초극소저출생체중아에서 출생 후 5일 이내에 발생하는 대량 폐출혈의 위험인자
Risk Factor for Massive Pulmonary Hemorrhage Occurring during the First Five Days after Birth in Extremely Low Birth Weight Infants
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목적: 생후 5일 이내에 발생하는 대량 폐출혈은 초극소저체중출생아에서 출생 초기의 주된 사망원인이다. 이에 본 연구에서는 초극소저체중출생아에서 출생 초기에 발생하는 대량 폐출혈의 위험인자를 분석하고자 하였다. 방법: 2007년 1월부터 2012년 9월까지 분당서울대학교병원 신생아집중치료실에 입원한 출생체중 1,000 g 미만의 초극소저체중출생아 115명의 의무기록을 후향적으로 조사하였다. 대량 폐출혈은 생후 5일 이내에 기도로부터 혈성체액의 분출이 있으면서 급성 호흡부전이 동반되는 경우로 정의하였다. 전체 대상 환아들에서 대량 폐출혈이 발생하기 전에 최초 심에코 및 뇌초음파 검사가 시행되었다. 대량 폐출혈이 있었던 환아들과 없었던 환아들의 임상적 특성들을 비교하고 대량 폐출혈의 위험인자를 분석하였다. 결과: 대량 폐출혈은 출생 후 54±30시간에 발생하였다. 산모의 나이가 많을수록, 임신 나이가 적을수록, 출생체중이 작을수록 대량 폐출혈 발생 빈도가 높았다. 심에코에서 확인된 동맥관개존증은 대량 폐출혈의 발생과 연관이 없었으며 일련의 뇌초음파 검사에서 확인된 뇌실내 출혈은 대량 폐출혈과 연관이 있었다. 로지스틱 회귀분석 결과 시간적으로 대량 폐출혈에 선행하는 인자들 중 적은 임신나이만이 유의하게 대량 폐출혈의 발생과 연관이 있었다. 결론: 적은 임신나이가 초극소저체중출생아에서 생후 5일이내에 발생하는 대량 폐출혈의 독립적인 위험인자로 생각된다.
Abstract
Purpose: Massive pulmonary hemorrhage(MPH) within the first five days after birth is a major cause of early death in extremely low birth weight(ELBW) infants. The objective of this study was to determine risk factors for MPH in ELBW infants.Methods: Data were retrospectively collected from 115 ELBW infants admitted to Seoul National University Bundang Hospital between January 2007 and September 2012. MPH was defined as the presence of hemorrhagic fluid in the trachea accompanied by acute respiratory failure within the first five days after birth. Initial echocardiography and cranial ultrasonography were performed in all subjects before MPH. Clinical characteristics of ELBW infants with and without MPH were compared and the risk factors for MPH were investigated. Results: MPH occurred at 54±30 h after birth and was more frequent in ELBW infants with lower gestational age and lesser birth weight. Older maternal age was also associated with MPH. The presence of patent ductus arteriosus diagnosed using initial echocardiography was not significantly associated with MPH. The presence of intraventricular hemorrhage diagnosed using serial cranial ultrasonography was significantly associated with MPH. Logistic regression analysis indicated that among the variables that preceded MPH, only lower gestational age was independently associated with MPH. Conclusion: Lower gestational age was found to be a risk factor for MPH within the first five days after birth in ELBW infants.
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