Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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A Case of Sick Sinus Syndrome in Extremely Low Birth Weight Infant with Annular Pancreas

고리췌장을 동반한 초극소저체중출생아에서 나타난 굴기능부전증후군 1례

  • Kim, Ji-Eun (Department of Pediatrics, College of Medicine, Korea University) ;
  • Bauer, Siegfried (Department of Pediatrics, College of Medicine, Korea University) ;
  • Boo, Yoon-Jung (Department of Pediatric Surgery, College of Medicine, Korea University) ;
  • Lee, Jang-Hoon (Department of Pediatrics, Ajou University School of Medicine) ;
  • Jang, Gi-Young (Department of Pediatrics, College of Medicine, Korea University) ;
  • Choi, Byung-Min (Department of Pediatrics, College of Medicine, Korea University) ;
  • Park, Moon-Sung (Department of Pediatrics, Ajou University School of Medicine)
  • 김지은 (고려대학교 의과대학 소아과학교실) ;
  • 바우어 지그프리드 (고려대학교 의과대학 소아과학교실) ;
  • 부윤정 (고려대학교 의과대학 외과학교실) ;
  • 이장훈 (아주대학교 의과대학 소아청소년과학교실) ;
  • 장기영 (고려대학교 의과대학 소아과학교실) ;
  • 최병민 (고려대학교 의과대학 소아과학교실) ;
  • 박문성 (아주대학교 의과대학 소아청소년과학교실)
  • Published : 2011.11.30
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Abstract

Sick sinus syndrome (SSS) is a disorder characterized by sinus node dysfunction. Although the condition is most common in the elderly, it can occur in children including neonates and its recognition and treatment are important. The diagnosis of SSS is based on the presence of sinus bradycardia, sinus arrest or exit block, combinations of sinoatrial and atrioventricular nodal conduction disturbances, and atrial tachyarrhythmias documented in the Holter recordings. In most children with SSS, previous history of congenital heart malformation or cardiac surgery is noted. SSS is also seen in the children including neonates without heart disease or other contributing factors, however SSS is most often idiopathic. The treatment of SSS depends on the basic rhythm problem, but generally involves the placement of a cardiac pacemaker. We report a case of SSS in extremely low birth weight infant without congenital heart disease and suggest that the treatment system is necessary for preterm infants with SSS.

굴기능부전증후군은 매우 드물지만 신생아에서도 발생할 수 있으며 소아 환자의 경우 대부분 선천심장병이 있거나 심장수술 후에 발생한다. 그러나 이와 같은 심질환의 선행 요인이 없는 신생아에서도 발생할 수 있기 때문에 이에 대한 인지가 필요하다. 굴기능부전증후군은 대부분 특발성으로 발생하며 증상도 다양하고 24시간 심전도 검사상에서도 다양한 형태로 관찰된다. 본 증례에서는 초극소저체중출생아에서 선천심장병 없이 발생한 굴기능부전증후군에 대해 보고하였다. 환아는 심전도상 굴느린맥과 함께 심방세동이 동반된 느린맥과 빠른맥이 반복되어 관찰되었으며 무호흡, 산소포화도의 저하, 청색증의 징후를 나타냈다. 증상이 있는 굴기능부전증후군의 경우 대부분 심장박동조율기의 삽입이 필요하나 본 환아는 당시 체중 750 g으로 심장박동조율기의 삽입에 실패하여 약물 치료를 시작하였다. Isoproterenol과 atropine으로 치료하면서 환아의 체중이 1,500 g을 넘어서자 증상과 심전도상의 호전을 보였다. 향후 본 환아에서처럼 심장박동조율기의 삽입이 어려운 소아 환자의 경우에 대한 치료 체계에 대해 많은 연구가 필요하다.

Keywords

References

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