쌍생아간 수혈 증후군에서의 신생아기 사망률 및 이환율
Neonatal Mortality and Morbidity of Twin-Twin Transfusion Syndrome
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 분만 후 생존한 쌍생아간 수혈 증후군 환자군과 주수를 짝지은 대조군을 비교함으로써 쌍생아 수혈 증후군의 신생아기 사망률 및 이환율을 분석하고 쌍생아간 수혈 증후군 내의 공혈자와 수혈자 간에도 사망률과 이환률을 비교하여 이를 토대로 쌍생아 수혈 증후군 환자의 진료에 도움이 되고자 한다. 방법: 2005년 4월부터 2011년 7월까지 서울대병원 어린이병원과분당 서울대병원에 입원한 환아를 대상으로 환자-대조군 연구를 시행하였다. 총 18쌍의 쌍생아간 수혈 증후군 환자와 36쌍의 주수를짝지은 쌍생아 대조군을 대상으로 후향적으로 신생아기 사망, 합병증에 대해 의무 기록을 고찰하였다. 결과: 쌍생아 간 출생 체중, 혈색소 차이는 쌍생아간 수혈 증후군에서 대조군에 비해 유의하게 높았다(29.9% vs. 10.1%, P<0.001; 0.2g/dL vs. -0.3 g/dL, P=0.024). 신생아기 사망률은 쌍생아간 수혈 증후군에서 유의하게 높았다(27.8% vs. 4.2%; P=0.001). 두 군간 신생아기 이환율을 비교하였을 때 쌍생아간 수혈 증후군에서 유의하게 높게 나타난 것은 급성 신부전(41.2% vs. 9.7%, P<0.001), 중등도 이상의 삼첨판 역류(12.5% vs. 1.4%, P=0.033), 심실 비대 (31.3% vs. 2.9%, P<0.001), 울혈성 심부전(45.6% vs. 5.6%, P<0.001), 2단계 이상의뇌실내 출혈(45.7% vs. 5.6%, P<0.001), 2단계 이상의 뇌실주위 백질연화증(24.2% vs. 2.8%, P=0.001)이었다. 쌍생아간 수혈 증후군 내의공혈자와 수혈자 간에 신생아기 사망률에는 유의한 차이가 없었으며, 두 군 간에 통계학적으로 유의한 차이가 있었던 합병증은 급성신부전(70.6% vs. 11.8%; P=0.001)이었고 그 외 심부전, 뇌실내 출혈,뇌실주위 백질 연화증을 포함한 다른 합병증에는 차이가 없었다. 결론: 쌍생아간 수혈 증후군 환아는 그렇지 않은 쌍생아에 비해신생아기 사망률 및 몇 가지 중대한 신생아기 질병 이환율이 유의하게 높았다. 따라서 출생 후 환아의 혈역학적 변화 및 발병 가능한 합병증에 대해 집중적으로 감시, 관찰하는 것이 매우 중요하며 발병시조기에 치료하는 것이 환아의 전체적인 예후에 큰 영향을 미칠 것이다.
Abstract
Purpose: This study was aimed to evaluate the neonatal mortality and morbidity of infants affected by twin-twin transfusion syndrome (TTTS) compared to the control twins matched for gestational age. Also the perinatal outcomes of donor parts of TTTS twins with their counterpart recipients were compared. Methods: A retrospective case-control study was conducted from infants born at Seoul National University Children’s Hospital and Seoul National University Bundang Hospital between April 2005 and July 2011. Eighteen pairs of TTTS infants were allocated to the TTTS group. The control group consisted of 36 pairs of twin infants unaffected by TTTS who were matched for gestational age. Neonatal deaths and morbidities were recorded. Results: The mortality in TTTS group was significantly higher than control group (27.8% vs. 4.2%, P=0.001). The incidence of acute renal failure (41.2% vs. 9.7%, P<0.001), cardiac ventricular hypertrophy (31.3% vs. 2.9%, P<0.001), congestive heart failure (45.7%vs. 5.6%, P<0.001), grade ≥2 intraventricular hemorrhage (33.3% vs. 11.1%, P=0.012) and grade ≥2 periventricular leukomalacia (24.2% vs. 2.8%, P=0.001) were significantly higher in TTTS group than control group. There was no significant difference in mortality and morbidities between donors and recipients except significantly higher incidence of acute renal failure in donors (70.6%vs. 11.8%, P=0.001). Conclusion: Twin infants affected by TTTS have higher risk of neonatal death and several severe morbidities. These results indicate that alert monitoring and checking about possible morbidities are very important in newborns with TTTS and early intervention is critical for improving the overall outcome of the affected infants.
참고문헌 (36)
- Denbow ML, "Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome", Am J Obstet Gynecol, 182, pp.417~426 (2000)
- D’Alton ME, "Syndromes in twins", Semin Perinatol, 19, pp.375~386 (1995)
- Sebire NJ, "Early prediction of severe twin-to-twin transfusion syndrome", Hum Reprod, 15, pp.2008~2010 (2000)
- 최은진, "쌍생아 임신의 융모막과 주산기 결과", Neonatal medicine, 15(1), pp.67~74 (2008), 대한신생아학회
- Gray PH, "Neurodevelopmental outcome and risk factors for disability for twin-twin transfusion syndrome treated with laser surgery", Am J Obstet Gynecol, 204(159), pp.e1~e6 (2011)
- Rossi AC, "The efficacy of Quintero staging system to assess severity of twin-twin transfusion syndrome treated with laser therapy: a systematic review with meta-analysis", Am J Perinatol, 26, pp.537~544 (2009)
- Lopriore E, "Neonatal morbidity in twin-twin transfusion syndrome", Early Hum Dev, 87, pp.595~599 (2011)
- Duncan KR, "The aetiology and management of twin-twin transfusion syndrome", Prenat Diagn, 17, pp.1227~1236 (1997)
- Roberts D, "Interventions for twin-twin transfusion syndrome: a Cochrane review", Ultrasound Obstet Gynecol, 31, pp.701~711 (2008)
- Hajrić-Egić A, "Twin transfusion syndrome-- diagnosis and prognosis", Srp Arh Celok Lek, 131, pp.17~20 (2003)
- Gonsoulin W, "Outcome of twin-twin transfusion diagnosed before 28 weeks of gestation", Obstet Gynecol, 75, pp.214~216 (1990)
- Stahlman M, "A six-year follow-up of clinical hyaline membrane disease", Pediatr Clin North Am, 20, pp.433~446 (1973)
- Walsh MC, "Necrotizing enterocolitis: treatment based on staging crit", Pediatr Clin North Am, 33, pp.179~201 (1986)
- Papile LA, "Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm", J Pediatr, 92, pp.529~534 (1978)
- de Vries LS, "The spectrum of leukomalacia using cranial ultrasound", Behav Brain Res, 49, pp.1~6 (1992)
- Wee LY, "The twin-twin transfusion syndrome", Semin Neonatol, 7, pp.187~202 (2002)
- Wenstrom KD, "Frequency, distribution, and theoretical mechanisms of hematologic and weight discordance in monochorionic twins", Obstet Gynecol, 80, pp.257~261 (1992)
- Weir PE, "Acute polyhydramnios-- a complication of monozygous twin pregnancy", Br J Obstet Gynaecol, 86, pp.849~853 (1979)
- Park SK, "A case of severe neonatal hypertension in twin-twin transfusion syndrome", J Korean Soc Neonatol, 12, pp.93~99 (2005)
- Rossi AC, "Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature", Am J Obstet Gynecol, 198, pp.147~152 (2008)
- Hikino S, "Long-term outcome of infants with twin-to-twin transfusion syndrome", Fetal Diagn Ther, 22, pp.68~74 (2007)
- Lopriore E, "Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome", Am J Obstet Gynecol, 189, pp.1314~1319 (2003)
- Lenclen R, "Neonatal outcome in preterm monochorionic twins with twin-totwin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins", Am J Obstet Gynecol, 196(450), pp.e1~e7 (2007)
- Cincotta R, "Antepartum and postpartum complications of twin-twin transfusion", Aust N Z J Obstet Gynaecol, 36, pp.303~308 (1996)
- Reisner DP, "Stuck twin syndrome: outcome in thirty-seven consecutive cases", Am J Obstet Gynecol, 169, pp.991~995 (1993)
- Cincotta RB, "Long term outcome of twin-twin transfusion syndrome", Arch Dis Child Fetal Neonatal Ed, 83, pp.F171~F176 (2000)
- Lopriore E, "Neonatal outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser occlusion of vascular anastomoses", J Pediatr, 147, pp.597~602 (2005)
- Beck M, "Long-term outcome of kidney function after twin-twin transfusion syndrome treated by intrauterine laser coagulation", Pediatr Nephrol, 20, pp.1657~1659 (2005)
- Lopriore E, "Twin-to-twin transfusion syndrome: from placental anastomoses to long-term neurodevelopmental outcome", Curr Pediat Rev, 1, pp.191~203 (2005)
- Lopriore E, "Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery", Congenit Heart Dis, 2, pp.38~43 (2007)
- Van Mieghem T, "The fetal heart in twin-to-twin transfusion syndrome", Int J Pediatr, 2010, pp.379792~ (2010)
- Lopriore E, "Incidence, origin, and character of cerebral injury in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery", Am J Obstet Gynecol, 194, pp.1215~1220 (2006)
- Sugama S, "Monozygous twin with polymicrohyria and normal co-twin", Pediatr Neurol, 11, pp.62~63 (1994)
- Burke MS, "Single fetal demise in twin gestation", Clin Obstet Gynecol, 33, pp.69~78 (1990)
- Pinette MG, "Treatment of twintwin transfusion syndrome", Obstet Gynecol, 82, pp.841~846 (1993)
- Haverkamp F, "Neurodevelopmental risks in twin-to-twin transfusion syndrome: preliminary findings", Eur J Paediatr Neurol, 5, pp.21~27 (2001)