Neonatal Medicine

  • 제16권1호
  • /
  • Pages.55-63
  • /
  • 2009
  • /
  • 2287-9412(pISSN)
  • /
  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
권호 표지

신생아중환자실 내 로타바이러스 감염의 발생 및 임상 양상

Incidence and Clinical Manifestations of Rotaviral Infections in a Neonatal Intensive Care Unit

  • 백재문 (고려대학교 의과대학 소아과학교실) ;
  • 김희영 (고려대학교 의과대학 의학통계학교실) ;
  • 이장훈 (고려대학교 의과대학 소아과학교실) ;
  • 최병민 (고려대학교 의과대학 소아과학교실) ;
  • 이정화 (고려대학교 의과대학 소아과학교실) ;
  • 이광철 (고려대학교 의과대학 소아과학교실) ;
  • 홍영숙 (고려대학교 의과대학 소아과학교실)
  • Baek, Jae-Moon (Department of Pediatrics, Korea University College of Medicine) ;
  • Kim, Hee-Young (Department of Biostatistics, Korea University College of Medicine) ;
  • Lee, Jang-Hoon (Department of Pediatrics, Korea University College of Medicine) ;
  • Choi, Byung-Min (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Jung-Hwa (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Kwang-Chul (Department of Pediatrics, Korea University College of Medicine) ;
  • Hong, Young-Sook (Department of Pediatrics, Korea University College of Medicine)
  • 발행 : 2009.05.31

⟨ 이전 논문 다음 논문 ⟩

초록

목적 : 본 연구에서는 신생아중환자실 내 로타바이러스 감염의 발생 현황과 임상 양상을 분석하고 타 병원에서 전원된 신생아의 로타바이러스 감염이 신샹아 중환자실 내 로타바이러스 감염의 발생에 미치는 영향을 알아보고자 하였다. 방법 : 2001년 1월부터 2006년 12월까지 고려대학교 부속 안산병원 신생아중환자실에 입원한 환아 중 대변 검체에서 로타바이러스 감염을 진단받은 94명을 대상으로 의무 기록을 후향적으로 분석하였다. 로타바이러스 감염의 진단을 환아의 대변 검체를 이용한 로타바이러스 항원 검사에서 양성일 경우로 정의하였다. 통계학적으로는 SPSS 프로그램에서 Student's t-test, chi-square test와 time series analysis를 이용하였으며 유의수준 <0.05로 검증하였다. 결과 : 연구 기간 동안 신생아중환자실에 입원한 1,501명 중 94명(6.3%)이 로타바이러스 감염으로 진단되었으며 1,000 재원일수 당 4.9건이 발생하는 것으로 확인되었다. 연구 기간 중 타 병원에서 전원된 신샹아 223명 중 24명(10.8%)이 입원 시 시행한 검사에서 로타바이러스 감염으로 진단되었다. 로타바이러스 감염의 주된 증상은 황달의 악화 및 발생이 33례(35.1%)였고 설사를 포함한 붉은 변 24례(25.5%), 구토 15례(16.0%)를 보였으며 그 밖에 발열 9례(9.6%), 무호흡 5례(5.3%), 보챔 5례(5.3%), 경련( 5례(5.3%), 끙끙거림 4례(4.3%), 위 잔류량 증가 3례(3.2%) 등을 보였다. Stage II이상의 신샹아 괴사성 장염으로 진단된 환아는 3례(3.2%)이었다. 미숙아군(n=44)과 만삭아군(n=50)의 비교에서 황달의 악화 및 발생이 미숙아군에서 유의하게 많았으며 경련이 만삭아군에서, 신생아 괴사성 장염이 미숙아군에서 많이 발생하는 경향을 보였으나 통계적으로 유의하지 않았다. 타 병원에서 전원된 신생아의 입원 1개월 후 기존의 샌생아중환자실 입원 환아에서 로타바이러스 감염의 빈도가 증가하는 것을 확인할 수 있었다. l이러한 로타바이러스 감염은 2내지 4개월 후에 그 발생빈도가 감소하는 것도 확인할 수 있었다. 결론 : 신생아중환자실 내 로타바이러스 감염은 드물지 않으며 황달의 악화 및 발생, 무호흡, 경련 등의 비전형적 증상이 상대적으로 많았다. Stage II 이상의 신샹아 괴사성 장염도 3.3%에서 발생하였으며 로타바이러스 감염을 지닌 환아가 신생아중환자실에 전원됨으로써 신생아중환자실 내 감염의 급증이 일어날 수 있으므로 로타바이러스 감염에 대한 상시적인 검사와 엄격한 관리가 필요하리라 생각된다.

Purpose: This study was conducted to investigate the incidence and clinical manifestations of rotaviral infections in the neonatal intensive care unit (NICU). We also investigated whether neonates referred from other hospitals cause outbreaks of rotaviral infections in the NICU. Methods: Neonates diagnosed wit rotaviral infections in the NICU at Korea University Ansan Hospital between January 2002 and December 2006 were evaluated retrospectively. Results: Of 1,501 neonates admitted to the NICU, the number of rotaviral infections was 94 (6.3%) and the prevalence was 4.9 cases per 1,000-hospital days. Of 223 neonates referred from other hospitals to our NICU, 24 (10.8%) were confirmed to have rotaviral infections at the time of referral. Common symptoms of rotaviral infections were jaundice diarrhea or loose stools, vomiting, fever, apnea, irritability, seizures, and moaning sounds. Necrotizing enterocolitis of stage II or more was diagnosed in 3 premature neonates, accounting for 3.2% of total infected neonates and 6.8% of premature infected patients. There were no statistically significant differences in the prevalence of symptoms between term and preterm neonates, except for jaundice that is more frequent in premature infants. In time series analysis, the admission of neonates who were born at other hospitals and diagnosed with rotaviral infections were associated 1 month later by increased cases of neonates with rotaviral infections who were born at our hospital, whereas new cases of rotaviral infections among inborn neonates were decreased 2 and 4 months later (P<0.05). Conclusion: Rotaviral infections in NICU were not rare and showed vague symptoms. Three cases (3.2%) were diagnosed with stage II or more necrotizing enterocolitis. The referred neonates with rotaviral infections may induce outbreaks in the NICU, therefore awareness and strict surveillance for rotaviral infections should be performed at the time of referral.

키워드

참고문헌

  1. Graharn DY, Sackman JW, Estes MK, Pathogenesis of rotavirus-induced diarrhea. Preliminary studies in miniature swine piglet. Dig Dis Sci 1984; 29; 1028-35 https://doi.org/10.1007/BF01311255
  2. Sharma R, Hudak ML, Premachandra BR, Stevens G, Monteiro CB, Bradshaw JA, et al. Clinical manifestations of rotavirus infection in the neonatal intensive care unit. Pediatr Infect Dis J 2002;21: 1099-105. https://doi.org/10.1097/00006454-200212000-00003
  3. Glass RI. Kilgore PE, Holman RC. Jin S. Smith JC, Woods PA. et al. The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden. J Infect Dis 1995;174: S5-11.
  4. Parashar UD, Holman RC. Clarke MJ, Bresee JS, Glass RI. Hospitalizations associated with rotavirus diarrhea in the United States. 1993 through 1995: surveillance based on the new lCD-9-CM rota-virus-specific diagnostic code. J Infect Dis 1998; 177:13-7. https://doi.org/10.1086/513808
  5. Langley JM, LeBlanc JC, Hanakowski M, Goloubeva O. Tbe role of Clostridium difficile and viruses as causes of nosocomial diarrhea in children. Infect Control Hosp Epidemiol 2002;23:660-4. https://doi.org/10.1086/501990
  6. Ratner AJ, Neu N, Jakob K, Grumet S, Adachi N, Della-Latta P. et al. Nosocomial rotavirus in a pediatric hospital. Infect Control Hosp Epidemiol 2001:22;299-301. https://doi.org/10.1086/501904
  7. Park MK, Park JO, Kim CH. Comparison of clinical manifestations of rotaviral gastroenteritis between neonates and infants. Korean J Pediatr Gastroenterol Nutr 2006; 9:153-61.
  8. Lee JH, Ko EY, Kim JO, Lee JH, Baek LJ, Kim SK. Comparison among diagnostic methods of rotaviral gastroenteritis in children. Korean J Pediatr Gasiroenterol Nutr 2001;4:34-40.
  9. Chung KO, Lee DS, Kim DK, Choi SM, Kim WT, Yu SH. Study of nosocomial infection of rotavirus in preterm and full-term neonates. J Korean Pediatr Soc 1999;42;332-338
  10. Lee SY, Kim HJ, Kjm MY, Kim WD, Lee DS, Kim DK, et al. The difference between clinical manifestations and feeding or delivery methods in healthy full term neonates and those with nosocomial rotaviral infection. J Korean Pediatr Soc 2003;46:454-8
  11. Park JY, Kim DH, Bae SY, Choi CH. Cho EY, Choi JH. et al. Study of nosocomial rotavirus infection in neonates admitted to a postpartum-care center. Korean J Pediatr Infect 2007;14:145-54.
  12. Verboon-Maciolek MA, Krediet TG, Gerards LJ, Fleer A, van Loon TM. Clinical and epidemiologic characteristics of viral infections in a neonatal intensive care unit during a 12-year period. Pediatr Infect Dis J 2005;24:901-4. https://doi.org/10.1097/01.inf.0000180471.03702.7f
  13. Murphy AM, Albrey MB, Crewe EB. Rotavirus infections of neonates. Lancet 1977;2:1149-50.
  14. Chrystie lL, Totterdell BM, Banatvala JE. Asymptomatic endemic rotavirus infections in the new born. Lancet 1978: 1: 1176-8.
  15. Bishop RF, Barnes GL, Cipriani E, Lund JS. Clinical immunity after neonatal rotavirus infection. A prospective longitudinal study in young children. N Engl J Med 1983;309;72-6. https://doi.org/10.1056/NEJM198307143090203
  16. Rotbart HA. Nelson WL. Glode MP. Triffon TC, Kogut SJ, Yolken RH et al. Neonatal rotavirus-associated necrotizing enterocolitis: case control study and prospective surveillance during an outbreak. J Pediatr 1988;112:87-93 https://doi.org/10.1016/S0022-3476(88)80128-8
  17. Rotbart HA, Levin MJ, Yolken RH, Manchester DK, Jantzen J. An outbreak of rotavirus-associated neonatal necrotizing enterocolitis. J Pediatr 1983:103:454-9. https://doi.org/10.1016/S0022-3476(83)80427-2
  18. Seo HJ, Jung YJ, Park SK, Choi SH, Lee JH, Kim MJ, et al. Rotavirus-associated neonatal necrotizing enterocolitis. Korean J Pediatr 2009;52:56-60. https://doi.org/10.3345/kjp.2009.52.1.56
  19. DiFazio MP, Braun L, Freedman S, Hickey P. Rotavirus-induced seizures in childhood. J Child Neurol 2007;22:1367-70. https://doi.org/10.1177/0883073807307083
  20. Widdowson MA, van Doornum GJ, van der Poel WH, de Boer AS, van de Heide R, Mahdi U, et al. An outbreak of diarrhea in a neonatal medium care unit caused by a novel strain of rotavirus: investigation using both epidemiologic and microbiological methods. Infect Control Hosp Epidemiol 2002; 23:665-70. https://doi.org/10.1086/501991
  21. Jang JM, Kim MJ, Cheong HW, Park DW, Sohn JW, Son CS, et al. The Epidemiologic characteristics and infection control measures for an outbreak of rotavirus infection in the neonatal unit. Infect Chemother 2005;37:311-8.
  22. Lee HJ, Choi HR, Cho SJ, Seo JW, Park EA. Rotavirus infection in the nursery. Korean J Perinatol 2003;14:36-41
  23. Mastretta E, Longo P, Laccisaglia A, Balbo L, Russo R, Mazzaccara A, et al. Effect of Lactobacillus GG and breast-feeding in the prevention of rotavirus nosocomial infection. J Pediatr Gastroenterol Nutr 2002;35:527-31. https://doi.org/10.1097/00005176-200210000-00013
  24. Sharma R, Garrison RD, Tepas JJ, 3rd, Mollitt DL, Pieper P, Hudak ML, et al. Rotavirus-associated necrotizing enterocolitis: an insight into a potentially preventable disease? J Pediatr Surg 2004;39: 453-7. https://doi.org/10.1016/j.jpedsurg.2003.11.016