지연 분만이 신생아의 사망률과 이환율에 미치는 영향
The Impact of Delayed Interval Delivery on Neonatal Mortality and Morbidity
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목적: 다태임신에서 지연 분만이 신생아 사망률과 이환율에미치는 영향에 대하여 알아보고자 하였다. 방법: 2005년 6월부터 2010년 7월까지 서울대학교병원에서지연 분만 방법으로 출생한 아기들을 대상으로 후향적 고찰을하였다. 결과는 신생아 사망률과 이환율로 하였으며, 이환율을조사한 질병에는 뇌실 내 출혈, 신생아 호흡 곤란 증후군, 기관지폐 형성 이상, 뇌실 주위 백색질연화증, 자궁 외 성장지연 등을 포함하였다. 다태아 중 이후에 출생한 아기들의 결과를 처음출생한 아기들, 그리고 재태주령과 출생체중이 비슷한 아기들로이루어진 대조군의 결과와 비교하였다. 결과: 총 4쌍의 쌍둥이, 5쌍의 세 쌍둥이가 있었으며, 처음 출생한 아기들(그룹 1)은 9명, 이후에 출생한 아기들(그룹 2)은 14명이었다. 그룹 1의 재태주령은 22주 6일-27주 5일, 그룹 2의 재태주령은 24주 6일-28주 0일이었다. 첫 분만과 지연 분만 사이간격의 평균은 10일이었으며, 모든 세 쌍둥이 가운데 둘째와 셋째 아기 사이의 지연 분만은 없었다. 부당 경량아는 그룹 2보다그룹 1에서 많았다(그룹 1: 66.7%, 그룹 2: 21.4%, P=0.03). 그룹1과 2 사이에 사망률의 차이가 있었지만 통계적으로는 유의하지 않았다(그룹 1: 33.3%, 그룹 2: 7.1%, P=0.106). 그룹 2에 대한대조군은 28명이었고, 그룹 2와 대조군 사이에 신생아기 사망률과 이환율은 통계적으로 의미있는 차이는 없었다. 결론: 대상수가 적기는 하지만, 다태임신에서 지연 분만으로남아 있는 태아의 부당경량아 빈도는 줄일 수 있으며 재태 기간연장으로 인해 출생 후에 나쁜 영향을 끼치지는 않을 것으로생각된다.
Abstract
Purpose: To evaluate the impact of delayed interval delivery on neonatal outcomes. Methods: This was a retrospective study of infants who were born at Seoul National University Hospital by delayed interval delivery from June 2005 to July 2010. Outcomes (neonatal mortality and morbidity) of later babies were compared to those of the first babies and the control group whose gestational ages and birth weights were similar to them. Results: There were 4 twin and 5 triplet pregnancies. The first babies (group 1, n=9) were delivered at 22^(+6) to 27^(+5) weeks of gestational age, and the later babies (group 2, n=14) were born at 24^(+6) to 28^(+0) weeks. The mean interval between the first and later deliveries was 10 days, and there was no delay between the second and third deliveries in all triplet pregnancies. There were more small for gestational age (SGA) infants in group 1 than group 2 (66.7% and 21.4% respectively, P=0.03). Two of three babies who died in group 1 were born before 24 weeks of gestational age and expired a week after birth. The mortality rate of group 2 (7.1%)was lower than group 1 (33.3%), but not significantly (P=0.106). The control group matched to group 2 consisted of 28 infants. There were no significant differences in neonatal mortality and morbidity between the two groups. Conclusion: Although there is a limitation to the number of infants in this study, it suggested that delayed delivery in a multiple pregnancy could decrease the incidence of SGA of the remaining fetuses and that prolonged gestation would not be harmful to those fetuses after birth.
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