미숙아 망막병증의 첫 선별 안저 검사의 적정 시기
Optimal Timing of the First Screening Examination for Retinopathy of Prematurity
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목적: 본 연구자들은 미숙아 망막병증의 첫 안저 검진 시기의 적절성 여부를 확인하고자 하였다. 방법: 2006년 1월 1일부터 2011년 12월 31일까지 서울대학교병원에서 출생하여 신생아 중환자실에 입원한 재태주령 35주 미만의 조산아 중, 32주 미만 혹은 출생체중 2 kg 미만의 환자를 대상으로 출생 후 4-5주 또는 재태주령 31-33주중 빠른 시기에 선별 검사를 시행한 환자 259명의 의무 기록을 후향적으로 분석하였다. 재태주령 별 발병과 수술시기를 월경 후 주령과 역연령으로 조사하였고, 첫 검진부터 발병과 수술까지의 기간을 조사하였다. 결과: 총 459명의 미숙아 중 139명(30.3%)에서 미숙아 망막병증이 발병하였으며, 이중 레이저 광응고술 치료를 시행한경우는 57명(12.4%)이었다. 미숙아 망막병증의 평균 발병 시기는 월경 후 주령 34+2±2+3였으며, 수술을 시행한 시기의 중간값은 월경 후 주령 36+0주(32+1-43+0주)로 환자군의 재태주령과 무관하였다. 본 연구의 선별 검사 방법으로 재태주령 26주 미만에서는 첫 검진 당시 진단된 경우는 없었고, 모든 경우에서 치료 시기를 놓치지 않았다. 첫 안저 검진부터 수술까지의 최소 기간은 17일 이었다. 재태주령 26주 미만에서 Type I ROP의 발병률은 47%로,월경 후 주령 31주 이전에 Type I 미숙아 망막병증이 발병한 경우는 4명이 있었다. 결론: 재태주령 26주 미만의 경우, Type I 미숙아 망막병증의 빈도가 높아 월경 후 주령 31주와 출생 후 4-5주 중 빠른시기를 기준하여 선별 검사를 시작하는 것이 적절한 것으로 생각된다.
Abstract
Purpose: In the present study, we aimed to evaluate the suitability of the first screening examination for retinopathy of prematurity (ROP) in a tertiary neonatal intensive care unit (NICU). Methods: A retrospective analysis of ROP screening records of 459 infants admitted to the NICU of Seoul National University Children’s Hospital between January 2006 and December 2011 was performed. The first examination was performed at 31-32 weeks of postmenstrual age (PMA) or 4-5 weeks of postnatal age (PNA), whichever was earlier. The infants were divided into subgroups according to the gestational age (GA), and the time of the first examination, time of onset of ROP, and time of laser surgery were assessed with regard to the PMA and PNA. Results: Of the 459 infants, 139 infants developed ROP, with the mean PMA at onset of ROP being 34+2±2+3 weeks. Type I ROP developed in 57 infants, with the median PMA at laser surgery being 36+0 weeks. The median PMAs at the time of onset and the time of surgery did not significantly differ between groups divided according to GA. Infants with a GA of <26 weeks showed a higher incidence of Type I ROP compared to those with a GA of ≥26 weeks. None of the infants with a GA of <26 weeks were diagnosed with ROP at the first examination, and none of the patients in either group missed treatment. Six infants developed ROP before 31 weeks of PMA, at which time the first screening for ROP is generally performed. Conclusion: We suggest that the timing of the initial examination for ROP should be based on PMA or PNA, whichever is earlier, particularly in infants with GA of <26 weeks.
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