Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

The relationship between the time from arrival at a hospital to delivery and the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age

재태주령 34주 이전에 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간과 뇌성마비 발생과의 관련성

  • Hwang, Jae Woong (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Heo, A Lum (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Koo, Soo Hyun (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Hae Jung (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Jun Wha (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Joo Seok (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Cho, Kyung Lae (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 황재웅 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 허아름 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 구수현 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 이해정 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 이준화 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 이주석 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 조경래 (성균관대학교 의과대학 마산삼성병원 소아과학교실)
  • Received : 2009.07.06
  • Accepted : 2009.10.08
  • Published : 2009.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : This study aimed to evaluate whether a shorter time from the arrival at a hospital to delivery is related to the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age. Methods : We studied 142 newborns of less than 34 weeks of gestational age. The time from the arrival at the hospital to delivery was measured. The correlation between the time required for delivery and the occurrence of cerebral palsy was elucidated by diagnosing cerebral palsy in neonates using the Korean Infant Development Screening Test and neurological examination. Results : Preliminary result suggested that a shorter time from hospital arrival to delivery was related to a lower development score for gross motor activity and to a higher frequency of cerebral palsy occurrence. Moreover, it was responsible for a tendency of obtaining lower Apgar scores at 1 and 5 minutes. The shorter delivery time was associated with a higher probability of respiratory distress syndrome (RDS) occurrence when the length of delivery time was less than 6 hours and there was a higher probability of a shorter gestation period. However, the multifactor analysis revealed that there was little impact of delivery time on the occurrence of cerebral palsy. Conclusions : The length of hospital arrival time to delivery did not significantly influence the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age.

목 적 : 34주 이하로 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간이 짧은 경우 향후 뇌성마비 발생과 관련이 있는지 알아보고자 하였다. 방 법 : 34주 이하의 미숙아 142례를 대상으로 하였다. 산모의 내원시점에서 분만까지 소요된 시간(소요시간)을 측정하였고 한국형 영유아 발달 검사 및 신경학적 검사를 통해 뇌성마비를 진단하여 분만에 소요된 시간과 뇌성마비 발생과의 상관관계 여부를 알아보았다. 결 과 : 병원 도착시점에서 분만에 이르는 시간이 짧으면 짧을수록 조대운동 발달지수가 낮아지고 뇌성마비의 발현빈도가 높아지는 경향을 보인 기본적인 결과 외에 1분 및 5분 Apgar 점수가 모두 작아지는 경향을 보였고 분만까지 소요된 시간이 짧을수록, 특히 분만에 소요된 시간이 6시간 이내인 경우 RDS의 발생가능성이 높은 것으로 나왔으며 제태기간이 짧을 가능성이 높은 것으로 나왔다. 그러나 다인자 분석에서 소요시간은 뇌성마비 발생에 영향을 주지 못하는 것으로 나왔다. 결 론 : 34주 이하로 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간은 뇌성마비의 발생에 영향을 주지 못하는 것으로 나왔다. 그러나 본 연구에서는 급박하게 이루어진 분만이 뇌성마비 발생에 영향을 줄 수 있는 가능성에 접근하는 결과를 보여 향후 추가적인 연구가 있어야 할 것으로 사료된다.

Keywords

References

  1. Stroll BJ, Adams-Chapman I. The high-risk infant. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 18th ed. Philadelphia: WB Saunders Co, 2007:698-711
  2. Grether JK, Nelson KB, Emery ES 3rd, Cummins SK. Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. J Pediatr 1996;128:407-14 https://doi.org/10.1016/S0022-3476(96)70292-5
  3. Chung SJ, Sung IK, Kim HJ, Woo YJ, Lee MH, Shin, SM. Developmental test in children. J Korean Pediatr Soc 2002; 45:817-21
  4. Salokorpi T, Sajaniemi N, Hällback H, Kari A, Rita H, von Wendt L. Randomized study of the effect of antenatal dexamethasone on growth and development of premature children at the corrected age of 2 years. Acta Paediatr 1997;86:294-8 https://doi.org/10.1111/j.1651-2227.1997.tb08893.x
  5. Arad I, Bromiker R. Developmental assessment of prematurely born children exposed to antenatal corticosteroids. IMAJ 2003;5:659-61
  6. Nelson KB, Grether JK. Can magnesium sulfate reduce the risk of cerebral palsy in very low birthweight infants? Pediatrics 1995;95:263-9
  7. Spinillo A, Capuzzo E, Cavallini A, Stronati M, De Santolo A, Fazzi E. Preeclampsia, preterm delivery and infant cerebral palsy. Eur J Obstet Gynecol Reprod Biol 1998;77:151-5 https://doi.org/10.1016/S0301-2115(97)00246-7
  8. Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: A population-based study in term infants. J Pediatr 2001;138:798-803 https://doi.org/10.1067/mpd.2001.114694
  9. Volpe JJ. Intraventricular hemorrhage in the premature infant- current concepts. Part II. Ann Neurol 1989;25:109-16 https://doi.org/10.1002/ana.410250202
  10. Takahashi R, Yamada M, Takahashi T, Ito T, Nakae S, Kobayashi Y, et al. Risk factors for cerebral palsy in preterm infants. Early Hum Dev 2005;81:545-53 https://doi.org/10.1016/j.earlhumdev.2004.11.007
  11. Garland JS, Buck R, Leviton A. Effect of maternal glucocorticoid exposure on risk of severe intraventricular hemorrhage in surfactant-treated preterm infants. J Pediatr 1995;126:272-9 https://doi.org/10.1016/S0022-3476(95)70560-0
  12. Journal of PediatricsLeviton A, Kuban KC, Pagano M, Allred EN, Van Marter L. Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns. Pediatrics 1993;91:1083-8
  13. O'Shea TM, Kuban KC, Allred EN, Paneth N, Pagano M, Dammann O, et al. Neonatal cranial ultrasound lesions and developmental delays at 2 years of age among extremely low gestational age children. Pediatrics 2008;122:e662-9 https://doi.org/10.1542/peds.2008-0594
  14. Whitaker AH, Feldman JF, Van Rossem R, Schonfeld IS, Pinto-Martin JA, Torre C, et al. Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age. Pediatrics 1996;98:719- 29
  15. Pinto-Martin JA, Riolo S, Cnaan A, Holzman C, Susser MW, Paneth N. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population. Pediatrics 1995;95:249-54
  16. Ancel PY, Livinec F, Larroque B, Marret S, Arnaud C, Pierrat V, et al. Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics 2006;117: 828-35 https://doi.org/10.1542/peds.2005-0091