미숙아 망막병증을 가진 극소 저체중 출생아에서 수술의 위험인자
Risk of Surgery for Retinopathy of Prematurity in Very Low Birth Weight Infants
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목적: 미숙아 망막병증의 주요한 위험인자는 낮은 재태주령과 저체중출생, 장기간의 산소 사용 등으로 보고되었는데, 최근 출생 후첫 수 주 동안 적은 체중증가가 미숙아 망막병증을 일으키는 원인인자로 제시되어 이에 미숙아 망막병증을 진단받은 극소 저체중 출생아에서 레이저 광응고수술의 위험인자를 알아보고자 하였다. 방법: 2004년 1월부터 2010년 6월까지 세브란스 어린이병원 신생아중환자실에 입원한 1,500 g 미만의 미숙아 중 미숙아 망막병증을진단받았던 140명의 환아를 대상으로 후향적으로 분석하였다. 국제분류법에 의해 stage 1은 20명(14.3%), stage 2는 101명(72.1%), stage 3 이상은 19명(13.6%)이 진단받았다. 이 중 레이저 광응고수술을 진행한 군은 66명, 수술을 진행하지 않은 군은 74명이었다. 결과: 수술군이 대조군보다 재태주령과 출생 체중, 1분 아프가 점수는 더 낮았고 재원일수와 산소 사용 일수, 수혈 횟수는 더 많았으며, 기관지폐이형성증, 뇌실내 출혈, 뇌실 주변 백질연화증, 패혈증이더 많았다. 산모의 융모양막염은 수술군에서 더 빈번하였으며, 산전스테로이드 투여는 더 적었다. 또한, 출생체중 대비 매주 체중증가는수술군에서 생후 4주에서 12주 사이에 통계적으로 유의하게 더 적었으나 재태주령을 보정한 다중회귀분석에서 생후 8주때 체중증가가 미숙아 망막병증에서 수술로 진행될 수 있는 위험인자로 통계적으로 유의하였다 (OR, 0.998; 95% CI, 0.996-0.999, P=0.013). 결론: 미숙아 망막병증이 있는 극소 저체중 출생아에서 생후 첫 8주간의 체중증가가 적으면 레이저 광응고수술을 진행할 가능성이높아지므로, 적극적인 영양관리를 통한 체중 증가가 필요할 것으로사료된다.
Abstract
Purpose: The main postnatal risk factors of retinopathy of prematurity (ROP) were described as prolonged oxygen therapy and lower gestational age. Recent data suggest poor early weight gain during the first weeks of life, which can be an additional predictor of severe ROP. We aimed to analyze the risk factors associated with requiring operation for ROP in preterm infants with very low birth weight (VLBW). Methods: In a retrospective case control study, from January 2004 to June 2010, 140 VLBW infants diagnosed as ROP by the International classification of ROP were recruited. There were 14% of infants with stage 1 disease, 65.7% stage 2, and 20% stage 3or more. A group requiring a laser surgery for ROP was 66 infants, and a group not requiring surgery was 74 infants. Results: By a univariate analysis, antenatal steroid, chorioamnionitis, gestational age, birth weight, days on oxygen, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalasia and sepsis were significantly associated with ROP requiring surgery. Weight differences between birth and each from 4 to 12 weeks were significantly lower in the infants requiring surgery (P<0.05). However, after adjustment for gestational age in logistic regression, weight difference between birth and 8th week was a significant predictive factor for the requirement of surgery in infants with ROP (OR, 0.998; 95% CI, 0.996-0.999,P=0.013). Conclusion: We suggest that careful monitoring of weight change and aggresive nutritional support for poorly growing infants, during the first 8 weeks of life, may possibly prevent laser surgery of ROP in preterm VLBW infants.
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