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미숙아에서 선별검사를 이용한 발달지연 위험인자 분석

Analysis of Risk Factors for Developmental Delay in Preterm Infants Using Screening Test

이건희|최성은
대한소아신경학회 (the Korean Child Neurology Society)|2018.09|대한소아신경학회지 (Journal of the korean child neurology society)|제26권 제3호|pp. 146-151|DOI 10.26815/jkcns.2018.26.3.146

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키워드

Risk factorsPreterm infantDevelopmental delaysDevelopmental screening test
주제분류신경과학

초록

목적: 미숙아의 출산율과 생존율이 높아짐에 따라 신경학적 예후에 대한 관심이 높아지고 있다. 신경학적 예후를 높이기 위해 발달지연 및 장애의 조기 진단과 중재 역시 많이 노력이 필요하다. 본 연구는NICU에서 치료를 받고 생존한 미숙아 출생아에서 발달선별검사를이용하여 발달지연의 가능성을 높이는 주산기 위험인자들을 조사하고자 한다. 방법: 2013년 1월에서 2016년 12월까지 본원 NICU에서 치료 후퇴원한 미숙아 출생아 151명을 대상으로 추적관찰을 통해 발달선별검사(K-ASQ:SE II)를 실시하였고 그 결과를 바탕으로 의무기록을 후향적으로 검토하여 유의한 요인들을 비교 후 이분형 로지스틱 회귀분석을 통해 위험인자들을 분석하였다. 결과: 총 151명의 환아들은 비정상군 36명, 정상군 115명의 두 군으로 나누어졌고 두 군간의 유의한 차이를 보이는 요인으로는 작은출생체중, 짧은 재태연령, 낮은 1분 및 5분 Apgar 점수, 긴 입원기간이있었으며 합병증 관련 요인으로는 신생아 호흡곤란 증후군, 뇌실 내출혈, 조기 패혈증, 만성폐질환 및 미숙아망막증, 치료력으로 침습적기계환기, 덱사메타손, 저혈압이 유의하였다. 발달선별검사 결과 전체에 영향을 미치는 위험인자는 작은 출생체중이었다. 각각의 세부적발달 영역에서 의사소통영역과 미세근육영역은 짧은 재태연령, 대근육 영역에서는 낮은 1분 Apgar 점수, 문제해결영역에서는 작은 출생체중, 사회정서영역에서는 긴 입원기간이 위험인자로 나타났다. 결론: 미숙아 출생아에서 발달지연을 조기에 발견하는 노력으로정기적인 발달 선별검사가 중요하며 특히, 발달지연의 위험인자인 재태연령(약 30주 미만), 출생체중(약 1,500 g 미만), 낮은 1분 Apgar점수 및 장기입원기간 요인들을 고려한 추적관찰이 발달지연의 조기진단에 도움된다고 생각한다.

Abstract

Purpose: The purpose of this study was to identify the risk factors for developmental delays in preterm infants. Methods: We studied 151 preterm infants admitted to the neonatal intensive care unit (NICU) at the Hallym University Kangnam Sacred Heart Hospital from January 2013 to November 2016. After discharge, the infants were evaluated by a pediatric neurologist via the developmental screening test K-ASQ:SE II, which consists of five domains: communication (CC), gross motor (GM), fine motor (FM), problem solving (PS), and social-emotional (SE). The subjects were divided into a normal group and an abnormal group (abnormal results on at least one of the five domains). Several variables were compared between the two groups and risk factors for developmental delays were analyzed. Results: Several factors, such as birth weight (BW), gestational age (GA), Apgar score at 1 and 5 min (AS1, AS5), hospital days (HDs), respiratory distress syndrome (RDS), chronic lung diseases, intraventricular hemorrhage (IVH), early sepsis, retinopathy of prematurity (ROP), and history of management of invasive ventilators, dexamethasone, anti-hypotensive, were significantly different between the normal and abnormal groups. BW was a risk factor for developmental delay according to the binary logistic regression analysis. On individual domain analysis, risk factors were lower GA for domains CC and FM, lower AS1 for GM domain, lower BW for PS domain, and longer HDs for SE domain. Conclusion: In preterm infants, regular developmental screening especially follow-up observation, is important for early detection of developmental delay, considering the risk factors, such as GA (≤30 weeks), BW (≤1,500 g), low AS1, and long HDs, which may be helpful in the early diagnosis of developmental delay.

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