무호흡 증상만으로 발현된 미숙아의 비전형적 경련
Partial Seizures Manifesting as Apnea Only in Preterm Infant
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 신생아집중치료실에 입원한 미숙아를 대상으로 하여 2차적인 원인의 무호흡증을 감별하여 교정하고 아미노필린을 투여한 후에도 반응하지 않는 무호흡증이 있는 신생아들을 대상으로 하여 그들의 특징을 알아보고 EEG 결과비정상소견을 보인 미숙아와 정상소견을 보인 미숙아들을 비교함으로서 무호흡증으로 발현된 신생아경련 환아의특징 및 그 요인에 대한 이해를 높이고 빠른 진단을 내릴 수 있는 방안을 모색하고자 시행하였다. 방법: 2006년 1월부터 2011년 12월까지 가톨릭대학교 서울성모병원에서 재태주령 37주 이전에 출생한 신생아들 중 무호흡 증상을 보이면서 패혈증, 폐렴, 질식(asphyxia), 체온 불안정, 빈혈, 저혈당 및 전해질 장애, rota virus 감염 등의 바이러스 감염 등 2차적인 원인의 무호흡증을 감별하여 교정하고 아미노필린을 투여하여도 반응하지 않는 미숙아를 연구 대상으로 의무기록지를 통한 후향적 조사를 실시하였다. 결과: 대상 미숙아는 총 37명 이었으며 그 중 32.4%가 비정상 뇌파소견을 보였다. 재태주령, 출생체중, 성별, 1분 아프가점수, 뇌파검사 검사시 재원일, BPD, NEC, PDA, IVH 등 합병증의 동반유무, 뇌초음파 검사상 grade I, 2의 IVH와MRI 결과에 따른 EEG 정상여부가 뇌파검사 결과 정상 유무에 따라 통계적으로 유의한 차이를 보이지 않았다. 단,5분 아프가 점수는 유의수준 0.05에서 통계적으로 유의한 차이가 있었다. EEG 정상 여부에 대한 로지스틱 회귀분석 결과 5분 아프가 점수가 EEG 정상 여부에 유의한 영향을 미치는 것으로 나타났다. 결론: 경련을 일으킬 만한 뚜렷한 원인질환이 없는 미숙아에게 무호흡증이 생기고 아미노필린에 반응하지 않은 경우 뇌파검사 결과 비정상으로 무호흡의 증상만으로 표현된 비 전형적인 미숙아 경련일 경우는 32.4% 이었으며 남아가신생아 경련에 이환될 확률이 높았다. 이들 환아 중 5분 아프가 점수 가 EEG 정상 여부에 유의한 영향을 미치는 것으로 나타났다.
Abstract
Purpose: Extremely-low-birth-weight infants (ELBWIs), especially those ≤24 gestational weeks (GW), presented extremes in IWL and changes of water balance. The purpose of the present study was to retrospectively investigate fluid and electrolyte balance in infants of ≤24-GW during the first postnatal week under high humidification. Methods: Medical records of extremely-low-birth-weight infants (ELBWIs) who were born and admitted to the Neonatal Intensive Care Unit at Samsung Medical Center during March 2004-September 2010 were reviewed. Fluid intake, urine output, insensible water loss (IWL), and electrolyte balance of 22-GW (n=14), 23-GW (n=40), and 24-GW (n=67) infants nursed in high humidity (95%) were compared with ≥26-GW (n=65) infants nursed in 60% humidity. Results: Survival rate until discharge was 33%, 82%, 75%, and 89.3% in 22-GW, 23-GW, 24-GW, and ≥26-GW infants, respectively. Fluid intake and IWL was higher in 22-GW and 23-WG, but not different in 24-GW, than in ≥26-GW infants. At postnatal days (P) 3-5, the urine output was significantly lower in ≥26-GW infants than in the other age groups. Serum sodium level was significantly higher in 22-, 23-, and 24-GW (P1-2) than in ≥26-GW infants. Hypernatremia (>150 mEq/dl sodium) was more frequent in 22-GW (71%), 23-GW (41%), and 24-GW (21%) than in ≥26-GW infants (14%). Conclusion: High-humidity environments significantly decreased fluid intake and improved electrolyte imbalance in 24-GW, but not 22- and 23-GW, infants. Increased IWL in the latter might be related to more immature skin, and implicates the need for additional nurturing conditions.
참고문헌 (30)
- Holden KR, "Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes", Pediatrics, 70, pp.165~176 (1982)
- Evans D, "Neonatal seizures", Arch Dis Child Fetal Neonatal Ed, 78, pp.F70~F75 (1998)
- Volpe JJ, "Neonatal seizures, In Neurology of the newborn", pp.178~214 (2001), W. B. Saunders
- Saliba RM, "Incidence of neonatal seizures in Harris County, Texas, 1992- 1994", Am J Epidemiol, 150, pp.763~769 (1999)
- Ronen GM, "The epidemiology of clinical neonatal seizures in Newfoundland: a population based study", J Pediatr, 134, pp.71~75 (1999)
- Lanska MJ, "A populationbased study of neonatal seizures in Fayette County, Kentucky", Neurology, 45, pp.724~732 (1995)
- Silverstein FS, "Neonatal seizures", Ann Neurol, 62, pp.112~120 (2007)
- Rennie JM., "Neonatal seizures", Eur J Pediatr, 156, pp.83~87 (1997)
- Yamamoto H, "Epilepsies and epileptic syndromes starting in the neonatal period", Brain Dev, 33, pp.213~220 (2011)
- Coulter DL, "Partial seizures with apnea and bradycardia", Arch Neurol, 41, pp.173~174 (1984)
- Andrade EO, "Partial epilepsy presenting as apneic seizures without posturing", Pediatr Neurol, 35, pp.359~362 (2006)
- Legido A, "Recent advances in the diagnosis, treatment, and prognosis of neonatal seizures", Pediatr Neurol, 4, pp.79~86 (1988)
- Zhao J, "Apnea of prematurity: from cause to treatment", Eur J Pediatr, 170, pp.1097~1105 (2011)
- Mathew OP, "Apnea of prematurity: pathogenesis and management strategies", J Perinatol, 31, pp.302~310 (2011)
- Abu-Shaweesh JM, "Neonatal apnea: what’s new?", Pediatr Pulmonol, 43, pp.937~944 (2008)
- Paul K, "Differential diagnosis of apneas in preterm infants", Eur J Pediatr, 168, pp.195~201 (2009)
- Walsh MC, "Necrotizing enterocolitis: treatment based on staging criteria", Pediatr Clin North Am, 33, pp.179~201 (1986)
- Papile LA, "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)
- Jobe AH, "Bronchopulmonary dysplasia", Am J Respir Crit Care Med, 163, pp.1723~1729 (2001)
- Pisani F, "Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures", Brain Dev, 31, pp.64~68 (2009)
- Thibeault-Eybalin MP, "Neonatal seizures: do they damage the brain?", Pediatr Neurol, 40, pp.175~180 (2009)
- Cockburn F, "Neonatal convulsions associated with primary disturbance of calcium, phosphorus and magnesium metabolism", Arch Dis Child, 48, pp.99~108 (1973)
- Doose H, "Neonatal seizures: relationship to epilepsy, In EEG in childhood epilepsy : initial presentation and long-term follow-up", pp.91~100 (2003), John Libbey Eurotext
- Patrizi S, "Neonatal seizures: characteristics of EEG ictal activity in preterm and fullterm infants", Brain Dev, 25, pp.427~437 (2003)
- Friderichsen C, "Tetany in a suckling: with latent osteitis fibrosa in the mother", Lancet, 233, pp.85~86 (1939)
- Kent AL, "Mortality and adverse neurologic outcomes are greater in preterm male infants", Pediatrics, 129, pp.124~131 (2012)
- Blackman JA, "The value of Apgar scores in predicting developmental outcome at age five", J Perinatol, 8, pp.206~210 (1988)
- Ehrenstein V, "Apgar score and hospitalization for epilepsy in childhood: a registry-based cohort study", BMC Public Health, 6, pp.23~ (2006)
- Teberg AJ, "Prediction of neurodevelopmental outcome in infants with and without bronchopulmonary dysplasia", Am J Med Sci, 301, pp.369~374 (1991)
- Bregman J, "Neurodevelopmental outcome in infants with bronchopulmonary dysplasia", Clin Perinatol, 19, pp.673~694 (1992)