Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

The effects of neonatal ventilator care or maternal chorioamnionitis on the development of bronchopulmonary dysplasia

산모의 융모양막염 및 인공호흡기 치료가 미숙아 만성 폐질환의 발생에 미치는 영향

  • 윤기태 (대구 파티마병원 소아청소년과) ;
  • 이동환 (대구 파티마병원 소아청소년과) ;
  • 이상길 (대구 파티마병원 소아청소년과)
  • Received : 2008.12.02
  • Accepted : 2009.07.29
  • Published : 2009.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Advances in neonatal intensive care have improved the survival rate of low-birth-weight infants, but mild bronchopulmonary dysplasia (BPD) with the accompanying need for prolonged oxygen supplement remains problematic. Maternal chorioamnionitis and neonatal ventilator care affect the development of BPD. This study aimed to examine whether maternal chorioamnionitis or neonatal ventilator care affect the development of BPD dependently or independently. Methods : We performed a retrospective study of 158 newborn infants below 36 weeks of gestational age and 1,500 gm birth weight admitted to the neonatal intensive care unit of Daegu Fatima Hospital between January 2000 and December 2006. We analyzed the incidence of BPD according to maternal chorioamnionitis and neonatal ventilator care. Result : Histologic chorioamnionitis was observed in 50 of 158 infants (31.6%). There were no significant differences in the development of BPD (P=0.735) between the chorioamnionitis (+) and chorioamnionitis (-) groups. In the multiple regression analysis, ventilator care (OR=7.409, 95% CI=2.532-21.681) and neonatal sepsis (OR=4.897, 95% CI=1.227-19.539) affected the development of BPD rather than maternal chorioamnionitis (OR=0.461, 95% CI=0.201-1.059). Conclusion : Ventilator care or neonatal sepsis may play a role in the development of BPD rather than maternal chorioamnionitis.

목 적 : 신생아 집중 치료의 발전으로 인해 저출생 체중아의 생존률은 많이 향상되었으나 장기간의 산소 보충이 필요한 미숙아 만성 폐질환자의 증가는 해결해야 할 문제이다. 산모의 융모양막염 및 신생아의 인공호흡기 치료가 만성 폐질환에 상당한 영향을 미칠 수 있는 것으로 알려져 있다. 이에 저자들은 만성 폐질환의 발생에 산모의 융모양막염 및 신생아의 인공호흡기 치료가 독립적 혹은 종속적으로 작용하는지를 알아보고자 하였다. 방 법 : 2000년 1월부터 2006년 12월까지 본원 신생아 중환자실에 입원한 재태 기간 36주 이하, 출생체중 1,500 g 이하의 환아 158례를 대상으로 융모양막염의 존재 여부와 인공호흡기 사용에 따른 만성 폐질환의 발생률을 병력지를 기초로 후향적으로 조사하였다. 결 과 : 대상 환아 총 158례 중 산모의 융모양막염 양성은 50례(31.6%), 음성은 92례(58.2%), 생검을 통한 조직학적인 검사가 이루어지지 않은 경우는 16례(10.1%)였다. 융모양막염 유무와 만성 폐질환 발생 간에 유의한 상관관계가 없었으며(P=0.735), 융모양막염이 있고 인공호흡기를 사용한 36례 중 15례(41.7%)에서 만성 폐질환이 발생하였으며 인공호흡기를 사용하지 않은 14례 중 4례(28.6%)에서 만성 폐질환이 발생하였다(P=0.018). 융모양막염이 없는 그룹에서도 인공호흡기를 사용한 73례 중 32례(43.8%)에서 만성 폐질환이 발생하였고 인공호흡기를 사용하지 않은 19례 중 1례(5.3%)에서 만성 폐질환이 발생하여(P=0.002), 융모양막염 유무보다는 인공호흡기 사용이 만성 폐질환 발생에 영향을 미친 것으로 보여진다. 다중회귀분석에서도 인공호흡기 사용(OR=7.409, 95% CI=2.532-21.681)과 패혈증(OR=4.897, 95% CI=1.227-19.539)이 각각 만성 폐질환 발생에 영향을 미치는 것으로 나타났고 산모의 융모양막염은 OR=0.461, 95% CI=0.201-1.059로 만성 폐질환 발생에 영향을 미치지 못하는 것으로 나타났다. 결 론 : 인공호흡기의 사용, 패혈증이 만성 폐질환의 발생과 유의한 상관관계가 있었으며, 산모의 융모양막염 자체가 만성 폐질환의 발생에 직접적으로 영향을 줄 가능성은 낮은 것으로 나타났다.

Keywords

References

  1. 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.107.1.e1
  2. Hack M, Friedman H, Fanaroff AA. Outcomes of extremely low birth weight infants. Pediatrics 1996;98:931-7
  3. Fanaroff AA, Wright LL, Stevenson DK. Very-low-birth- weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992. Am J Obste Gynecol. 1995;173: 1423-31 https://doi.org/10.1016/0002-9378(95)90628-2
  4. Peevy KJ, Hernandez LA, Moise AA, Parker JC. Barotrauma and microvascular injury in lungs of nonadult rabbits: effect of ventilation pattern. Crit Care Med 1990;18:634-7 https://doi.org/10.1097/00003246-199006000-00012
  5. Dreyfuss D, Daumon G. Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 1992;18:139-41 https://doi.org/10.1007/BF01709236
  6. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M, et al. Chorioamnionitis, mechenical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants. J Pediatrics 2002;140;171-6 https://doi.org/10.1067/mpd.2002.121381
  7. Watterberg KL, Dermers LM, Scott SM, Murphy S. Chrioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996;97: 210-5
  8. Shimoya K, Taniguchi T, Matsuzaki N, Moriyama A, Murata Y, Kitajima H, et al. Chorioamnionitis decreased incidence of respiratory distress syndrome by elevating fetal interleukin-6 serum concentration. Hum Reprod 2000;15:2234-40 https://doi.org/10.1093/humrep/15.10.2234
  9. Elimian A, Verma U, Beneck D, Cipriano R, Visintainer P, Tejani N. Histologic chorioamnionitis, antenatal steroid, and perinatal outcome. Obstet gynecol 2000;96:333-6 https://doi.org/10.1016/S0029-7844(00)00928-5
  10. Morales WJ. The effect of chorioamnionitis on the developmental outcome of preterm infants at one year. Obstet gynecol 1987;70:183-6
  11. Park JJ, Lee PS, Lee SG The effects of early surfactant treatment and minimal ventilation on prevention of bronchopulmonary dysplasia in respiratory distress syndrome. Korean J Pediatr 2009;52:44-9 https://doi.org/10.3345/kjp.2009.52.1.44
  12. Russell P. Inflammatory lesions of the human placenta. I. clinical significance of acute chorioamnionitis. Am J Diagn Gynecol Obstet 1979;1:127-37
  13. Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1998;319:972-8 https://doi.org/10.1056/NEJM198810133191503
  14. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1989;73:383-9
  15. Dudell GG, Stoll BJ. Nelson textbook of Pediatrics. In : Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders 2007;737-40
  16. Welty SE. Antioxidants and oxidations in bronchopulmonary dysplasia: There are no easy answers. J Pediatr 2003;143: 697-8 https://doi.org/10.1067/S0022-3476(03)00626-7
  17. Sinkin RA, Phelps DL. New strategies for the prevention of bronchopulmonary dysplasia. Clin Perinatol. 1987;14:599-620
  18. Robert AS, Christopher C, Dale L. Phelps. Predicting Risk for Bronchopulmonary Dysplasia: Selection Criteria for Clinical Trials. Pediatrics 1990;86:728-36
  19. Hollander D. Diagnosis of chorioamnionitis. Clin Obstet Gynecol 1986;29;816-25 https://doi.org/10.1097/00003081-198612000-00008
  20. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Clin Obstet Gynecol 1989;73:383-9
  21. Yoon BH, Roberto R, Park JS, Kim MH, Oh SY, Kim CJ, et al. The relationship among inflammatory lesions of the umbilical cord(funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol 2000;183:1124-9 https://doi.org/10.1067/mob.2000.109035
  22. Hitti J, Krohn MA, Patton DL, Hornoch P, Hillier SL, Cassen EM, et al. Amniotic fluid tumor necrosis factor-a and the risk of respiratory distress syndrome among preterm infants. Am J Obstet Gynecol 1997;177:50-6 https://doi.org/10.1016/S0002-9378(97)70437-X
  23. Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res 1997;42:1-8 https://doi.org/10.1203/00006450-199707000-00001
  24. Kim BI, Park JD, Yoon BH. Interleukin-8 and neutrophils in the tracheobronchial aspirate at birth and the risk for development of chronic lung disease of prematurity. J Korean Soc Neonatal 2000;5:375-82
  25. Son DW, Kim BI. Significance of interleukin-6 and ureaplasma urealyticum detected by polymerase chain reaction in the tracheal aspirates at birth for the development of chronic lung disease (CLD) of prematurity and the risk factors for the different types of CLD according to the preceding illnesses. J Korean Soc Neonatal 2004;11:170-84

Cited by

  1. Risk Factors of Bronchopulmonary Dysplasia and Prediction in Korea vol.20, pp.3, 2009, https://doi.org/10.5385/nm.2013.20.3.292