Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Improved survival rate with decreased neurodevelopmental disability in extreme immaturity

초극소저출생체중아의 생존율 향상에 따른 장기 신경발달 장애의 감소

  • Jeon, Ga Won (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Myo Jing (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung Shin (Department of Pediatrics, Bucheon Hospital, Soonchunhyang University, College of Medicine) ;
  • Shim, Jae Won (Department of Pediatrics, Kangbuk Samsung Hospital, 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) ;
  • Lee, Mun Hyang (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 전가원 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김묘징 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김성신 (순천향대학교 의과대학 부천병원 소아청소과) ;
  • 심재원 (성균관대학교 의과대학 강북삼성병원 소아청소과) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 이문향 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2007.08.19
  • Accepted : 2007.10.30
  • Published : 2007.11.15
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Abstract

Purpose : The aim of this study was to determine whether improved survival of extremely low birth weight infants (ELBWI) was associated with decreased neurodevelopmental disability later in life, and also to identify the factors influencing this disability. Methods : ELBWI admitted to the neonatal intensive care unit of Samsung Medical Center, survived, and followed up until the corrected age of 18 months were enrolled. They were divided into two groups according to admission time: period I (1994-1999, n=36) and period II (2000-2004, n=98). Clinical data were collected retrospectively from the medical records. Results : Survival rates increased from 60.0% to 74.7%, cerebral palsy rates decreased from 22.2% to 8.2% and catch-up growth rate increased from 25.0% to 51.0% during period I and II. Despite less gestational age and birth weight, ELBWI during period II had less periventricular leukomalacia (PVL), sepsis and bronchopulmonary dysplasia compared to period I. The highest risk factors for cerebral palsy were intraventricular hemorrhage (IVH) (${\geq}$Grade III), failure of catch-up growth and PVL. Conclusion : In summary, improved viability was associated with decreased neurodevelopmental disability in ELBWI. Improved neonatal care with resultant decrease in PVL and IVH, and better nutritional support seem to be primarily responsible for this improved outcome.

목 적 : 초극소저출생체중아의 생존율 향상에 따라 장기 신경발달 장애가 감소했는지 여부와 이들의 장기 신경발달의 예후 인자에 대해 알아보고자 하였다. 방 법 : 1994년 11월부터 2004년 7월까지 삼성서울병원 신생아중환자실에서 입원 치료 받은 초극소저출생체중아 중 교정나이 18개월에 외래에서 추적관찰이 가능하였던 134명을 대상으로 하였으며 외래 방문 시 진찰소견과 의무기록을 후향적으로 분석하였다. 대상 환아를 1994년 11월부터 1999년 12월까지인 제 I기와 2000년 1월부터 2004년 7월까지인 제 II기로 나누었으며 각각 36명과 98명이 해당되었다. 결 과 : 제 I기에 비하여 제 II기에 재태연령과 출생체중이 낮았지만 생존율은 향상되었으며(제 I기: 60.0%, 제 II기: 74.7%) 뇌성마비는 감소하였고(제 I기: 22.2%, 제 II기: 8.2%) 따라잡기 성장은 향상되었다(제 I기: 25.0%, 제 II기: 51.0%). 뇌실주위 백질연화증, 패혈증과 기관지폐 이형성증의 이환율은 제 II기에 감소하였다. 뇌성마비의 가장 큰 위험요인은 3도 이상의 고도 뇌실내출혈, 따라잡기 성장의 실패와 뇌실주위 백질연화증이었다. 결 론 : 초극소저출생체중아의 생존율 향상은 장기적인 예후의 향상과 관련되어 있으며 신생아 관리의 질향상과 관련된 뇌실주위 백질연화증의 감소, 고도 뇌실내출혈의 감소, 더 나은 영양공급이 장기적인 예후의 향상과 관련된 것으로 보인다.

Keywords

Acknowledgement

Supported by : Ministry of Health & Welfare, Republic of Korea

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