단일기관에서 도출된 출생 후의 경피적 빌리루빈의 노모그램
Nomogram of Transcutaneous Bilirubin Level after Birth Driven from a Single Center
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목적:신생아 황달은 신생아기에 가장 흔한 질환 중 하나로 핵황달과 같은 심각한 후유증을 유발할 수 있기 때문에 조기발견과 치료가 중요하다. 본 연구에서는 경피적 황달 측정을 이용하여 황달 수치(TcB)를 측정하고 황달 수치의 변화를 노모그램으로 산출해 건강한 신생아 황달의 자연경과를 살펴보고 추적 관찰과 치료가 필요한 경우를 예측하고자 하였다. 방법:2007년 10월 1일부터 2009년 4월 30일까지 성애병원에서 출생한 재태연령 35주 이상의 건강한 만삭아와 준만삭아 중 부모가 모두 한국인인 986명을 대상으로 하였다. 출생 6시간 후부터 6시간 간격으로 퇴원 시까지 경피적 황달 측정기(Minolta, JM-103)을 이용하여 이마에서 측정하였으며 이를 통해 얻어진 데이터로 노모그램을 산출하였다. 분만방법, 재태연령, 수유방법에 따른 차이를 비교하였다. 결과:통계 데이터를 통해 시간에 따른 백분위수 그래프가 그려졌으며, 재태기간 35주에서 37주 6일의 신생아에서는 90 백분위수 이상, 38주 이상은 95 백분위수 이상에서 광선치료가 필요할 것으로 나타났다. 생후 24시간, 48시간, 72시간, 96시간에 TcB 수치의 평균을 분만방법, 재태연령, 수유방법에 따라 비교하였을 때 생후 48시간에서 제왕절개로 출생한 신생아가 자연분만으로 출생한 신생아에 비해 TcB 수치가 의미 있게 높았으며, 나머지 시간에서는 통계학적 의미가 없었다. 이외 수유방법에 따른 두 군의 비교에서는 모든 시간에서 통계학적 유의성이 없었다. 결론:편리하고 비침습적인 경피적 황달 측정기를 이용하여 시간에 따른 TcB 수치의 변화를 노모그램을 산출하였으며 이를 이용하여 심각한 황달을 예측하는데 도움이 될 것으로 사료된다.
Abstract
Purpose:The goal of this study was to measure bilirubin levels over 6 hours using a transcutaneous bilirubinometer. The change in the bilirubin levels were recorded in a nomogram. The natural progress of jaundice in neonates was monitored using the nomogram and cases were identified that needed further follow-up observation and treatment. Methods:The subjects of this study were 986 healthy term or near-term infants at the age of 35 weeks or older who were born at Sung-Ae General Hospital during the period from October 1, 2007 to April 30, 2009 and whose parents were both Koreans. Transcutaneous bilirubin measurements were obtained using a transcutaneous bilirubinometer (Minolta, JM-103) from 6 hours of life to discharge at intervals of 6 hours. A nomogram was derived from the obtained data and compared to the delivery method, gestational age, and feeding method. Results:Percentile graphs were drawn according to time. Based on the graphs, phototherapy was necessary in more than 90 percent of the infants between 35 and 37.6 weeks off age and in 95 percent of the infants 38 weeks and older. The mean bilirubin level at 24, 48, 72 and 96 hours after birth were compared according to the delivery method, gestational age, and feeding method. The bilirubin level in 48 hours was significantly higher in neonates born via cesarean section delivery compared to the neonates born via vaginal delivery, of the infants the levels were not statistically different at the other hours. Conclusion:The results of this study show the nomogram derived from hour-specific transcutaneous bilirubin levels. This information can be used to predict the risk for subsequent significant hyperbilirubinemia.
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