방사선 검사에서 뇌병변이 확인된 미숙아에서의 대근육 운동발달의 예후 인자
Prognostic Indicators of Gross Motor Developmental Outcomes in Preterm Infants with Cerebral Insults as Detected by Neuroimaging
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목 적:주산기 신생아 관리 기술이 향상됨에 따라 미숙아의 생존율이 높아지고 있다. 이에 따른 미숙아들의 발달지연에 대해 관심을 높이고 조기 개입을 통한 발달향상을 기대하고자 한다. 뇌병변을 갖고 있는 환아들을 대상으로 대근육 운동발달을 평가하고 발달지연과 관련된 예후 인자를 찾고자 하였다. 방 법:37주 미만 미숙아로서 2004년 3월부터 2008년 9월까지 분당서울대병원에서 출생하여 신생아 집중치료센터에서 입원 치료를 받은 환아들을 대상으로 후향적으로 차트를 분석하였다. 뇌병변 양성 소견, 교정연령 2세까지 발달체크, 교정연령 3개월 베일리 영유아 발달 검사를 받은 48명의 환자를 대상으로 하였다. 뇌 기형을 갖고 있는 경우는 제외하였다. 결 과:48명의 환자 중 정상운동발달군 29명(60.4%), 지연운동발달군 19명(39.6%)으로 분류하여 분석하였다. 출생 시 재태연령에서 정상운동발달군은 31.1±2.9주, 지연운동발달군은 29.0±3.9주였다. 출생 시 체중에서 정상운동발달군은 1,482 ±477 g, 지연운동발달군은 1,286±618 g 이었다. 단변량 분석에서 P 값이 0.05 미만인 변수에는 출생 시 재태연령, 조기 양막파수, 기관지폐 이형성증, 신생아 호흡 곤란 증후군, 동맥관 개존, 교정연령 3개월 인지발달지수가 있었다. 다변량 분석에서 조기 양막파수와 산전 스테로이드 사용이 통계적으로 유의한 차이를 보였다. 32주 미만으로 재태연령을 제한하여 동일한 분석을 시행하였을 때 조기 양막파수가 통계적으로 유의한 차이를 보였다. 그리고 37주 미만 미숙아 48명에 대하여 뇌병변에 따른 기준으로 단변량 분석을 시행하였다. 출생 시 재태연령, 남녀 비율, 인공호흡기 적용 기간, 제왕절개술, 3개월 인지발달지수가 통계적으로 유의한 차이를 보였다. 결 론:뇌병변을 갖고 있는 미숙아에서 조기 양막파수와 산전 스테로이드 투여가 대근육 운동발달지연에 독립 인자로 작용하였다.
Abstract
Purpose:To examine the developmental outcome of preterm infants with cerebral insults and to evaluate the prognostic indicators for gross motor development. Methods:Forty-eight preterm infants less than 37 weeks of gestation, who had been born at Seoul National University Bundang Hospital between March, 2004 and September, 2008 where the subjects of this. The infants' charts were reviewed to obtain data, including gestational age, birth weight, gender, 1/5 minute Apgar scores, neuroimaging findings, and others. Results:Of the 48 patients, 29 infants (60.4%) were put into a normal developmental group and 19 (39.6%) were put into developmental delay group. Univariate analysis of the two groups showed that P values less than 0.05 were observed with respect to gestational age, premature rupture of membrane (PROM), respiratory distress syndrome, bronchopulmonary dysplasia, and patent ductus arteriosus. PROM and antenatal steroid showed statistically significant differences on a multivariate analysis. The same analysis method was applied to preterm infants less than a corrected age of 32 weeks. Multivariate analysis suggested that PROM showed statistically significant differences. Also, 48 patients were analyzed with respect to neuroimage finding. Twenty-five infants (52.1%) were assigned to a germinal matrix hemorrhage (GMH) group and 23 infants (47.9%) were allocated to a non-GMH group. Cesarean section delivery showed statistically significant difference according to univariate analysis. Conclusion:In preterm infants with cerebral insults, PROM and antenatal steroids were independent risk factors for impaired gross motor development.
참고문헌 (30)
- Escobar GJ, "Outcome among surviving very low birth weight: a meta-analysis", Arch Dis Child, 66, pp.204~211 (1991)
- Stewart AL, "Outcome for infants of very low birth weight: survey of world literature", Lancet, 1, pp.1038~1041 (1981)
- Lorenz JM, "Survival of extremely preterm infants in North America in the 1990s", Clin Perinatol, 27, pp.255~262 (2000)
- Deanne WC, "Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002", Pediatrics, 119, pp.37~45 (2007)
- Cooke RW, "Perinatal and postnatal factors in very preterm infants and subsequent cognitive and motor abilities", Arch Dis Child Fetal Neonatal Ed, 90, pp.60~63 (2005)
- Hope PL, "Precision of ultrasound diagnosis of pathologically verified lesions in the brain of very preterm infants", Dev Med Child Neurol, 30, pp.457~471 (1988)
- Stewart AL, "Probability of neurodevelopmental disorders estimated from ultrasound appearance of brains of very preterm infants", Dev Med Child Neurol, 29, pp.3~11 (1987)
- De WK, "Hemodynamics in preterm infants with late-onset sepsis", J pediatr, 156, pp.918~922 (2010)
- Gray PH, "Neurodevelopmental outcome of preterm infants with bronchopulmonary dysplasia", Arch Dis Child Fetal Neonatal Ed, 73, pp.128~134 (1995)
- Shim SS, "Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes", Am J Obstet Gynecol, 191, pp.1339~1345 (2004)
- Bayley N, "Bayley scales of infant development", pp.227~228 (1993), Psychological Corporation
- 김지훈, "발달 지연아에서 한국형 영유아 발달 검사와 베일리 영유아 발달 검사의 비교 분석", Korean Journal of Pediatrics, 52(7), pp.772~777 (2009), 대한소아과학회
- Richard EB, "Nelson textbook of pediatrics 17th edition", pp.38~39 (2003), Saunders Co
- Apgar V, "Proposal for new method of evaluation of newborn infant", Anesth Analg, 32, pp.260~267 (1953)
- Nelson KB, "Apgar scores as predictors of chronic neurologic disability", Pediatrics, 68, pp.36~44 (1981)
- Kiechl KU, "Adverse neurodevelopmental outcome in preterm infants: risk factor profiles for different gestational ages", Acta Pediatr, 98, pp.792~796 (2009)
- Vollmer B, "Predictors of long- term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound", ~
- Madan JC, "Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome", Pediatrics, 123, pp.674~681 (2009)
- Kaltreider DF, "Epidemiology of preterm delivery", Clin Obstet Gynecol, 23, pp.17~31 (1980)
- Garite TJ, "The use of amniocentesis in patients with premature rupture of membranes", Obstet Gynecol, 54, pp.226~230 (1979)
- Yoon BH, "Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes", Obstet Gynecol, 88, pp.1034~1040 (1996)
- Yoon BH, "Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity", Am J Obstet Gynecol, 172, pp.960~970 (1995)
- Crowley P, "The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials", Br J Obstet Gynaecol, 97, pp.11~25 (1990)
- Sims EJ, "Preterm premature rupture of the membranes is associated with a reduction in neonatal respiratory distress syndrome", Am J Obstet Gynecol, 187, pp.268~272 (2002)
- Dammann O, "Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn", Pediatr Res, 42, pp.1~8 (1997)
- Adams DF, "Antenatal therapies and the developing brain", Semin Neonatol, 6, pp.173~183 (2001)
- Crowley P, "The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials", Br J Obstet Gynaecol, 97, pp.11~25 (1990)
- Tyson JE, "National institute of child health and human development neonatal research network intensive care for extreme prematurity-moving beyond gestational age", N Engl J Med, 358, pp.1672~1681 (2008)
- Malloy MH, "The effects of caesarean delivery on birth outcome in very low-birth weight infants", Obstet Gynecol, 77, pp.498~503 (1991)
- Vollmer B, "Predictors of long- term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound", Pediatrics, 112, pp.1108~1114 (2003)