Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Evaluation of Perinatal and Management Factors Associated with Improved Survival in Extremely Low Birth Weight Infants

출생 체중 1,000 g 미만의 초극소 미숙아의 생존율 향상과 연관된 산과 및 치료인자

  • Park, Sung Eun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Ga Won (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Chang Won (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Hwang, Jong Hee (Department of Pediatrics, Ilsan Paik Hospital, Inje University School of Medicine) ;
  • Koo, Soo Hyun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yu Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Chang Hoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 박성은 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 전가원 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 최창원 (분당 서울대학교병원 소아과) ;
  • 황종희 (인제대학교 의과대학 일산백병원 소아과) ;
  • 구수현 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 김유진 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 이장훈 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아과)
  • Received : 2005.07.06
  • Accepted : 2005.09.05
  • Published : 2005.12.15
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Abstract

Purpose : The aim of this study was to evaluate recent improvements in the survival rate of extremely low birth weight (ELBW) infants and to identify perinatal and management factors that are associated with improved survival. Methods : Two groups of ELBW infants who were admitted to our neonatal intensive care unit (NICU) during two distinct eras : November 1994-December 1999 (Period 1 : n=100) and January 2000-April 2004 (Period 2 : n=166) were retrospectively reviewed. Results : Despite the younger gestational age and smaller birth weight of the ELBW infants in period 2, not only did their survival rate increased to 75 percent from 60 percent in period 1, but their incidence of morbidities such as bronchopulmonary dysplasia, confimed sepsis and intraventricular hemorrhage (${\geq}$Grade III) also declined. Factors significantly associated with improved survival included the use of antenatal steroids, a longer duration of nasal continuous positive airway pressure and the absence of intraventricular hemorrhage (${\geq}$Grade III). Conclusion : We believe that optimized clinical practice, that emphasized less invasive care, contributed to the recent improvements in the survival rate of ELBW infants.

목 적 : 최근 1,000 g 미만의 초극소 미숙아의 생존율이 괄목할 만큼 향상되었고 이는 또한 신생아 집중치료술 평가의 지표로 간주되고 있어 초극소 미숙아의 생존율이 얼마나 향상되었는 지를 평가하고 생존율 향상과 연관된 주산기 및 치료인자를 알아보고자 하였다. 방 법 : 본원 신생아 중환자실에 입원한 출생 체중 1,000 g 미만의 초극소 미숙아들을 대상으로 1994년부터 1999년까지를 1기(n=100)로, 2000년부터 2004까지를 2기(n=166)로 분류하여 후향적 의무기록 분석을 통해 두 시기의 임상양상을 비교하였다. 결 과 : 1기에 비해 2기에서 평균 재태연령과 출생 체중($27{\pm}2$주, $841{\pm}121g$ vs. $26{\pm}2$주, $794{\pm}143g$)이 유의하게 낮았으나 생존율이 60%에서 75%로 현저히 향상되었다. 또한 재태연령과 출생 체중을 보정한 분석에서 두 시기간 유의한 차이를 보인 합병증으로는 기관지폐이형성증, 균혈증이 확인된 패혈증과 3도 이상의 뇌실내 출혈로 2기에서 낮은 빈도를 보였다. 대상 환아들의 생존율 향상과 연관된 주산기 및 치료인자를 확인하기 위해 두 시기 간 유의한 차이를 보인 임상인자를 로짓회귀분석을 한 결과 산전 스테로이드 치료, 비강 지속성 기도 양압 치료기간과 3도 이상의 뇌실내 출혈의 부재가 포함되었다. 결 론 : 본원의 초극소 미숙아들의 생존율이 최근 향상된 것은 덜 침습적인 치료 방법을 중요시 여겼던 신생아 중환자실팀의 임상적 관리의 향상을 바탕으로 산전 스테로이드 치료 증가, 비강 지속성 양입기도 사용 증가와 3도 이상의 뇌실내 출혈감소에 기인한 것으로 사료된다.

Keywords

References

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