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Kim YJ, Kim EK, Cheon JE, Song H, Bang MS, Shin HI, Shin SH, Kim HS. Impact of Cerebellar Injury on Neurodevelopmental Outcomes in Preterm Infants With Cerebral Palsy. Am J Phys Med Rehabil 2023; 102:340-346. [PMID: 36075880 DOI: 10.1097/phm.0000000000002099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to analyze brain imaging findings and neurodevelopmental outcomes of preterm infants diagnosed with cerebral palsy. DESIGN Brain magnetic resonance imaging of preterm infants born between 23 and 32 wks' gestation and diagnosed with cerebral palsy at 2 yrs of corrected age were evaluated. Brain lesions were categorized as periventricular leukomalacia, intraventricular hemorrhage, and cerebellar hemorrhage and graded by the severity. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, at 18-24 mos corrected age, and the Korean Ages and Stages Questionnaire at 18 and 24 mos of corrected age. RESULTS Cerebral palsy was found in 38 children (6.1%) among 618 survivors. Cerebellar injury of high-grade cerebellar hemorrhage and/or atrophy accounted for 25%. Among patients with supratentorial lesions, those having cerebellar injury showed significantly lower scores on each Korean Ages and Stages Questionnaire domain except gross motor than patients without cerebellar injury. They also revealed a high proportion of patients below the cutoff value of Korean Ages and Stages Questionnaire in language, fine motor, and problem-solving domains ( P < 0.05) and lower Bayley Scales of Infant and Toddler Development, Third Edition, language composite scores ( P = 0.038). CONCLUSIONS Poor neurodevelopmental outcomes other than motor function were associated with cerebellar injury. Evaluation of the cerebellum may help predict functional outcomes of patients with cerebral palsy.
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Affiliation(s)
- Yoo Jinie Kim
- From the Division of Neonatology, Department of Pediatrics, Konkuk University Medical Center, Seoul, South Korea (YJK); Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea (YJK, E-KK, SHS, H-SK); Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea (EK-K, SHS, H-SK); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J-EC); Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (HS); and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea (MSB, H-IS)
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King WE, Carlo WA, O'Shea TM, Schelonka RL. Cost-effectiveness analysis of heart rate characteristics monitoring to improve survival for very low birth weight infants. FRONTIERS IN HEALTH SERVICES 2022; 2:960945. [PMID: 36925786 PMCID: PMC10012671 DOI: 10.3389/frhs.2022.960945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022]
Abstract
Introduction Over 50,000 very low birth weight (VLBW) infants are born each year in the United States. Despite advances in care, these premature babies are subjected to long stays in a neonatal intensive care unit (NICU), and experience high rates of morbidity and mortality. In a large randomized controlled trial (RCT), heart rate characteristics (HRC) monitoring in addition to standard monitoring decreased all-cause mortality among VLBW infants by 22%. We sought to understand the cost-effectiveness of HRC monitoring to improve survival among VLBW infants. Methods We performed a secondary analysis of cost-effectiveness of heart rate characteristics (HRC) monitoring to improve survival from birth to NICU discharge, up to 120 days using data and outcomes from an RCT of 3,003 VLBW patients. We estimated each patient's cost from a third-party perspective in 2021 USD using the resource utilization data gathered during the RCT (NCT00307333) during their initial stay in the NICU and applied to specific per diem rates. We computed the incremental cost-effectiveness ratio and used non-parametric boot-strapping to evaluate uncertainty. Results The incremental cost-effectiveness ratio of HRC-monitoring was $34,720 per life saved. The 95th percentile of cost to save one additional life through HRC-monitoring was $449,291. Conclusion HRC-monitoring appears cost-effective for increasing survival among VLBW infants.
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Affiliation(s)
- William E King
- Medical Predictive Science Corporation, Charlottesville, VA, United States
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert L Schelonka
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
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Kim ES, Kim EK, Kim SY, Song IG, Jung YH, Shin SH, Kim HS, Kim JI, Kim BN, Shin MS. Cognitive and Behavioral Outcomes of School-aged Children Born Extremely Preterm: a Korean Single-center Study with Long-term Follow-up. J Korean Med Sci 2021; 36:e260. [PMID: 34636503 PMCID: PMC8506418 DOI: 10.3346/jkms.2021.36.e260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND School-aged children born very preterm have been suggested to have worse cognitive and behavioral outcomes than children born full-term. Executive function (EF) is a higher level of cognitive function related to academic achievement. The present study aimed to evaluate the cognitive (including EF) and behavioral outcomes of Korean children born extremely preterm (EP) and to analyze any biological or socioeconomic risk factors for poor cognitive outcomes in this population. METHODS A total of 71 infants weighing < 1,000 g at birth or born before 30 weeks of gestation (EP group) who were admitted to the neonatal intensive care unit from 2008 to 2009 were included in this study and compared with 40 term-birth controls. The Korean Wechsler Intelligence Scale for Children-Fourth Edition, Advanced Test of Attention (ATA), Stroop test, Children's Color Trails Test (CCTT), and Wisconsin Card Sorting Test (WCST) were used. Additionally, the Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) were completed. Perinatal and demographic data were collected and analyzed. RESULTS The mean full-scale intelligence quotient (FSIQ) score in the EP group was significantly lower than that of the term control group (89.1 ± 18.3 vs. 107.1 ± 12.7; P < 0.001). In the EP group, 26 (37%) children had an FSIQ score below 85, compared to only one child (3%) in the control group. Furthermore, the EP group showed significantly worse EF test results (ATA, Stroop test, CCTT, WCST). Except for the higher social immaturity subscore in the EP group, the K-CBCL and K-ARS scores were not different between the two groups. EP children who received laser treatment for retinopathy of prematurity (ROP) had an 8.8-fold increased risk of a low FSIQ score, and a 1-point increase in the discharge weight Z-score decreased the risk of a low FSIQ score by approximately half in this EP cohort. CONCLUSION This is the first Korean study to investigate the cognitive and behavioral outcomes of school-aged children born EP. In the study cohort, EP children exhibited significantly lower FSIQ scores and EF than their full-term peers, and 37% of them had cognitive problems. Nonetheless, except for social immaturity, the behavioral problems were not different in EP children. Severe ROP and low discharge weight Z-score were identified as independent risk factors for low FSIQ score after adjusting for birth weight.
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Affiliation(s)
- Eun Sun Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea.
| | - Sae Yun Kim
- Department of Pediatrics, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Gyu Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Han Shin
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | | | - Bung Nyun Kim
- Department of Psychiatry and Behavioural Science, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Sup Shin
- Department of Psychiatry and Behavioural Science, Seoul National University College of Medicine, Seoul, Korea
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Sarda SP, Sarri G, Siffel C. Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review. J Int Med Res 2021; 49:3000605211028026. [PMID: 34284680 PMCID: PMC8299900 DOI: 10.1177/03000605211028026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Neurodevelopmental impairment (NDI) is a major complication of extreme prematurity. This systematic review was conducted to summarize the worldwide long-term prevalence of NDI associated with extreme prematurity. Methods Embase and MEDLINE databases were searched for epidemiologic and observational/real-world studies, published in English between 2011 and 2016, reporting long-term prevalence of NDI (occurring from 1 year) among extremely preterm infants born at gestational age (GA) ≤28 weeks. Results Of 2406 articles identified through searches, 69 met the protocol NDI definition (24 North America, 25 Europe, 20 Rest of World). Prevalence of any severity NDI in North America was 8%–59% at 18 months to 2 years, and 11%–37% at 2–5 years; prevalence of moderate NDI in Europe was 10%–13% at 18 months to 2 years, 3% at 2–5 years, and 9%–19% at ≥5 years; prevalence of any NDI in Rest of World was 15%–61% at 18 months to 2 years, and 42% at 2–5 years (no North America/Rest of World studies reported any NDI at ≥5 years). A trend toward higher prevalence of NDI with lower GA at birth was observed. Conclusions Extreme prematurity has a significant long-term worldwide impact on neurodevelopmental outcomes.
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Affiliation(s)
- Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
| | - Grammati Sarri
- Evidence Synthesis, Modeling & Communication, Evidera, London, UK
| | - Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA.,College of Allied Health Sciences, 1421Augusta University, 1421Augusta University, Augusta, GA, USA
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Han S, Kim O, Yoo C, Heo JS, Lee HS, Jeon J. Neurodevelopmental Correlations between the Korean Developmental Screening Test and Bayley Scale III in Very-Low-Birth-Weight Infants. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kim JH, Lee DH, Lee B, Lim SH, Ahn YH, Kang HG, Ha IS, Cheong HI. Renal Syndromic Hearing Loss Is Common in Childhood-onset Chronic Kidney Disease. J Korean Med Sci 2020; 35:e364. [PMID: 33200591 PMCID: PMC7669456 DOI: 10.3346/jkms.2020.35.e364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hearing loss (HL) in children may adversely affect their development. HL is more prevalent in patients with chronic kidney disease (CKD) than in the general population. This study evaluated the prevalence of HL and its underlying diseases in patients with childhood-onset in CKD. METHODS In this retrospective study of a tertiary referral center, childhood-onset CKD patients (stage 2-5, age at onset of renal symptom < 18 years) were recruited. We referred to the "renal" syndromic HL as cases with genetic or syndromic diseases, or extra-renal anomalies in addition to HL and CKD. RESULTS A total of 421 patients (male:female = 279:142) were reviewed according to the causes of CKD: congenital anomalies of the kidney and urinary tract (CAKUT; n = 184, 43.7%), glomerulopathies (GP; n = 105, 24.9%), cystic kidney diseases (CYST; n = 39, 9.3%), perinatal problems (PP; n = 29, 6.9%), and others (n = 64, 15.2%). HL was detected in 82 (19.5%) patients, including 51 (12.1%) patients with sensorineural hearing loss (SNHL), 30 (7.1%) with conductive hearing loss (CHL), and 1 patient with mixed HL. The prevalence of HL in each group was as follows: 16.8% in the CAKUT group, 28.6% in the GP group, 12.8% in the CYST group, 24.1% in the PP group, and 14.1% in the others group. HL was more common in higher CKD stages, especially CHL in end-stage renal disease. SNHL was more prevalent in CKD from GP. Of the 82 patients with HL, 50% had renal syndromic HL: 58.8% of SNHL and one-third of CHL were renal syndromic HL. CONCLUSION One-fifth of the childhood-onset CKD had HL. Collectively, renal syndromic HL comprised half of the HL in this study. To improve the quality of life in patients with childhood-onset CKD, we suggest that HL should be considered, requiring surveillance, and if necessary, early intervention.
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Affiliation(s)
- Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Bongjin Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Wide River Institute of Immunology, Seoul National University, Seoul, Korea.
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Lee JH, Youn Y, Chang YS. Short- and long-term outcomes of very low birth weight infants in Korea: Korean Neonatal Network update in 2019. Clin Exp Pediatr 2020; 63:284-290. [PMID: 32023404 PMCID: PMC7402988 DOI: 10.3345/cep.2019.00822] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/11/2019] [Indexed: 01/26/2023] Open
Abstract
Korea currently has the world's lowest birth rate but a rapidly inreasing number of preterm infants. The Korean Neonatal Network (KNN), launched by the Korean Society of Neonatology under the support of Korea Centers for Disease Control, has collected population-based data for very low birth weight infants (VLBWIs) born in Korea since 2013. In terms of the short-term outcomes of VLBWIs born from 2013 to 2016 registered in the KNN, the survival rate of all VLBWIs was 86%. Respiratory distress syndrome and bronchopulmonary dysplasia were observed in 78% and 30% of all VLBWIs, respectively. Necrotizing enterocolitis occurred in 7%, while 8% of the VLBWIs needed therapy for retinopathy of prematurity in the neonatal intensive care unit (NICU). Sepsis occurred in 21% during their NICU stay. Intraventricular hemorrhage (grade ≥III) was diagnosed in 10%. In terms of the long-term outcomes for VLBWIs born from 2013 to 2014 registered in the KNN, the post-discharge mortality rate was approximately 1.2%-1.5%, mainly owing to their underlying illness. Nearly half of the VLBWIs were readmitted to the hospital at least once in their first 1-2 years of life, mostly as a result of respiratory diseases. The overall prevalence of cerebral palsy was 6.2%-6.6% in Korea. Bilateral blindness was reported in 0.2%-0.3% of VLBWIs, while bilateral hearing loss was found in 0.8%-1.9%. Since its establishment, the KNN has published annual reports and papers that facilitate the improvement of VLBWI outcome and the formulation of essential healthcare policies in Korea.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - YoungAh Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim HS, Kim EK, Park HK, Ahn DH, Kim MJ, Lee HJ. Cognitive Outcomes of Children with Very Low Birth Weight at 3 to 5 Years of Age. J Korean Med Sci 2020; 35:e4. [PMID: 31898433 PMCID: PMC6942132 DOI: 10.3346/jkms.2020.35.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/05/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The cognitive consequences and risk factors based long-term outcome of very-low-birth-weight (VLBW; < 1,500 g) infants in Korea has not been studied. The aim of this study was to determine the influence of perinatal and neonatal risk factors on the cognitive performance of VLBW children at 3 to 5 years of age. METHODS We enrolled 88 VLBW infants without cystic periventricular leukomalacia for the assessment of their demographic data, cognitive performance, and development of cerebral palsy (CP) at 3 to 5 years of age. Cognitive performance was assessed using the Korean version of the Wechsler Preschool and Primary Scale of Intelligence IV. Growth data were assessed with measurements of weight, height, and head circumference (HC) at the corrected ages of 6, 12, and 18 months, and 3 to 5 years of age. RESULTS In the VLBW group, the full-scale intelligence quotient (FSIQ) was 96.1 ± 15.2 at the mean age of 4.5 years. The incidence rate of CP was 3.4%. Overall, 17% (15/88) of the VLBW children had a below-average FSIQ (< 85). We divided the VLBW children into the abnormal FSIQ group (< 85, n = 15) and the normal FSIQ group (≥ 85, n = 73). VLBW children with intrauterine growth retardation (IUGR) was associated with a below-average FSIQ at the mean age of 4.5 years (< 85, 8/15, 53.3% vs. ≥ 85, 5/73, 6.8%; P < 0.001). After controlling for associated clinical factors, IUGR in the VLBW children was found to be associated with an abnormal FSIQ at the mean age of 4.5 years (P = 0.025). The weight, height, and HC obtained for both groups showed that normal growth was maintained at the mean age of 4.5 years with no significant difference between abnormal and normal FSIQ groups. CONCLUSION Fifteen of 88 (17%) of the VLBW children had a below-average FSIQ (< 85). VLBW with IUGR is associated with poor cognitive outcomes at the mean age of 4.5 years.
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Affiliation(s)
- Hee Sun Kim
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Inclusive Clinic for Developmental Disorders, Hanyang University Hospital, Seoul, Korea
| | - Ee Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kyung Park
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Inclusive Clinic for Developmental Disorders, Hanyang University Hospital, Seoul, Korea
| | - Dong Hyun Ahn
- Hanyang Inclusive Clinic for Developmental Disorders, Hanyang University Hospital, Seoul, Korea
- Division of Child Psychiatry, Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Jung Kim
- Hanyang Inclusive Clinic for Developmental Disorders, Hanyang University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Ju Lee
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Inclusive Clinic for Developmental Disorders, Hanyang University Hospital, Seoul, Korea.
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Park HS. Cerebral Palsy Rate of Very Low Birth Weight Infants Born at 36 Weeks of Gestation. J Korean Med Sci 2019; 34:e77. [PMID: 30886548 PMCID: PMC6417993 DOI: 10.3346/jkms.2019.34.e77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/21/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
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Chang YS. Two Year's Long-term Outcomes of Very Low Birth Weight Infants in Korea. J Korean Med Sci 2018; 33:e294. [PMID: 30473647 PMCID: PMC6249172 DOI: 10.3346/jkms.2018.33.e294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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