 136 were dichorionic (DC) and 68 were monochorionic (MC), including 15 pairs with TTTS. After adjusting for GA, brain injury, including severe intraventricular hemorrhage and periventricular leukomalacia, was mostly found in the MC with TTTS group, with a higher incidence of cerebral palsy and motor delay at CA 24 months. After excluding TTTS, multivariable analysis showed no association between chorionicity and neonatal and developmental outcomes, whereas small infants among co-twins (adjusted odds ratio (aOR) 3.33, 95% confidence interval 1.03–10.74) and greater discordance (%) of weight at birth (aOR 1.04, 1.00–1.07) were associated with neurodevelopmental impairment. Monochorionicity might not determine adverse outcomes among very preterm twins from uncomplicated pregnancy.
Introduction: Surgical ligation for hemodynamically significant patent ductus arteriosus (PDA) is sometimes required in preterm infants; however, some patients experience worsened respiratory status after the surgery. This study aimed to evaluate the risk factors that could predict worsened respiratory outcomes after PDA ligation. Methods: A retrospective cohort study was performed on 57 preterm infants born at less than 32 weeks of gestational age and in whom the PDA was surgically ligated between January 2014 and December 2018 at Seoul National University Children’s Hospital. Participants were divided into two groups: infants with worsened respiratory outcomes 14 days after ligation and control. Worsened respiratory outcome was defined as increase in respiratory severity score (RSS) by 30% or more at 14 days after ligation compared to RSS before ligation, or death at 14 days after ligation. Results: Among the 57 PDA-ligated infants, 12 had worsened respiratory outcomes and 45 did not. The worsened respiratory outcomes were associated with oligohydramnios (adjusted OR 1.373, 95% CI 1.113-1.694.), histologic chorioamnionitis (adjusted OR 1.240, 95% CI 1.016-1.512), and decreased weight on the day of surgery (adjusted OR 0.999, 95% CI 0.999-0.999) compared to that in the control. Conclusion: Worsened respiratory outcomes after PDA ligation appeared to be associated with oligohydramnios, histologic chorioamnionitis, and weight on the day of surgery.
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