Su-Kyung Lee, M.S., Su Jin Oh, M.S., Seoheui Choi, M.D., Soo Han Choi, M.D., Seon-Hee Shin, M.D., Eun Jin Lee, M.D., Eun-Jung Cho, M.D., Jungwon Hyun, M.D., Hyun Soo Kim, M.D.. Ann Lab Med 2021;41:181-9. https://doi.org/10.3343/alm.2021.41.2.181

To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database. From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples. Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons. Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.

Appropriate stress reportedly influences memory gains. However, stress levels may vary across individuals and may lead to changes in vital signs as a physiological response induced by endogenous hormone secretion. The aim of this study was to evaluate the impact of high-fidelity simulation (HFS) training on cognitive performance using Perceived Stress Scale (PSS) scores as a subjective stress indicator and vital sign measurements as an objective stress indicator during Neonatal Resuscitation Program training. This study was conducted as a single-blind randomized controlled study with a pre-post design for health care workers, including paediatric residents and nurses in charge of neonatal care. The trainees' vital signs and PSS scores were measured and determined before, during, and after each training session, and the results were analysed. A comparison of vital signs between groups after each training session revealed significant changes in heart rate (HR), and the PSS score significantly increased after practical training (2nd HR; 78.4 ± 9.0 vs. 87.7 ± 8.7, p = 0.05; 3rd HR 83.1 ± 9.0 vs. 76.7 ± 8.1, p = 0.041: 2nd PSS 15.1 ± 3.3 vs. 18.2 ± 4.8, p = 0.040), but there was no difference between the groups in terms of the final confirmed test result or PSS score (3rd result 66.3 ± 24.4 vs. 72.7 ± 12.7, p = 0.360; 3rd PSS 17.2 ± 4.9 vs. 16.1 ± 4.8, p = 0.510). When comparing vital signs, test scores, and PSS scores before and after HFS, regardless of the training sequence, no statistically significant changes were observed in the HR or respiratory rate (RR). However, body temperature (BT; 36.5 ± 0.3 vs. 36.7 ± 0.3, p < 0.001), mean blood pressure (BP; 81.9 ± 11.8 vs. 84.8 ± 10.2, p = 0.030), test scores (51.0 ± 26.2 vs. 56.6 ± 23.2, p < 0.001), and PSS scores (15.8 ± 3.8 vs. 17.7 ± 4.8, p = 0.036) significantly increased, whereas SpO₂ significantly decreased (99.3 ± 0.8 vs. 98.8 ± 1.4, p = 0.017). Multiple regression analysis was conducted to assess the relationship between PSS variability and final test score improvements. This revealed a significant relationship, as described by the following equation: final score difference = 34.997 + 1.637 × PSS variability (p = 0.006). The results of the analysis revealed a statistically significant relationship between the variability in subjective stress levels (PSS variability) and the improvement in final scores. This finding suggests that the greater the variability of subjective stress levels is, the greater the improvement in final scores is. Further research is needed to explore these relationships across different populations and training scenarios.

Objective: This study was conducted to find a more effective education method in a neonatal resuscitation program (NRP) using a high-fidelity simulation that has recently shown positive results in terms of its effectiveness. Study design: A single-blind prospective cohort study was performed. The high-fidelity simulation model was used in a formal NRP training course for trainees caring for neonatal patients. The trainees were divided into a group that conducted the scenario after the lecture (Group A) and a group that attended the lecture after the scenario (Group B) and they both took the test before, during, and after the training. Results: The increase in score after theory training was statistically significant in both groups, but the final score did not differ between the two groups. However, when compared by career, in Group A, trainees under 24 months tended to be more effective, and in Group B, trainees over 24 months tended to be more effective. Conclusion: The difference in short-term memory of trainees according to the order of education identified by the test score was not prominent, but it was found that the degree of difference in test scores for the order of education tended to be different according to the career. It is thought that the effectiveness of the training might be increased by changing the education order according to the degree of experience of each trainee. More effective educational methods should be introduced by continuously developing lectures for repeated education of various trainees in the future.

Background/Objectives: There has been an increase in the incidence of comorbidities among very-low-birth-weight infants (VLBWIs), including periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Parenteral nutrition is essential for very-low-birth-weight infants (VLBWIs) who are born with a birth weight of less than 1500 g, but a longer duration of parenteral nutrition is known to have a risk of comorbidity, such as ROP. This study aims to investigate the relationship between the duration of parenteral nutrition and the comorbidities of the VLBWIs. Methods: Using the prospective cohort of Korean neonatal network, we analyzed the perinatal and postnatal data before discharge of the total 2490 subjects born in 2021 and 2022. The primary outcomes were the diagnoses of PVL, BPD, and ROP. The secondary outcomes were the severity of BPD and ROP, treatment of ROP, and proposing the predictive model of comorbidities using the duration of parenteral nutrition. Results: This study found that prolonged parenteral nutrition exceeding 28 days was associated with a higher risk of PVL (odds ratio [OR] 1.71, 95% confidence interval [CI] [1.11, 2.64], p = 0.002) and BPD (OR 1.51, 95% CI [1.10, 2.08], p = 0.011). Furthermore, an intermediate duration of parenteral nutrition was found to be significantly associated with an increased risk of ROP in male subjects. Additionally, a prolonged duration of parenteral nutrition was observed to be linked to greater severity of BPD. Predictive models incorporating the duration of parenteral nutrition demonstrated a high degree of explanatory power in relation to both BPD and ROP. Conclusions: Longer duration of parenteral nutrition has a risk of critical comorbidities in VLBWIs. The nutrition strategy for shorter parenteral nutrition should be encouraged for the prevention of comorbidities.