Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Gastrointestinal surgery in very low birth weight infants: Clinical characteristics

극소 저체중 출생아에서 시행한 소화기계 수술의 임상적 특성

  • Kim, Ji Eun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Hye Soo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hea Eun (Division of Pediatric Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Soo Kyoung (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Yoo Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Seo Heui (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seo, Hyun Joo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seo, Jeong Meen (Division of Pediatric Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Suk Koo (Division of Pediatric Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김지은 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 유혜수 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 김혜은 (성균관대학교 의과대학 삼성서울병원 소아외과학교실) ;
  • 박수경 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 정유진 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 최서희 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 서현주 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 서정민 (성균관대학교 의과대학 삼성서울병원 소아외과학교실) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 이석구 (성균관대학교 의과대학 삼성서울병원 소아외과학교실)
  • Received : 2008.08.25
  • Accepted : 2008.10.26
  • Published : 2009.03.15
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Abstract

Purpose : To report our experience of gastrointestinal (GI) operations (OP) performed in very low birth weight infants (VLBWI) and to evaluate their clinical characteristics. Methods : Among the 1,117 VLBWI admitted to the SMC neonatal intensive care unit from November 1994 to February 2007, the medical records of 37 infants who underwent GI OP (except inguinal hernia OP) and 1,080 VLBWI without GI OP were retrospectively reviewed. Results : The mean gestational age ($27^{+6}2^{+3}$ vs. $28^{+5}{\pm}$2^{+6}$) and birth weight (979${\pm}$241 g vs. 1,071${\pm}$271 g) of the 37 VLBWI who underwent the GI OP was lower than the VLBWI without GI OP group (n=1,080). Mortality rates in the GI OP group were significantly higher than in the non GI OP group (28% vs. 15%, P<0.001). The incidence of cholestasis, retinopathy of prematurity and periventricular leukomalacia were higher in the GI OP group than in the non GI OP group, but the incidence of bronchopulmonary dysplasia was not significantly different between the GI OP group and the non GI OP group. For GI OP indications, focal intestinal perforation was most common and showed a more favorable outcome than necrotizing enterocolitis. Compared with an earlier 7-year period, 1994-2000, the incidence and survival rates increased in the subsequent 2001-2007 period. Conclusion : GI OP was associated with high mortality and morbidity in VLBWI. Further efforts to improve outcomes of GI OP in VLBWI should be investigated to improve the quality of care in VLBWI.

목 적 : 단일 기관에서 경험한 소화기계의 수술적 치료를 받은 극소 저체중 출생아들의 임상적 특성을 연구하였다. 방 법 : 1994년 11월부터 2007년 2월까지 삼성서울병원 신생아 집중 치료실에 입원하였던 극소 저체중 출생아 총 1,117명에 대해 서혜부 탈장을 제외한 소화기계의 수술적 치료를 받은 군(37명)과 소화기계 수술을 받지 않은 군(1,080명)으로 나누어 이들에 대해 의무기록을 통해 후향적으로 조사 분석하였다. 결 과 : 극소 저체중 출생아 37명(3.3%)이 소화기계 수술적 치료를 받았으며. 이들은 소화기 수술을 받지 않은 군(n=1,080)에 비해 재태 연령($27^{+6}2^{+3}$ vs. $28^{+5}{\pm}$2^{+6}$)과 출생 체중(979${\pm}$241 g vs. 1071${\pm}$271 g)이 더 작았다. 사망률은 소화기계 수술을 받은 군에서 유의하게 높았다(28% vs. 15%, P<0.001). 또한 생존한 환자 분석에서 담즙 정체증, 미숙아 망막증, 뇌백질 연화증는 소화기계 수술을 받은 VLBWI에서 유의하게 높았으나 기관지폐이형성증에서 유의한 차이는 없었다. 수술 적응증으로는 국소성 장천공이 가장 많았고 괴사성 장염에 비해 좋은 예후를 보였다. Period I (1994-2000)과 Period II (2001-2007. 2) 두 기간 동안 ELBWI의 소화기 수술이 크게 증가하였고 생존율이 향상되었다. 결 론 : 극소 저체중 출생아에서 소화기계 수술적 치료는 사망률과 이환율 증가와 관계된 중요한 인자이다. 미숙아 치료의 질적 향상을 위하여 소화기계 수술적 치료의 사망률과 이환율을 줄이기 위한 노력은 필수적이며 따라서 이들에 대한 좀 더 체계적 연구가 필요하다.

Keywords

Acknowledgement

Supported by : In-Sung Foundation

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