Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Outcomes and Management of Fetal Infants with Birth Weight Below 500 g at a Tertiary Center

출생체중 500 g 미만의 태아영아 치료성적 및 치료의 실제

  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Universtiy School of Medicine) ;
  • Kim, Yu Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Universtiy School of Medicine) ;
  • Koo, Soo Hyun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Universtiy School of Medicine) ;
  • Lee, Jang Hoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Universtiy School of Medicine) ;
  • Hwang, Jong Hee (Department of Pediatrics, Ilsan Paik Hospital, Inje University School of Medicine) ;
  • Choi, Chang Won (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Shim, Jae Won (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan Universtiy School of Medicine) ;
  • Kim, Sung Shin (Department of Pediatrics, Bucheon Hospital, Soonchunhyang University, College of Medicine) ;
  • Ko, Sun Young (Department of Pediatrics, Samsung Cheil Hospital, Sungkyunkwan Universtiy School of Medicine) ;
  • Lee, Eun Kyung (Department of Pediatrics, Kangnam Cha Hospital, Pochon Cha University) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Universtiy School of Medicine)
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 김유진 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 구수현 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 이장훈 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 황종희 (인제대학교 의과대학 일산백병원 소아과) ;
  • 최창원 (분당서울대학교병원 소아과) ;
  • 심재원 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 김성신 (순천향대학교 의과대학 부천병원 소아과) ;
  • 고선영 (성균관대학교 의과대학 삼성제일병원 소아과) ;
  • 이은경 (포천중문의과대학교 강남차병원 소아과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아과)
  • Received : 2005.05.06
  • Accepted : 2005.07.22
  • Published : 2005.09.15
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Abstract

Purpose : The purpose of this study was to report outcome of fetal infants with birth weight below 500 g known as lower limit of viability and to evaluate treatment characteristics and short-term morbidity of their survivors. Methods : We retrospectively analyzed the medical records of all fetal infants with birth weight below 500 g who were delivered at Samsung Medical Center(SMC), or transferred to neonatal intensive care unit(NICU) of SMC within 24 hrs after birth between 1994 and 2004. Data for all interventions and morbidity outcome were analyzed for infants who were admitted to the NICU and were compared between NICU survivors and deaths. Results : Among 53 infants with birth weights of 400 to 499 g who were born in SMC during the study period, 8(15.1%) infants were admitted to the NICU and one was transferred to NICU from other hospital. Overall, 4(44%) of 9 survived and were discharged from the NICU. The smallest infant who survived weighed 439 grams. The least gestational age was $23^{+3}$ among the survivors. Compared with NICU deaths, NICU survivors had larger gestational age($24^{+2}{\pm}1^{+3}$ vs. $25^{+4}{\pm}2^{+3}$) and birth weight($424{\pm}17$ vs. $453{\pm}19$)(P<0.05). Median survival duration of NICU deaths was 15 days. None of NICU survivors had severe IVH, but 3(75%) had laser therapy for retinopathy of prematurity and bronchopulmonary dysplasia, respectively. Conclusion : Fetal infants with birth weight below 500 g known as lower limit of viability survived successfully. Study for their long-term follow-up will be needed to define our limit of viability and indication for their active resuscitation.

목 적 : 생존 한계인 출생체중 500 g 미만의 태아영아에 대한 치료성적을 알아보고 이들 중 성공적으로 치료하여 생존하였던 생존아들의 치료적 특성 및 단기 유병률을 분석해 보고자 하였다. 방 법 : 1994년부터 2004년까지 삼성서울병원에서 출산되거나 생후 24시간 내에 전원된 출생체중 500 g 미만의 태아영아들의 분만 기록과 신생아 집중치료실 입원 기록을 후향적으로 조사였다. 신생아 집중치료실에 입원하였던 태아영아들을 사망아들과 생존아들로 나누어 비교하였고 생존아들의 치료적 특성과 단기 유병률을 조사하였다. 결 과 : 10년간 400 g에서 499 g까지의 태아영아 출산 총 53례 중 8례(15.1%)가 생존의 징후가 있어 신생아 집중치료실에 입원하였으며 외부 전원 1명을 포함하여 총 9례의 태아영아가 신생아 집중치료실 입원 치료를 받았다. 이중 4명이 생존하여 44%의 생존율을 보였으며, 출생체중이 가장 작은 생존아는 439 g, 생존아들 중 가장 작은 재태연령은 $23^{+3}$주였다. 사망아들의 사망 시점 중앙값은 15일이었으며 모두 생후 28일 이내에 사망하였다. 사망아들은 생존아들에 비해 재태연령($24^{+2}{\pm}1^{+3}$ vs. $25^{+4}{\pm}2^{+3}$)과 출생체중($424{\pm}17$ vs. $453{\pm}19$)이 의미 있게 작았으나(P<0.05), 성별, 단생아, 부당 경량아, 제왕절개 분만, 산전 스테로이드 투여 비율은 차이가 없었다. 생존아들에서 중증 뇌실 내 출혈은 한례도 없었고 기관지 폐 이형성증 및 수술이 필요했던 미숙아 망막증은 각각 75%였으며 평균 입원기간은 $138{\pm}28$일 이었다. 결 론 : 단일기관의 연구이나 생존한계로 알려진 500 g 미만의 태아영아들의 성공적인 생존이 가능하다. 이들에 대한 장기적 발달신경학적 추적 연구를 통해 이들의 생존한계 및 소생술 적용기준의 국내 합의가 필요할 것으로 생각된다.

Keywords

Acknowledgement

Supported by : 보건복지부

References

  1. Bae YM, Bae CW. The changes in the mortality rates of low birth weight infant and very low birth weight infant in Korea over the past 40 years. J Korean Med Sci 2004; 19:27-31 https://doi.org/10.3346/jkms.2004.19.1.27
  2. Kim JT, Park HK, Jun NL, Lim JW, Kim EA, Kim K, et al. Recent outcome of extremely low birth weight infants at Asan Medical Center. J Korean Soc Neonatol 2003;10: 133-42
  3. Hwang JH, Choi CW, Chang YS, Choe YH, Park WS, Shin SM, et al. The efficacy of clinical strategies to reduce nosocomial sepsis in extremely low birth weight infants. J Korean Med Sci 2005; Accepted.
  4. Park SE, Jeon GW, Chang YS, Choi CW, Hwang JH, Koo SH, et al. Evaluation of Perinatal and Management Factors Associated with Improved Survival in Extremely Low Birth Weight Infants. Korean J Pediatr Submitted 2005
  5. Mercier C. Survival and outcomes of infants with birth weight less than 1001 grams. Pediatr Res 2002;51:292A
  6. Choi CW, Hwang JH, Shim JW, Kim SS, Ko SY, Lee EK, et al. Change in the limit of viability of fetal infants. J Korean Pediatr Soc 2003;46:1194-9
  7. Kim CR. The limit of viability and care of fetal infants. Korean J Perinatol 2004;15:341-9
  8. Basic newborn resuscitation : a practical guide : World Health Organization, available from http://www.who.int/reproductive- health/publications/MSM_98_1/basic_newborn_resuscitat ion.pdf, 1997
  9. Walther F. Marginally viable, fetal infants : A Dutch experience and viewpoint. Proceedings of the Hot topics 2002 in neonatology; 2002 December 8-10; Washington, DC; Ross Special Conference : p39-41, 2002
  10. Sauve RS, Robertson C, Etches P, Byrne PJ, Dayer- Zamora V. Before viability : a geographically based outcome study of infants weighing 500 grams or less at birth. Pediatrics 1998;101:438-45 https://doi.org/10.1542/peds.101.3.438
  11. Nishida H. Who is too young or small to live : Japanese experience. Proceedings of Hot topics 2002 in neonatology; 2002 December 8-10; Washington, DC; Ross Special Conference : p53-8, 2002
  12. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage : a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92:529-34 https://doi.org/10.1016/S0022-3476(78)80282-0
  13. Blaymore-Bier J, Pezzullo J, Kim E, Oh W, Garcia-Coll C, Vohr BR. Outcome of extremely low-birth-weight infants : 1980-1990. Acta Paediatr 1994;83:1244-8
  14. Pleasure JR, Dhand M, Kaur M. What is the lower limit of viability? Intact survival of a 440-g infant. Am J Dis Child 1984;138:783-5
  15. Amato M. The care of fetal babies : survival of a 390-g infant. Acta Paediatr Suppl 1992;382:7-9
  16. Muraskas JK, Carlson NJ, Halsey C, Frederiksen MC, Sabbagha RE. Survival of a 280-g infant. N Engl J Med 1991; 324:1598-9 https://doi.org/10.1056/NEJM199105303242213
  17. Moro G, Minoli I. Survival with birth weight of less than 500 grams. Pediatrics 1991;87:270-1
  18. Hokuto I, Ikeda K, Tokieda K, Mori K, Sueoka K. An ultra premature baby of 290 g birth weight needed more than 500 mg/kg of calcium and phosphorus daily. Eur J Pediatr 2001;160:450-1 https://doi.org/10.1007/s004310100761
  19. Lucey JF, Rowan CA, Shiono P, Wilkinson AR, Kilpatrick S, Payne NR, et al. Fetal infants : the fate of 4172 infants with birth weights of 401 to 500 grams-the Vermont Oxford Network experience(1996-2000). Pediatrics 2004;113: 1559-66 https://doi.org/10.1542/peds.113.6.1559
  20. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996 NICHD Neonatal Research Network. Pediatrics 2001; 107:E1 https://doi.org/10.1542/peds.107.5.e71
  21. Rennie JM. Perinatal management at the lower margin of viability. Arch Dis Child Fetal Neonatal Ed 1996;74:F214-8 https://doi.org/10.1136/fn.74.3.F214
  22. Louis JM, Ehrenberg HM, Collin MF, Mercer BM. Perinatal intervention and neonatal outcomes near the limit of viability. Am J Obstet Gynecol 2004;191:1398-402 https://doi.org/10.1016/j.ajog.2004.05.047
  23. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002;110:143-51
  24. Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network : changes in practice and outcomes during the first 15 years. Semin Perinatol 2003;27:281-287 https://doi.org/10.1016/S0146-0005(03)00055-7
  25. Hoffman EL, Bennett FC. Birth weight less than 800 grams : changing outcomes and influences of gender and gestation number. Pediatrics 1990;86:27-34
  26. Hoekstra RE, Ferrara TB, Couser RJ, Payne NR, Connett JE. Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23-26 weeks' gestational age at a tertiary center. Pediatrics 2004;113:e1-6
  27. Lorenz JM, Paneth N. Treatment decisions for the extremely premature infant. J Pediatr 2000;137:593-5 https://doi.org/10.1067/mpd.2000.110532
  28. De Leeuw R, Cuttini M, Nadai M, Berbik I, Hansen G, Kucinskas A, et al. Treatment choices for extremely preterm infants : an international perspective. J Pediatr 2000; 137:608-16 https://doi.org/10.1067/mpd.2000.109144
  29. O'Shea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG. Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979 and 1994. Pediatrics 1997;100:982-6. https://doi.org/10.1542/peds.100.6.982
  30. Hack M, Friedman H, Fanaroff AA. Outcomes of extremely low birth weight infants. Pediatrics 1996;98:931-7
  31. The Victorian Infant Collaborative Study Group. Economic outcome for intensive care of infants of birthweight 500- 999 g born in Victoria in the post surfactant era. J Paediatr Child Health 1997;33:202-8 https://doi.org/10.1111/j.1440-1754.1997.tb01580.x
  32. Yu VY. Developmental outcome of extremely preterm infants. Am J Perinatol 2000;17:57-61 https://doi.org/10.1055/s-2000-9277
  33. Kang MA, Kim SS, Kim MH, Chang YS, Kim MJ, Han HK, et al. Effect of fluid restriction through high humidification on the management of very low birth weight infant. J Korean Soc Neonatol 2000;7:1-10
  34. Jeon GW, Park SE, Choi CW, Hwang JH, Chang YS, Park WS. The effects of early enteral feeding in extremely low birth-weight infants. Korean J Pediatr 2005; 48:711-5