Purpose
Education on infant safe sleep practices has been known to reduce the risk of sleep-related sudden unexpected infant death. Since sleep environments may vary across sociocultural contexts, infant safe sleep education needs to reflect specific sociocultural settings. This study aimed to develop an educational Protocol for Infant Safe Sleep (PISS) for primary caregivers in Korea that considers parenting behaviors and cultural characteristics.
Methods
This study was conducted in three key methodological steps: (1) retrieval, defining, and systematic classification of PISS content; (2) the structural formulation of the content as an educational protocol; and (3) content validation. For the first step, a literature review was conducted, along with an analysis of educational materials from institution websites related to infant safe sleep and online parenting communities. Field observations were also conducted to identify relevant Korean culture characteristics. Based on these findings, the PISS was developed. Content validity index was assessed by six professionals, and the results were reflected into the educational program.
Results
The PISS intervention provided an educational video and booklet and enhanced learning via phone counseling and educational kit, which comprised an illustrated safe sleep sticker and a calendar-style activity diary. The educational content consisted of (1) sleep location, (2) sleep position, (3) bedding, (4) clothes and temperature, and (5) other considerations.
Conclusion
This study developed the PISS, an intangible educational intervention based on Korean sociocultural characteristics and specific guidelines for primary caregivers. Future research should evaluate the effectiveness of this program in promoting safe sleep practices.

Purpose
Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel.
Methods
A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID.
Results
A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP.
Conclusion
Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Purpose
Sudden unexplained infant death (SUID) is a major contributor to infant mortality, and pediatric nurses have the responsibility to educate parents on SUID-reducing strategies. This study was conducted to measure pediatric nurses' knowledge of SUID-related safe sleep practices (K-SSSP) and infant cardiopulmonary resuscitation (K-ICPR).
Methods
In total, 136 pediatric nurses were administered a survey including K-SSSP (13 items), K-ICPR (5 items), confidence in K-SSSP education (1 item; 5 points), and other factors relating to SUID experiences or education.
Results
The correct answer rates of the K-SSSP and K-ICPR were 62.6% and 62.5%, retrospectively. The mean score for confidence in K-SSSP education was 2.6±0.9. Only 18 nurses (13.2%) responded that they educated parents on the content of the K-SSSP, while 76 nurses had received education on SUID. Positive relationships were observed between K-SSSP scores and higher education, between K-ICPR scores and having own child(ren) and clinical experience, and between confidence in K-SSSP education and higher education or having one's own child(ren). Nurses caring for newborns performed more SUID education than nurses working in other units.
Conclusion
There is a profound need to implement a systemic educational program on SUID and strategies to reduce SUID for pediatric nurses.

Citations

• Development of an educational intervention program for infant safe sleep practices in Korea: a methodological study
  Jung Ae Cho, Young Mee Ahn, Min Sohn, Ok Kyung Ham, Min Kyung Lim, Hyun Young Koo
  Child Health Nursing Research.2026; 32(1): 16.     CrossRef
• An Evidence‐Based Safe Sleep Program Is Associated With Less Infant Sleep‐Related Deaths
  Marilyn Stringer, Jessica Lazzeri, Nicholas A. Giordano, Rosemary C. Polomano, Elizabeth Quigley, Bonnie Renner Ohnishi, Marianne Fray, Elizabeth Dunlevey, Roy Hoffman, Lori Christ
  Worldviews on Evidence-Based Nursing.2025;[Epub]     CrossRef
• Promoting infant safe sleep practices among neonatal and paediatric nurses through simulation-based training program
  Mahitab Mohamed Abdelrahman, Reham Hashem, Lareen Magdi El-Sayed Abo-Seif
  Journal of Pediatric Nursing.2024; 77: e474.     CrossRef
• Educational Boost Slashes SIDS Risk Awareness Gap Among Nurses in Iraq
  Safa Ahmed Mohammed, Afifa Radha Aziz
  Academia Open.2024;[Epub]     CrossRef
• Assessment of Nurses' Performance Regarding Infant Sleep Position on Sudden Infant Death Syndrome at Neonatal Intensive Care Units
  Ali Soliman A.S., Abd-Elmonem H.H., Ismail S.S.
  African Journal of Health, Nursing and Midwifery.2022; 5(2): 55.     CrossRef
• Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study
  Young Mee Ahn, Jung Ae Cho
  Child Health Nursing Research.2022; 28(4): 299.     CrossRef

Purpose
Nursing protocols for glucose management are well known for both healthy term newborns and high-risk newborns. However, for less risky newborns who are under only observation surveillance, hypoglycemia could be overlooked unless clinical symptoms develop.
Methods
A retrospective study was performed to explore factors influencing variations in glucose levels in 91 newborns who did not require any interventions, but were under nursing surveillance, at a level II neonatal intensive care unit. Data were retrieved from electrical medical records on glucose levels, demographic characteristics, and other clinical characteristics of newborns in their first day of life from January 2016 to May 2019.
Results
Glucose levels tended to stabilize within the normal range (60~80 mg/dL) as time passed during the first day of life. Cesarean section, multiple gestation, abnormal growth, and later preterm birth were associated with low glucose levels in the first 2 hours of life. Thirty-one newborns experienced a hypoglycemic episode (< 45 mg/dL) during the first 24 hours of life.
Conclusion
The findings of this study support the active encouragement of early feeding within 2 hours of birth and urgent adoption of a structural protocol for glucose surveillance in newborns with potential health problems immediately after birth.

Sudden infant death syndrome (SIDS) in Korea remains a poorly-understood subject for both professionals and the public. Recent reports have emphasized ethnic differences in SIDS rates, suggesting that making adjustments in child-rearing practices may contribute substantially to SIDS reduction. Two of the three major risk factors for SIDS-vulnerability of the infant and exogenous factors-need to be understood in particular depth due to their broad scope and sociocultural grounding. This paper presents substantial issues regarding preterm birth and male gender on infants’ vulnerability to SIDS in Korea. Practices of caring for healthy infants are addressed in the context of sleeping practices, including sleeping position, bedding arrangements, sleeping on the floor, the back-to-sleep position, high indoor temperatures and ondol floor heating, and swaddling. Professional and social awareness about how to reduce SIDS should be raised by promoting a better understanding of risk factors in the context of ethnic and cultural variations in child-rearing practices.

Citations

• Development of an educational intervention program for infant safe sleep practices in Korea: a methodological study
  Jung Ae Cho, Young Mee Ahn, Min Sohn, Ok Kyung Ham, Min Kyung Lim, Hyun Young Koo
  Child Health Nursing Research.2026; 32(1): 16.     CrossRef
• Analysis of sleep-related sudden unexpected infant deaths and sleep environment factors: clinical experience from a single tertiary medical center
  Mi Ae Chu, Jung Eun Kwon
  Pediatric Emergency Medicine Journal.2025; 12(3): 133.     CrossRef
• A Qualitative Study on Korean Mothers’ Dysfunctional Beliefs and Meaning Structures Regarding Their Experiences With Infant Sleep Problems
  Solbi Kang, Seockhoon Cheong, Sooyeon Suh
  Journal of Sleep Medicine.2023; 20(3): 175.     CrossRef
• Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study
  Young Mee Ahn, Jung Ae Cho
  Child Health Nursing Research.2022; 28(4): 299.     CrossRef
• Cultural variation in factors associated with sudden infant death during sleep
  Young Mee Ahn, Kyung-moo Yang, Hong Il Ha, Jung Ae Cho
  BMC Pediatrics.2021;[Epub]     CrossRef
• Knowledge on Sudden Unexplained Infant Death-related Safe Sleep Practices and Infant Cardiopulmonary Resuscitation in Pediatric Nurses
  Jung Ae Cho, Min Sohn, Sangmi Lee, Young Mee Ahn
  Child Health Nursing Research.2020; 26(4): 454.     CrossRef

Purpose
This study was conducted to evaluate cognitive ability in preschoolers born prematurely and to investigate related factors.
Methods
A prospective, longitudinal study was conducted with 64 children at 5-6 years of corrected age (CA) (second follow-up) among 76 children who had been assessed at 2.0~3.5 years of CA (first follow-up) from a sample of 343 preterm infants born from 2008 to 2010. To evaluate each child’s cognitive ability, during a home visit, we used the Kaufman Assessment Battery for Children-II (KABC-II) at the second follow-up. To explore factors related to cognitive ability, we measured children’s hemoglobin level at the second follow-up and used the data collected in our previous study, including the Bayley Scale of Infant Development-II (BSID-II) at the first follow-up.
Results
The mean total KABC-II quotient was 117.0±14.4. The 5-minute Apgar score (β=.29, p=.006), hemoglobin level (β=.22, p=.032), and the mental development index quotient of the BSID-II (β=.51, p<.001) were statistically significant predictors of the KABC-II quotient in multiple linear regression analysis.
Conclusion
The cognitive function of young children born prematurely was influenced by early neurodevelopment and factors reflecting their health status, such as anemia and a low 5-minute Apgar score.

Citations

• Effect of a Follow-up Program Involving an Early Intervention and Self-help Group on Parenting Stress, Depression, and Parenting Efficacy for Mothers of Premature Infants
  Eun Sun Ji, Jinhee Choi, Kaka Shim
  Journal of The Korean Society of Maternal and Chil.2023; 27(4): 256.     CrossRef

Purpose
The study was conducted to measure stratum corneum hydration (SCH) and pH (SCP) in high-risk newborns in the early postnatal period and to explore the features related to patterns of change in those parameters.
Methods
SCH and SCP were measured on the dorsal hand in 99 hospitalized newborns during the first 14 days of life and the results were analyzed using a general linear model.
Results
The mean hydration was 42.9% on day 1, which decreased to 34.6% by 2 weeks (F=15.61, p=<.001). An association was observed between SCH and prematurity (F=21.12, p<.001), as well as for their interaction (F=8.11, p<.001). The mean SCP was 6.2±0.3 on day 1, and decreased to 5.7±0.2 (F=95.75, p<.001), with no association with prematurity. After adjusting for birth weight, SCH was higher in newborns with vaginal delivery (F=9.07, p=.023) and who received phototherapy (F=11.81, p=.011). For SCP, only delivery type had a significant influence (F=6.40, p=.044).
Conclusion
This study suggests that SCH is typically in the 30% range during the early postnatal period, and that an acid mantle on the SC surface is very unlikely to form; these findings could be applied to the nursing process for promoting skin integrity in high-risk neonates.

Citations

• The Effect of Sunflower Seed and Almond Oil on Preterm Infant Skin: A Randomized Controlled Trial
  Seda Caglar, Gizem Kerimoglu Yildiz, Ilkay Bakoglu, Ozgul Salihoglu
  Advances in Skin & Wound Care.2020; 33(8): 1.     CrossRef

Purpose
This study was conducted to measure adiposity and to investigate related factors in preschoolers born prematurely.
Methods
A longitudinal follow-up study was conducted with 52 preschoolers at 5 years of corrected age among 343 preterm infants. Their adiposity status was evaluated based on measurements of body mass index, subscapular and triceps skin fold thickness (SFT), waist circumference, waist-to-height ratio, and mid-arm circumference at a home visit.
Results
The findings showed that SFT measurements, particularly at the triceps, reflected the degree of adiposity more accurately than other conventional measures. A shorter gestation, older maternal age, and the mother having more years of formal education were associated with higher levels of adiposity in the preschoolers.
Conclusion
The adiposity of children born prematurely needs to be thoroughly monitored with additional SFT measurements, considering the risk of accelerated growth patterns overriding regular catch-up growth in children born prematurely.

Purpose
Maintaining body temperature is a key vital function of human beings, but little is known about how body temperature of high-risk infants is sustained during early life after birth. The aim of this study was to describe hypothermia in high-risk infants during their first week of life and examine demographic, environmental, and clinical attributors of hypothermia.
Methods
A retrospective longitudinal study was done from January 1, 2013 to December 31, 2015. Medical records of 570 high-risk infants hospitalized at Neonatal Intensive Care Units (NICU) of a university affiliated hospital were examined. Body temperature and related factors were assessed for seven days after birth.
Results
A total of 336 events of hypothermia (212 mild and 124 moderate) occurred in 280 neonates (49.1%) and most events (84.5%) occurred within 24 hours after birth. Logistic regression analysis revealed that phototherapy (aOR=0.28, 95% CI=0.10-0.78), Apgar score at 5 minute (aOR=2.20, 95% CI=1.17-4.12), and intra-uterine growth retardation or small for gestational age (aOR=3.58, 95% CI=1.69-7.58) were statistically significant contributors to hypothermia.
Conclusion
Findings indicate that high-risk infants are at risk for hypothermia even when in the NICU. More advanced nursing interventions are necessary to prevent hypothermia of high-risk infants.

Citations

• Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement
  Huong (Kelle) T. Phan, Teresa M. McIntyre
  Advances in Neonatal Care.2022; 22(3): 193.     CrossRef

Purpose
Oral glucose and pH are known as critical indicators for the growth of microorganism inside the oral cavity. This study was performed to identify oral glucose and pH variances in the early postnatal days of newborns.
Methods
An explorative study which included 67 newborns was conducted to measure the oral glucose and pH during the first three days of life. Oral secretions were collected every 8 hours for three days or 6 to 9 times immediately after birth up to discharge. Oral glucose and pH variances during the three days were analyzed using the SPSS 22.0.
Results
Oral glucose was 30.66±22.01mg/dl at birth then increased to 54.77±27.96mg/dl at the third day of life (F=8.04, p<.001) while oral pH decreased from 7.35±0.36 to 5.53±0.39 during the three days (F=113.35, p<.001). Oral glucose and pH were related to gestational age, regurgitation, and maternal diabetic mellitus. A negative correlation was found between oral glucose and pH (r=-.34, p<.001).
Conclusion
Oral glucose and pH can be utilized for oral health assessment in newborns. Further study is needed to explore the factors which influence oral glucose and pH in high-risk newborns.

Purpose
A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth.
Methods
Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth.
Results
Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was 34.4±3.2 weeks and weight was 2,266±697.5 grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%), and Coagulase- Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was 29.2±23.0 mg/dL~58.2±39.5 mg/dL. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034).
Conclusion
High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.

Citations

• Glucose and pH of Oral Secretions in Newborns
  Namhee Kim, Youngmee Ahn
  Child Health Nursing Research.2017; 23(3): 353.     CrossRef

Purpose
This study was conducted to describe health in optimal fitness (HOF) in young children born prematurely and to analyze factors affecting HOF in health status, investment resources, and anthropological values, based on HOF theory.
Methods
A case-control study of 76 children with preterm births (PTB) was conducted at 24 to 42 months of corrected age. Their HOF status was evaluated based on height, weight, head circumference, and the Korean-Bayley Scale of Infant Development-II and classified as either HOF-achieved or HOF-uncertain in the domain of growth, development, and all together.
Results
For growth, development, and all, 26.3%, 27.6%, and 47.4% of children, respectively, belonged to the HOF-uncertain group. Logistic regression analysis showed that longer length of hospital stay (≥21 days; OR=7.8; 95% CI [1.5, 40.5]), worse scores on the Home Observation for Measurement of the Environment (HOME) (≥38; OR=0.1; 95% CI [0.0, 0.4]), having a working mother, (OR=5.7; 95% CI [1.2, 27.6]), and an older mother (≥35 years; OR=8.8; 95% CI [2.1, 37.3]) were statistically significant contributors of HOF-uncertain in the domain of all.
Conclusion
Findings show that young children born prematurely with prolonged stays in a neonatal intensive care unit and insufficient socioeconomic resources at home are more likely to exhibit delayed growth and development.

Citations

• Cognitive Ability and Related Factors in Preschoolers Born Prematurely
  Young Mee Ahn, Sangmi Lee
  Child Health Nursing Research.2019; 25(4): 468.     CrossRef

Purpose
The study was done to investigate behavioral problems in toddlers who were born prematurely and to analyze related factors.
Methods
A cross-sectional explorative study was conducted with 72 preterm birth (PTB) children at 24 to 41 months of corrected age who were born at 28 to 37 weeks’ gestation. During home visits, behavior problems were assessed using the Behavior Rating Index for Children (BRIC). Using a BRIC score of ≥30, children with suspected behavior problems were grouped in the non-regular behavior group.
Results
Of the children, 38.9% belong to the non-regular behavior group. The mental development index score for the Korean-Bayley Scale of Infant Development-II was higher for the non-regular behavior group compared to the regular behavior group (t = 2.26, p = .027). Logistic regression analysis showed that lower maternal attachment (<96, OR=3.4, 95% CI[1.1, 10.4]) and higher parenting stress (≥97, OR=4.8, 95% CI[1.3, 17.3]) were independently related to non-regular behavior.
Conclusion
PTB Toddlers are at risk for behavior problems which are associated with low cognitive performance. Maternal-child attachment and maternal parenting stress were strongly related to behavior problems in these children. More attention is needed to understand possible behavior problems in young children with PTB, particularly focusing on maternal-child interaction and maternal mental well-being.

Citations

• Validation of the Korean Version of the Maternal Postpartum Attachment Development Scale for Mothers of Children who were in a Neonatal Intensive Care Unit
  Ah Rim Kim, Young Ran Tak
  Korean Journal of Child Studies.2018; 39(1): 129.     CrossRef
• Factors Influencing Parenting Stress in Mothers of Preschoolers Born Prematurely
  Sangmi Lee
  Child Health Nursing Research.2017; 23(4): 470.     CrossRef

Purpose
The purpose of this study was to identify international students’ use of university health centers by individual characteristics and seasons.
Methods
This was a retrospective descriptive study using data obtained from the electronic record system of one university health center. The study participants were international undergraduate students who registered for any of two semesters between March 1, 2014 and February 28, 2015 and visited the university health center during their registration period.
Results
The most common reasons for visits were problems of head, eye, nose and throat systems, followed by respiratory system. Their visits mostly occurred in the fall and spring. The most frequently used services were distribution of oral medication followed by wound treatment. The number of visits per individual was statistically different by gender (u = -3.307, p = .001), but not by their major (χ² = .543, p = .762) or nationality (χ² = 5.518, p = .271).
Conclusion
Further study is necessary to better define health needs and related factors for this unique population. The electronic record system provides great opportunities in development and application of need based health services for international students and for research in this area.

Citations

• Revisiting the Andersen Model: Transnational Ties With the Home Country and Healthcare Utilization Among Chinese International Students in South Korea
  Sou Hyun Jang, Yong Jeong Yi
  Sage Open.2024;[Epub]     CrossRef
• The Effects of Foreign Students Perceived Social Support and Grit on Adaptation to College Life: Focusing on the Mediating Effect of Learning Flow and Academic Achievement
  Wei HONG, Yang LI, Jin-Ho CHO
  THE JOURNAL OF FISHERIES AND MARINE SCIENCES EDUCA.2023; 35(1): 33.     CrossRef

Purpose
This descriptive study was performed to explore trends in child health nursing research by analyzing the themes, contents and structure of articles published in 2014 in Child Health Nursing Research, the official journal of the Korean Academy of Child Health Nursing.
Methods
Thirty-eight articles were reviewed using keywords, author (s), subjects, ethical considerations, designs, statistics involved, funding resources, and others.
Results
Ten domains from 160 keywords were identified as follows, child related, psycho-social variable related, parents and family related, nursing and health related, and others. A mean of 2.9 authors per article was identified and 71% of the authors were academic-affiliated. Twenty-eight articles were human-participant related while 21 articles addressed both Institutional Review Board and written consent. Non-experimental design was the most commonly used method followed by experimental design, and qualitative design. The duration for acceptance was a mean of 89.1 days from submission with most articles requiring a second round of article review. Half of the articles were supported by grant organizations such as Korean National Research Foundation.
Conclusion
The findings of the analysis show an improvement in the scientific quality with a diversity of articles in Child Health Nursing Research.

Citations

• Research trends in nurse–parent partnership: A scoping review of the paediatric field in South Korea
  Seo Jin Park, Ji Yeong Yun, Jina Lee, In Young Cho
  Nursing Open.2024;[Epub]     CrossRef
• Text Network Analysis of Research Topics and Trends on Simulations Using Virtual Patients in Nursing Education
  Miok Song, Jeong Eun Moon, Aeri Jang
  CIN: Computers, Informatics, Nursing.2023; 41(9): 639.     CrossRef
• Journal statistics, directions for development, and appreciation for reviewers
  Hyun Young Koo
  Child Health Nursing Research.2022; 28(1): 5.     CrossRef
• Analysis of Studies on High-Risk Infants and Quality Assessment of Intervention Studies
  Hyejung Lee, Anna Kim, Anna Maeng, Gayeong Kim
  Child Health Nursing Research.2016; 22(2): 153.     CrossRef

Purpose
This study was performed to explore the weight variations in high-risk term newborns hospitalized during the early postnatal period.
Methods
A retrospective explorative study was performed with 64 term newborns who were hospitalized in the NICU after birth. Data on daily weight, birth information, and clinical features such as phototherapy, placements, nutritional status were reviewed through medical records for 14 days of life. General Linear Model, GLM was applied to analyze the weight variation by clinical features of these high–risk term newborns for 14 days of life.
Results
Newborns at 40 weeks of gestation showed little weight loss during the few days after birth then steadily gained weight to 7.6% at the 14th day. Infants born at 37-39 gestation showed little weight gain for 14 days though the weight loss itself was not apparent. As well, return to birthweight was not observed in newborns with phototherapy, infants placed on a warmer or infants having gastrointestinal dysfunction for 14 days of life.
Conclusion
Even for term newborns, physiologic weight loss may not be warranted even if newborn is born at less than 40 week of gestation, or with high-risk conditions that warrant admission to NICU.

Purpose
The study purposes were to explore school nurses’ experience, perceived barriers, and education needs in diabetes management at school.
Methods
This study was a cross sectional study and the study participants were recruited conveniently at continuing education seminars for school nurses at Incheon Metropolitan City.
Results
Data for 101 school nurses were analyzed. The nurses were all women and their mean age was 46.9±9.3 years. About 66% of them had experience with children with diabetes at school. The school nurses reported that 74.6% of the students tested their blood glucose by themselves, the school clinic was the most common place for blood glucose tests (47.8%) and insulin injections (50.8%) and the nurses knew students’ diagnosis through the student health survey (58.2%). About half of the nurses (53.7%) reported that glucagon should be available at school and 49.2% were willing to inject glucagon when necessary. The most frequently reported barrier in diabetes management was role confusion (6.0±1.3) and the most common educational need was emergency responses (5.9±1.4).
Conclusions
School health policy for diabetes management and diabetes resources are necessary to minimize role confusion of school nurses, improve emergency response, and facilitate health promotion activities in diabetes management.

Citations

• Navigating Role Challenges in School Healthcare Partnerships With Families: A Qualitative Study
  Ju-Yeon Uhm, Seok-Yeong Hong, Yangmi Kim
  Western Journal of Nursing Research.2026; 48(2): 121.     CrossRef
• School nurses' competency in supporting students with type 1 diabetes: A mixed methods systematic review
  Ju-Yeon Uhm, Suhee Kim
  Nurse Education Today.2025; 146: 106554.     CrossRef
• Perception and utilisation of information and communication technology (ICT) in the management of diabetes in children: Insights from health students in Indonesia
  Mustamu Cherry
  Scripta Medica.2024; 55(1): 33.     CrossRef
• An Integrated Review of Health Care in Child and Adolescent Cancer Survivors Based on Roy’s Adaptation Model
  Hye Jin Kim, Eunjoo Lee
  Asian Oncology Nursing.2024; 24(2): 82.     CrossRef
• Educational needs of school health teachers caring for students with type 1 diabetes: An analysis using the Borich needs assessment and the locus for focus models
  Heewon Seok, Ju-Yeon Uhm
  The Journal of Korean Academic Society of Nursing .2024; 30(4): 347.     CrossRef
• School Health Teachers as Partners in Diabetes Caring: Maternal Perspectives
  Ju-Yeon Uhm, Mi-Young Choi
  Western Journal of Nursing Research.2023; 45(10): 942.     CrossRef
• Factors Included in T1DM Continuing Education for Korean School Nurses: A Systematic Review
  Eun-Mi Beak, Yeon-Ha Kim
  International Journal of Environmental Research an.2021; 18(4): 1620.     CrossRef
• Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes
  Eun Young Joo, Ji-Eun Lee, Hee Sook Kang, Shin Goo Park, Yong Hee Hong, Young-Lim Shin, Min Sohn
  Diabetes & Metabolism Journal.2018; 42(6): 480.     CrossRef

PURPOSE
The study was done to explore growth variation in head circumference (HC) in extremely premature infants (EPI) with brain injury.
METHODS
A retrospective cohort study was conducted with 79 cohort samples from the archives of the catch-up growth project. Mean age of the infants was 29.2 weeks of gestation and mean HC, 27.1 cm at birth. Their HC measurements were retrieved from the archives up to 6 month of corrected age (CA) and analyzed against history of brain injury during hospitalization.
RESULTS
Overall growth retardation in HC was observed in the cohort sample compared to longer gestation premature infants. EPI with brain injury showed decreased HC compared to infants without brain injury, and resulting growth variation across 6 month of CA. Highest retardation in HC growth was observed in male infants with brain injury.
CONCLUSION
Extreme preterm birth itself may function as a major obstacle against HC growth toward term age in EPI. Sustainability of brain injury could be observed with higher HC growth retardation after term. Evolutionary favor to female infants may exist in HC growth of EPI. Intensive education on HC monitoring is highly suggested for parents of EPI, particularly with children with brain injury.

Citations

• Effects of Direct Practice of Newborn Health Assessment on Students’ Nursing Clinical Competence and Self-Efficacy
  Seol Hui Park, Se Ang Ryu
  Child Health Nursing Research.2016; 22(2): 117.     CrossRef
• Growth of Korean preterm infants in a family‐centered tradition during early infancy: The influence of health risks, maternal employment, and the sex of infants
  Youngmee Ahn, Min Sohn, Sangmi Lee
  Japan Journal of Nursing Science.2014; 11(4): 281.     CrossRef

PURPOSE
The study was done to measure the effects of maternal heart sound on body weight, physiologic reactions (heart rate [HR] and cortisol) and behavioral states of preterm infants.
METHODS
Thirty-five preterm infants were recruited from a neonatal intensive care unit at a university hospital. Institutional Review Board approval and informed consent were obtained. The infants were assigned to an experimental group (n=18) with an auditory stimulation for 7 days of life, a continuous delivery of maternal heart sound using MP3 attached inside the incubator, or to a control (n=17) without any auditory stimulation. The outcome variables, daily variations in weight, HR and behavioral states, and differences in cortisol were analyzed.
RESULTS
There were differences in variations of daily weights (F=3.431, p=.011) and in cortisol (t=3.184, p=.006) between groups, but no difference in variations of daily HR (F=0.331, p=.933) and behavioral states (F=1.842, p=.323).
CONCLUSION
The findings support the safety of continuous maternal heart sound as no changes in HR and behavioral states occurred, and the efficacy as weight increased and cortisol decreased. This auditory simulation may lead to more efficient utilization of energy in preterm infants by consistently providing familiar sounds from intrauterine life and blocking noxious sounds from NICU environments.

Citations

• Manual Expression of Breastmilk: Integrating Tools with Marmet Technique
  Chele Marmet, Lora Cash
  Clinical Lactation.2025; 16(1-2): 40.     CrossRef
• Effects of Music Intervention Techniques on Very-Low-Birth-Weight Infants in Neonatal Intensive Care Unit: A Preliminary Study
  Ji Yun Yun, Ji Sun Kim, So-Yeon Shim, Su Jin Cho, Eun Ae Park, Hyun Ju Chong
  Neonatal Medicine.2020; 27(4): 174.     CrossRef
• Effects of Hearing Recorded Mother's Voice on Physiological Reactions and Behavioral State of Sleep, Weight of Very Low Birth Weight Infants
  Mi-Hyang Choi, In-Soon Kang, Young-Hae Kim
  Child Health Nursing Research.2014; 20(3): 185.     CrossRef
• Effects of the 'Intervention - Mother's Song' on Physical Response and Behavioral State of Low-Birth Weight Infants in a Neonatal Intensive Care Unit.
  Ji Sun Park, Kyung Ja Hong, Kyung Sook Bang
  Child Health Nursing Research.2013; 19(3): 198.     CrossRef

PURPOSE
This quasi-experimental study was conducted to identify the effects of dental health education on dental health knowledge and dental hygiene status in preschoolers.
METHODS
Forty-one children were recruited from two daycare centers, one of which served as the experimental group and the other as the comparative group without dental health education. Dental health education consisted of knowledge-oriented lecture and individual practice with a tooth simulator. The dental health knowledge was measured using a self-report questionnaire and dental hygiene using a dental plague index. The measurements were taken before and after the education program in the experimental group while only before the education program in comparative group.
RESULTS
Increases in dental health knowledge and decreases in dental plague index were observed 4 days after the education and lasted at least 8 days after the education.
CONCLUSION
The findings of this study indicate that dental health care education consisting of a lecture with simulation practice can be effective in improving dental health care in preschoolers at day care center.

Citations

• Effect of Toothbrushing Application for Kids on Dental Plaque Removal and Interest in Toothbrushing of Preschool Children
  Chae-Ha Hwang, Hyeon-Ju Song, Min-Ji Jung, Yeon-Jae Choi, Young Sun Hwang
  Journal of Dental Hygiene Science.2023; 23(3): 208.     CrossRef
• A Basic Study for Introducing Pilot Projects and Analyzing the Effects of Children’s Dentists
  Yeojin Yoon, Songee Che, Ohtak Kwon, Kyungrim Kang
  Health Insurance Review & Assessment Service Resea.2021; 1(2): 221.     CrossRef
• Development and Effects of a Hand-washing Program using Role-playing for Preschool Children
  Hyun Sook Lim, In Soo Kwon
  Child Health Nursing Research.2019; 25(2): 123.     CrossRef
• Effect of Oral Health Education on Oral Health Knowledge, Oral Health Behavior and Oral Hygiene Status in Children from North Korea
  Jieun Han, Horan Park
  Child Health Nursing Research.2017; 23(4): 440.     CrossRef
• Effect of Repeated Oral Health Education on the Oral Health of Preschool Children
  Jee-Won Lee, Ha-Na Choi
  Journal of Dental Hygiene Science.2017; 17(5): 423.     CrossRef
• The Effects of S-solution and A-solution on Oral Health in Preschool Children
  Hee Jung Son, Hae Sook Hong
  Journal of Korean Biological Nursing Science.2015; 17(2): 150.     CrossRef
• Knowledge and Attitudes towards Infant Oral Health, and Related Health Behavior among Parents.
  Haeryun Cho
  Child Health Nursing Research.2014; 20(3): 196.     CrossRef
• Influences of oral health behaviors according to oral health education experiences in middle school students
  Mi-Sook Cho, Min-Kyung Park, Kyeung-Ae Jang
  Journal of Korean society of Dental Hygiene.2013; 13(4): 639.     CrossRef
• Effects of Mothers Involved in Dental Health Program for Their Children
  Hye Seon Choi, Hye Young Ahn
  Journal of Korean Academy of Nursing.2012; 42(7): 1050.     CrossRef

Child is a being and provides the genetic continuity of parents and society, and therefore the fitness of these children for survival, growth and development towards reproduction, is of significance to parents and society. The aim of health care for high-risk children is not only to minimize or eliminate health problems, but also to optimize their fitness. Considering that the health care of children is influenced by available resources of parents and society, and sociocultural values and paradigms in a given environment of evolutionary adaptedness (EEA), child health care professionals need to understand factors affecting the optimal fitness of children with risks. This paper introduces a new integrated theory for health care in high-risk children, entitled, Health for Optimal Fitness of High-Risk Children. Five main components were identified with associate concepts or midrange theories affecting heath for optimal fitness of high-risk children; EEA, optimal fitness, health problems, investment resources, and anthropological values. It may provide an integrated perspective on health of high-risk children in both the proximately biomedical approach and ultimately evolutionary approach as optimizing their fitness. Further study is needed to develop substantial statements between components with existential examples.

Citations

• Health in Optimal Fitness and its Related Factors in Young Korean Children Born Prematurely
  Sangmi Lee, Min Sohn, Shinjeong Kim, Sunha Choi, Yonghoon Jun, Youngmee Ahn
  Child Health Nursing Research.2016; 22(4): 336.     CrossRef

PURPOSE
Study purposes were to exam effects of self-care education for children with type 1 diabetes on their diabetes management behaviors and to explore the relationship among diabetes management behaviors, knowledge, self-efficacy and clinical variables.
METHODS
This study was a one group quasi-experimental study. Study participants were children with type 1 diabetes and attended a four hour self-care education of a diabetes camp. Data were collected using structured questionnaires including Diabetes Management Behavior Scale (DMBS), Michigan Diabetes Research and Training Center's Brief Diabetes Knowledge Test and Self-Efficacy for Diabetes Self-Management.
RESULTS
The mean age of the participants was 12 (+/-2.3) years. After the education, their DMBS and knowledge improved, but the improvement was not statistically significant (t=1.758, p=.101; t=0.528, p=.606). Two areas of DMBS, daily prevention behaviors and modification of care plan, were associated with study variables. Daily prevention behaviors were associated with duration of diabetes (r=.653, p=.008), HbA1c (r=.563, p=.038) and having a complication (r=-2.788, p=.015). Modification of care plan was associated with age at diagnosis (r=-.552, p=.033).
CONCLUSION
Children with type 1 diabetes could improve some parts of their diabetes management behaviors even after a short diabetes camp.

Citations

• Tecnologias educacionais para familiares e crianças com diabetes tipo 1: revisão de escopo
  Patricia Carli Morgado, Liliane Faria da Silva, Rosane Cordeiro Burla de Aguiar, Juliana Rezende Montenegro Medeiros de Moraes, Tatiane Marinz de Souza Luquez, Euzeli da Silva Brandão, Michelle Darezzo Rodrigues Nunes, Isabelle de Freitas Lopes, Débora Câ
  Revista da Escola de Enfermagem da USP.2024;[Epub]     CrossRef
• Educational technologies for families and children with type 1 diabetes: a scoping review
  Patricia Carli Morgado, Liliane Faria da Silva, Rosane Cordeiro Burla de Aguiar, Juliana Rezende Montenegro Medeiros de Moraes, Tatiane Marinz de Souza Luquez, Euzeli da Silva Brandão, Michelle Darezzo Rodrigues Nunes, Isabelle de Freitas Lopes, Débora Câ
  Revista da Escola de Enfermagem da USP.2024;[Epub]     CrossRef
• Effects of Virtual Reality Program on Glycated Hemoglobin, Static and Dynamic Balancing Ability, and Falls Efficacy for Diabetic Patients: A Systematic Review and Meta-Analysis
  Yi-Rang Yim, Myung-Haeng Hur
  Journal of Korean Academy of Fundamentals of Nursi.2023; 30(2): 155.     CrossRef
• Illness Experiences of Adolescents with Type 1 Diabetes
  Ji Eun Kim, Ilaria Campesi
  Journal of Diabetes Research.2022; 2022: 1.     CrossRef
• Factors Affecting the Self-Management of Adolescents with Type 1 Diabetes Mellitus based on the Information-Motivation-Behavioral Skills Model
  Hooyun Lee, Eun Kyoung Choi, Heejung Kim, Ho-Seon Kim, Hee-Soon Kim
  Child Health Nursing Research.2019; 25(2): 234.     CrossRef
• Blood Glucose Control and Related Factors at a Camp for Korean Children and Adolescents with Type 1 Diabetes
  Narae Kang, Jieun Lee, Dong-Ho Park, Soo-Kyung Lee, So-Young Nam, Sanghyun Lee, Mincheol Kim, Heesook Kang, Euiyeon Kim, Misoon Kim, Min Sohn
  Comprehensive Child and Adolescent Nursing.2018; 41(1): 58.     CrossRef
• School Nurses’ Management for Children and Adolescents with Diabetes
  Heesook Kang, Youngmee Ahn, Ji Eun Lee, Min Sohn
  Child Health Nursing Research.2015; 21(2): 176.     CrossRef

PURPOSE
This study was conducted to examine the effects of simulation education integrated with problem based learning (SIM-PBL) on clinical competency and self-efficacy in post operation nursing care for children.
METHODS
This study was a quasi-experimental design. Thirty six students in the third year of a 4-year baccalaureate nursing program were recruited conveniently and assigned to the control or intervention groups using time difference. Students were all in a pediatric nursing clinical practicum. The control group received the regular clinical practicum in a hospital setting. For the intervention group, a SIM-PBL education replaced 150 minutes of their clinical practicum.
RESULTS
The intervention group showed greater improvement in two areas of clinical competency compared with the control group; physical assessment (t=3.019, p=.005) and post operation advice (t=2.428, p=.021). However, no statistically significant differences in improvement in any areas of self-efficacy were found between two groups.
CONCLUSION
The results indicate that the SIM-PBL education is effective in improving some areas of clinical competence, but not self-efficacy in post operation nursing care for children. Further study is needed to develop SIM-PBL programs for various clinical topics and evaluate the effectiveness on the learning outcomes.

Citations

• Development and evaluation of a pediatric nursing competency-building program for nursing students in South Korea: a quasi-experimental study
  Hyun Young Koo, Bo Ryeong Lee
  Child Health Nursing Research.2022; 28(3): 167.     CrossRef
• Effects of Virtual Reality Simulation Program Regarding High-risk Neonatal Infection Control on Nursing Students
  Mi Yu, Miran Yang, Boram Ku, Jon S. Mann
  Asian Nursing Research.2021; 15(3): 189.     CrossRef
• Effects of a Neonatal Nursing Practice Program on Students’ Stress, Self-efficacy, and Confidence
  Yunsoo Kim, Horan Park, Sung Sil Hong, Hee Jin Chung
  Child Health Nursing Research.2018; 24(3): 319.     CrossRef
• Educating Undergraduate Psychiatric Mental Health Nursing Students in Screening, Brief Intervention, Referral to Treatment (SBIRT) Using an Online, Interactive Simulation
  Cathy Koetting, Patricia Freed
  Archives of Psychiatric Nursing.2017; 31(3): 241.     CrossRef
• Effects of Simulation with Problem-based Learning on Care for Patients with Autonomic Dysreflexia
  Ji Eun Park
  The Korean Journal of Rehabilitation Nursing.2017; 20(2): 140.     CrossRef
• Effects of Blended Cardiopulmonary Resuscitation and Defibrillation E-learning on Nursing Students’ Self-efficacy, Problem Solving, and Psychomotor Skills
  Ju Young Park, Chung Hee Woo, Jae Yong Yoo
  CIN: Computers, Informatics, Nursing.2016; 34(6): 272.     CrossRef
• Development and Application of Integrated-Simulation Practice Program using Standardized Patients : Caring for Alcoholism with Diabetes Mellitus in the Community
  Gwang-Soon Kang, Younkyoung Kim
  Journal of the Korea Academia-Industrial cooperati.2016; 17(8): 662.     CrossRef

PURPOSE
The study purposes were to describe the process of developing the Korean versions of the Six Dimension Scale of Nursing Performance (Six-D) and Student Nurse Stress Index (SNSI) and psychometric evaluation of the two measurements.
METHODS
This was a methodology study using a descriptive cross-sectional design with 51 nursing students in 4th year of university. Internal consistency reliability was assessed using Cronbach alphas. Construct validity was determined by exploring correlations among Six-D, SNSI, objective structured clinical examination (OSCE), self-efficacy and grade point average (GPA).
RESULTS
Internal consistency reliability of Six-D and SNSI was acceptable with Cronbach's alpha of .95 and .82. Correlation analysis to determine construct validity revealed that Six-D presented positive correlations with OSCE (r=.109~.272) and self-efficacy (r=.005~.161) and negative correlation with GPA (r=-.246~-.394), although all were not statistically significant. SNSI presented all negative correlations with OSCE (r= -.007~-.238), self-efficacy (r=-.246~-.394), and GPA (r=-.092~-.426) and were mostly statistically significant except OSCE.
CONCLUSION
Six-D needs more evidence to confirm validity to predict observed clinical competency and theoretical relationships with self-efficacy and GPA. However, SNSI presented trends of expected relationships with relevant variables. Therefore, further research is recommended in testing validity of Six-D with other student populations.

Citations

• Development and psychometric evaluation of Clinical Practice Self-Efficacy Scale for nursing students
  Heejung Choi, Sueun Kim, Harim Jeong
  The Journal of Korean Academic Society of Nursing .2022; 28(3): 236.     CrossRef
• Effectiveness of a self-directed learning program using blended coaching among nursing students in clinical practice: a quasi-experimental research design
  Gie-Ok Noh, Dong Hee Kim
  BMC Medical Education.2019;[Epub]     CrossRef
• Associations Among Nursing Work Environment and Health‐Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach
  Hyeonmi Cho, Kihye Han
  Journal of Nursing Scholarship.2018; 50(4): 403.     CrossRef
• Turkish Version of the Student Nurse Stress Index: Validity and Reliability
  Gamze Sarikoc, Meral Bayram Demiralp, Emine Oksuz, Berrin Pazar
  Asian Nursing Research.2017; 11(2): 128.     CrossRef
• Development of a simulation-based assessment to evaluate the clinical competencies of Korean nursing students
  Kyongok Park, Youngmee Ahn, Narae Kang, Min Sohn
  Nurse Education Today.2016; 36: 337.     CrossRef
• Influence of Nursing Students’ Anxiety during Simulation Training on Personal Satisfaction of Simulation, Self-efficacy, Clinical Competence
  Mi Young Kim, Soohyun Park, Jongsoon Won
  Journal of Korean Academy of Fundamentals of Nursi.2016; 23(4): 411.     CrossRef
• Effectiveness of Simulation Integrated with Problem Based Learning on Clinical Competency and Self-efficacy in Nursing Students
  Mijin Lee, Youngmee Ahn, Insook Cho, Min Sohn
  Child Health Nursing Research.2014; 20(2): 123.     CrossRef

PURPOSE
The quasi-experimental study was conducted to investigate the effects of the integrated NICU hospitalization education on maternal attachment, maternal self-esteem, and EPDS in the 26 mothers of high-risk infants(HRI).
METHOD
The subjects were divided into the experimental group to received the integrated NICU hospitalization education included the enforced direct education of NICU and HRI to the mothers using a booklet and the provision of the neomaternal exposure as soon as possible after delivery. The control group received the routine education of the NICU hospitalization, mostly including the admission process and the NICU rules delivering to the husband. The research variables were maternal attachment, maternal self-esteem, and EPDS.
RESULTS
The results showed the increases in these variables after the integrated education in experimental group compared to the control group.
CONCLUSION
It supports the benefits of the early direct NICU education and the neomaternal exposures on maternal adaptation process in the mothers of HRI.

The article reports the process, contents and strategies in the development of community based-heath care management program for high-risk infants and family, which was based on literature review, empirical needs assessment from pilot study. The program was divided into two emphasis areas: (1) identification and home visiting nursing care program, and (2) the construction of self-supporting group. The contents of home visiting nursing care were developed from the pilot study of the direct home visiting to premature infants after discharge. The documentation form for home care was standardized, including the demographic data, birth history, home care services, education and counsels, and visiting schedules. The integrated education protocol was elaborated to enhance the body of knowledge as well as clinical competency in caring high-risk infants and family by the supports of neonatologists, nursing scholar, and clinical specialists. In addition, the process and strategies in developing self-supporting group, consisting the high-risk infants and family, and any significant others were addressed. Emphases were given to the role of public health center and the recycling health care referral system to maximize the growth and development of high-risk infants on the community-base, which in turn, contributing to decrease the postneonatal mortality rate.

This study analyzed the services as operated by the Child Health Telephone Service Center. The Center is a toll free service operated as part of the community services of the Korean Academic Society of Child Health Nursing. The aim of the study was to describe the concerns of child caregivers regarding child health care as discussed during telephone counseling. Specific objectives were as follows: 1. To analyze the activities of the Center. 2. To describe the characteristics of caregivers who made phone calls for counseling services and also the characteristics of their children. 3. To analyze the content of the counseling sessions. 4. To analyze counseling content according to the characteristics of the caregivers and their children. Data used for the study were obtained from the counseling records for the period from Sept. to Dec. 1999, as kept by the three counselors at the Center. The total number of calls was 8,261 and that consisted of 15,150 questions. The total questions were merged into 13,236 by eliminating those questions which overlapped or were of similar content. The final 13,236 questions were used for the final analyses. Almost of the callers (98.4%) were mothers. Among them 89.6% were between 25 and 35 years of age. Geographical distribution of the callers covered the whole nation. The largest numbers who made the calls were from the Seoul metropolitan area (36%), followed by 28% from Kyung Gi Province, and 20% were from the Kyung Sang area. Among 8,261 callers, 72.8% were first users. Sex of the babies and children in question for counseling was about even for males and females and ages ranged from one month to six years. The largest group (62.5%) was the less than six month age group. The finalized 13,236 questions/problems were categorized into 11 problem areas. They were in order of frequency, physical problems, feedings and nutrient concerns, information on child rearing, growth and development, guidance on utilization of child care facilities, elimination problems, sleeping concerns, immunization related concerns, behavior problems, injury and accidents, and safety measures. The most frequent problems for counseling were physical signs and symptoms (27.3%), followed by feeding and nutrients, information on child rearing, and growth and development. Of physical problems, abnormal gastrointestinal signs and symptoms were the most frequent concern and skin problems were next at 25% and 23.3% respectively. Loose bowels, vomiting and constipation were the most frequent gastrointestinal problems. Atopic dermatitis had the highest frequency at 53.3% with diaper rash being the second highest among the skin problems. About 80% of the growth and developmental category were physical development concerns related to physiological, body growth, and motor and sensory development. This study constitutes the activity report for the first year of the Center. The findings correspond with literature reports on child health problems and parents educational needs. One recommendation from this study is that since the services of the Center are carried out only by telephone, the psychology of the counselees and the counselor relationship must be considered for better services.

The goal of respiratory management in high risk infants is to maintain proper oxygenation by supporting respiration, therefore to minimize the secondary complications and to promote the maximum growth and development. While on artificial ventilator to achieve this goal, the infants require endotracheal suctioning(ETS) to remove lung secretions. however, the negative effects of ETS in neoates have been documented and include hypoxia, bradycardia, mucosal damage, increased intracranial pressure, and death result. The purpose of the study was to investigate how ETS is currently performed in NICU, which would be beneficial to develop the standardized ETS protocol and to apply it to these population. A national-wide survey on clinical protocol of ETS was performed to 149 neonatal nurses with the average of 3 years and 6 months experience in neonatal nursing, 34.2% of whom was bachelor in nursing. The results showed that about 89% of the nurses initiate ETS primarily based on the need of the subjects. The aseptic regulation on ETS was used in 83.9% of the subjects. There was no regulation on the length of catheter in 32.9% and on ID/OD ratio in 17.4%. Many nurses administered hyperoygenation/hyperinflation/hyperventilation based on personal knowhow, rather than scientific rationals(77.2%, 40.9%, 75.2%, retrospectively). About 41% of the nurse regulate subjectively the suction power, while 73.8% of them rotate the subject's head during suctioning and the half of the nurses was favorable in adapting the closed-suctioning protocol. With the findings of the study, the current clinical application of ETS in neonates appears to be based on adult care practices, or personal preference, rather than scientific validation of the safety and effectiveness of the procedure. This study support the needs for developing and applying the standardized ETS protocolin conjunction with the consideration given to the physiologic characteristics of the neonates in respiratory distress.

Prematurity is the main cause for respiratory disorders in neonates. The goal in respiratory management is to maintain respiration with adequate oxygenation. Chest vibration(CV) prior to endotracheal suctioning(ETS) has been arbitrarily applied to ventilated premature infants without the scientific evaluation of its safety and efficacy. A repeated measure within subjects experimental study was conducted to investigate the effects of CV prior to ETS on oxygenation and lung secretions in twenty-one ventilated premature infants. The independent variable was the type of research protocol, the control type(ETS without CV) and the intervention(ETS with CV). The dependent variables were oxygen saturation(SpO2), heart rate (HR), measured by pulse oximeter, and the amount of lung secretions measured in gram, the results showed there was no difference in SpO2 responses regardless CV employed before ETS. But there was a significant difference in HR responses between the control and the intervention, even without clinical significance. There was a significant difference in the amount of lung secretions retrieved during ETS with CV, compared to ETS without CV. This study suggested the safety of CV by demonstrating no clinically significant changes in SoO2 and HR in premature infants. The efficacy of CV could be supported by the increases in the amount of sputum during ETS with CV compared to ETS without CV in premature infants.

Newborn period is a transitional stage for independent adaptation from intrauterine to extrauterine life by maintaining respiration, temperature and nutrition. In general, the adaptability of the newborn is proportional to the gestational age(GA), so knowing the accurate GA is critical to develop nursing process in the newborn nursery. A newborn maturity rating, a Ballard examination, has been used to measure GA by assessing the maturity of newborn. It consists a total of 12 items, which is the 6 items for the neuromuscular maturity and the 6 items for the physical maturity. A total of 75 newborn were assessed for the maturity and GA using the Ballard examination. The results are follows: 1) The score of each item of Ballard examination is proportional to GA using the Ballard examination as well as LMP. 2) There was a greater positive relationship between neuromuscular, physical and total maturity, and the GA measured by Ballard examination, than the GA measured by LMP. 3) Any stressful environment to the newborn could influence to the maturity of newborn. In summary, the study showed the Ballard examination is more reliable and clinically feasible method to measure the accurate GA, compared to the GA by LMP. Therefore, it suggests the application of Ballard examination to measure the newborn maturity and GA is beneficial in developing nursing process. The expansion of the study with the variety of the subject characteristics will enhance the clinical applicability of the examination.

PURPOSE
An exploratory study was done to examine the validity of the new Ballard scale with extended scoring system(eNBS) in estimating gestational age(AG) in full-term newborns.
METHOD
The eNBS scoring system was extended to include all numbers of total score of NBS and GA to allow a 3-days variation in GA estimation compared to the original scale which has a 2-week variation due to the application of a 5-score interval for the total NBS score and only even numbers for GA. GA by eNBS(GA-eNBS) was compared with GA by LMP(GA-LMP) and GA by standard NBS(GA-sNBS) in 133 full-term newborns. Difference between GA-LMP and GA-eNBS was analyzed for each GA.
RESULTS
Positive correlations were observed in GA-sNBS and GA-eNBS with GA-LMP. There was no difference between GA-LMP and GA-eNBS at 39GA and 40GA. At 37GA and 38GA, GA-eNBS overestimated GA-LMP up to 1 week, while underestimating up to 1 week at 41GA.
CONCLUSIONS
The accuracy of eNBS was validated within 3 days of variation in GA estimation at 39-40GA. Overestimation by eNBS suggests the possible acceleration of fetal maturity in premature newborns, while underestimation, of the deceleration of fetal maturity in postterm newborns.