Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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중증 태변흡입증후군의 임상적 특성

Clinical characteristics of severe meconium aspiration syndrome

  • 최창원 (서울대학교 의과대학 소아과학교실) ;
  • 김병일 (서울대학교 의과대학 소아과학교실) ;
  • 이현주 (서울대학교 의과대학 소아과학교실) ;
  • 정경은 (서울대학교 의과대학 소아과학교실) ;
  • 심규홍 (서울대학교 의과대학 소아과학교실) ;
  • 임인숙 (서울대학교 의과대학 소아과학교실) ;
  • 이진아 (서울대학교 의과대학 소아과학교실) ;
  • 김이경 (서울대학교 의과대학 소아과학교실) ;
  • 김한석 (서울대학교 의과대학 소아과학교실) ;
  • 최중환 (서울대학교 의과대학 소아과학교실)
  • Choi, Chang Won (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kim, Beyong Il (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Hyun Ju (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Joung, Kyoung Eun (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Shim, Gyu Hong (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lim, In Suk (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Jin-A (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kim, Ee-Kyung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kim, Han-Suk (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Choi, Jung-Hwan (Department of Pediatrics, Seoul National University College of Medicine)
  • 투고 : 2008.03.25
  • 심사 : 2008.06.20
  • 발행 : 2008.07.15
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초록

목 적 : 본 연구에서는 48시간 이상의 기계 환기요법이 필요한 중증 태변흡입증후군(meconium aspiration syndrome, MAS)의 임상적 특성과 시간의 경과에 따른, 또한 폐표면 활성제 투여 전후의 호흡 부전 정도와 방사선 영상 소견의 변화를 분석해보고자 하였다. 방 법 : 2004년 1월부터 2007년 7월까지 분당서울대학교병원 신생아중환자실에 중증 MAS로 입원하였던 12명의 환아를 대상으로 후향적인 분석을 하였다. 결 과 : PPHN의 발생은 긴 입원기간과 긴 총 기계 환기요법 적용기간에 독립적으로 영향을 미치는 인자였다. 폐표면 활성제는 RDS의 방사선 영상 소견이 있었던 경우에만 투여되었다. RDS의 방사선 영상 소견이 있었던 8명(75%)의 환아들에서는 그렇지 않았던 경우에 비해 고빈도진동환기기 적용기간이 유의하게 길었다. PPHN은 8명(75%)의 환아들에서 발생하였고 이들은 PPHN이 발생하지 않았던 환아들에 비해 기계 환기요법 기간이 유의하게 길었다. 폐표면 활성제를 투여 받은 환아들은 투여 후 12시간 이내에 모두 방사선 영상 소견의 호전을 보였으나 같은 기간 동안 호흡 부전 정도의 유의한 변화는 관찰되지 않았다. PPHN이 발생하지 않은 환아들에서는 폐표면 활성제를 투여한 후 12시간 이내에 유의한 호흡 부전 정도의 감소가 관찰되었으나 PPHN이 발생한 환아들에서는 그렇지 않았다. 결 론 : 중증 MAS의 임상경과는 PPHN의 발생여부에 따라 유의한 차이를 보였다. RDS에 합당한 방사선 영상 소견이 동반되었던 환아들에서의 폐표면 활성제의 투여는 방사선 영상 소견의 호전을 가져왔지만 이들의 임상경과에는 유의한 영향을 주지 못하였다.

Purpose : This study aims to describe the clinical characteristics of severe meconium aspiration syndrome (MAS) which required mechanical ventilation over 48 h and to delineate the progress of respiratory failure and radiographic findings in severe MAS. Methods : Twelve infants admitted to the Neonatal Intensive Care Unit (NICU) of the Seoul National University Bundang Hospital diagnosed with severe MAS from January 2004 to July 2007 were analyzed retrospectively. Results : The presence of persistent pulmonary hypertension of the newborn (PPHN) is the only independently significant risk factor for a longer hospital stay and longer duration of mechanical ventilation. Surfactant replacement therapy (SRT) was not randomized but only performed in infants with radiographic findings for respiratory distress syndrome (RDS). In the presence of radiographic findings for RDS, the duration of high-frequency oscillatory ventilation was significantly longer. PPHN developed in 8 infants (75%). The PPHN group had a significantly longer duration of mechanical ventilation. All infants who received SRT showed radiographic improvement within 12 h, but there was no significant change in the severity score during the same period. Infants without the PPHN complications showed significant decrease in the severity score within 12 h after SRT, whereas infants with PPHN complications did not. Conclusion : The clinical course of severe MAS differed significantly depending on the development of PPHN. SRT conferred radiographic improvement in infants who showed radiographic findings for RDS, but did not influence the clinical course of MAS significantly.

키워드

참고문헌

  1. Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998;45:511-29 https://doi.org/10.1016/S0031-3955(05)70025-0
  2. Gelfand SL, Fanaroff JM, Walsh MC. Meconium stained fluid: approach to the mother and the baby. Pediatr Clin North Am 2004;51:655-67 https://doi.org/10.1016/j.pcl.2004.01.012
  3. Lin HC, Su BH, Lin TW, Peng CT, Tsai CH. Risk factors of mortality in meconium aspiration syndrome: review of 314 cases. Acta Paediatr Taiwan 2004;45:30-4
  4. Dargaville P A, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006;117:1712-21 https://doi.org/10.1542/peds.2005-2215
  5. Lee C, Park KI, Lee JY, Han DG. A clinical observation of meconium aspiration syndrome. J Korean Pediatr Soc 1984; 27:958-64
  6. Yoo CS, Kim MK, Lee K. A study of meconium aspiration syndrome. J Korean Pediatr Soc 1988;31:1425-31
  7. Kim DH, Ko DH, Woo YJ, Choi YY, Hwang TJ. Clinical observation of meconium aspiration syndrome: prognostic implication of early meconium suctioning. J Korean Pediatr Soc 1992;35:484-91
  8. Yoon YR, Kim JS, Kim MK, Kho SY, Lee SJ, Kim MJ, et al. Clinical observation of meconium aspiration syndrome: in relation to fetal heart rate monitoring. J Korean Pediatr Soc 1993;36:1656-62
  9. Yoon YH, Kim KA, Ko SY, Lee YK, Shin SM. Clinical observation of meconium aspiration syndrome and effect of suctioning through endotracheal intubation on prognosis of meconium aspiration syndrome. Korean J Pediatr 2007;50: 959-64 https://doi.org/10.3345/kjp.2007.50.10.959
  10. Greenough A. Surfactant replacement therapy for non-respiratory distress syndrome neonatal respiratory disease-research or clinical application? Eur J Pediatr 1995;154(8 Suppl 3):S2-4 https://doi.org/10.1007/BF01972965
  11. Moses D, Holm BA, Spitale P, Liu MY, Enhorning G. Inhibition of pulmonary surfactant function by meconium. Am J Obstet Gynecol 1991;164:477-81 https://doi.org/10.1016/S0002-9378(11)80003-7
  12. Cleary GM, Antunes MJ, Ciesielka DA, Higgins ST, Spitzer AR, Chander A. Exudative lung injury is associated with decreased levels of surfactant proteins in a rat model of meconium aspiration. Pediatrics 1997;100:998-1003 https://doi.org/10.1542/peds.100.6.998
  13. El Shahed AI, Dargaville P, Ohlsson A, Soll RF. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev 2007:CD002054
  14. Shon SM, Lee BY, Kim CS, Lee SL, Kwon TC. The outcome of surfactant replacement therapy in above nearterm neonates with severe pulmonary disease. Korean J Pediatr 2007;50:1200-5 https://doi.org/10.3345/kjp.2007.50.12.1200
  15. Ballard RA, Truog WE, Cnaan A, Martin RJ, Ballard PL, Merrill JD, et al. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006;355: 343-53 https://doi.org/10.1056/NEJMoa061088
  16. Thureen PJ, Hall DM, Hoffenberg A, Tyson RW. Fatal meconium aspiration in spite of appropriate perinatal airway management: pulmonary and placental evidence of prenatal disease. Am J Obstet Gynecol 1997;176:967-75 https://doi.org/10.1016/S0002-9378(97)70387-9
  17. Burgess AM, Hutchins GM. Inflammation of the lungs, umbilical cord and placenta associated with meconium passage in utero. Review of 123 autopsied cases. Pathol Res Pract 1996;192:1121-8 https://doi.org/10.1016/S0344-0338(96)80029-X
  18. Wiswell TE, Peabody SS, Davis JM, Slayter MV, Bent RC, Merritt T A. Surfactant therapy and high -frequency jet ventilation in the management of a piglet model of meconium aspiration syndrome. Pediatr Res 1994;36:494-500 https://doi.org/10.1203/00006450-199410000-00015
  19. Altshuler G. Hyde S. Clinicopathologic implications of placental pathology. Clin Obstet Gynecol 1996;39:549-70 https://doi.org/10.1097/00003081-199609000-00006
  20. Yeh TF, Harris V, Srinivasan G, Lilien L, Pyati SSP. Roentgenographic findings in infants with meconium aspiration syndrome. JAMA 1979;242:60-3 https://doi.org/10.1001/jama.242.1.60
  21. Findlay RD, Taeusch HW, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics 1996;97:48-52
  22. Lam BC, Yeung CY. Surfactant lavage for meconium aspiration syndrome: a pilot study. Pediatrics 1999;103:1014-8 https://doi.org/10.1542/peds.103.5.1014
  23. Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H, Walsh WF et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002;109:1081-7 https://doi.org/10.1542/peds.109.6.1081
  24. Ibara S, Ikenoue T, Murata Y, Sakamoto H, Saito T, Nakamura Y et 31. Management of meconium aspiration syndrome by tracheobronchial lavage and replacement of SurfactantT A. Acta Paediatr Jpn. 1995;37:64-7 https://doi.org/10.1111/j.1442-200X.1995.tb03688.x
  25. Kinsella JP, Neish SR, Shaffer E, Abman SH. Low-dose inhalational nitric oxide in persistent pulmonary hypertension of the newborn. Lancet 1992;340:819-20 https://doi.org/10.1016/0140-6736(92)92687-B
  26. Ballard RA, Hansen TN, Corbet A. Respiratory failure in the term infant. In: Taeusch HW, Ballard RA, Gleason CA, editors. Avery's diseases of the newborn. 8th ed. Philadelphia: Elsevier Inc; 2005:705-22
  27. Dargaville P A, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006;117:1712-21 https://doi.org/10.1542/peds.2005-2215
  28. Miller MJ, Fanaroff AA, Martin RJ. Respiratory disorders in preterm and term infants. In: Fabaroff AA, Martin RJ, editors. Neonatal-perinatal medicine. 7th ed. St. Louis: Mosby Inc; 2002:1025-49
  29. Mazor M, Furman B, Wiznitzer A, Shoham-Vardi I, Cohen J, Ghezzi F. Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid. Obstet Gynecol 1995;86:830-3 https://doi.org/10.1016/0029-7844(95)00265-S
  30. Yoder BA, Kirsch EA, Barth WH, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol 2002;99: 731-9 https://doi.org/10.1016/S0029-7844(02)01942-7

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