생존한계의 미숙아(23, 24주)에서 저체온 예방을 위한 임상전략 의 효과
Effect of Clinical Strategy for Preventing Heat Loss Between 23 And 24 Weeks of Gestation
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생존한계에 있는 23, 24주 초극소 미숙아는 기존에 NRP에서 권고하고 있는 분만장 온도 상승뿐 아니라 시술 간 NICU 온도를 상승하는 전략으로 저체온 빈도가 감소, 혈액가스 검사 개선 효과를 확인하였으며 출생 초기 IWL을 줄이는 결과를 얻을 수 있었다. 이에 생존한계의 23, 24주 환아는 분만장 온도뿐 아니라 NICU 온도 상승을 통해 저체온 예방을 하는 것이 유리하며 저체온 예방을 위한 추가적인노력이 더 필요하다. 요약목적: 생존한계에 있는 23, 24주 초극소 미숙아에서는 출생 후 저체온 빈도가 높아 이를 예방하기 위한 임상전략을 수립하여 효과를확인하고자 하였다. 방법: 2007년 1월부터 2011년 5월까지 삼성서울병원 신생아중환자실에 입원한 23, 24주 환아를 대상으로 임상전략 시행 전인 2007년 1월부터 2010년 7월까지를 1기(n=55), 임상전략 수립 후 시행한2010년 8월부터 2011년 5월까지를 2기(n=17)로 나누고 후향적으로의무기록을 조사하였다. 임상전략은 저체온 예방을 위해 분만장 온도상승, 출생 후 투명 랩으로 감싸기, 신생아집중치료실 입실시간을단축, 입실 전 신생아집중치료실 온도상승, 그리고 피부체온 36℃ 도달 시 제대도관 시술을 포함하였다. 결과: 신생아집중치료실 입실 시 평균체온과 신생아집중치료실에서 시술 후 평균체온 및 체온분포는 1기에 비해 2기에서 의미있게높았으며, 2기에서 첫째날과 둘째날의 불감 수분손실 및 혈액가스검사 결과는 1기에 비해 의미있는 개선효과를 보였다. 결론: 생존한계에 있는 23, 24주 환아는 분만장 온도 뿐 아니라 신생아집중치료실 온도 상승이 저체온 예방에 유리할 것으로 보인다.
Abstract
Purpose: With conventional methods it has been difficult to maintain a normal body temperature in the case of premature infants born between 23 and 24 weeks of gestation (23/24W). The aim of the present study involves the evaluation of the efficacy of novel clinical strategies to prevent the initial symptoms of hypothermia in 23/24W. Methods: We retrospectively analyzed the medical records of all 23/24W who were born and admitted to Samsung Medical Center from January 2007 to July 2010 (Period 1) and from August 2010 to May 2011 (Period 2). Data collected from medical charts included body temperature, admission delay time intervals, blood gas analysis, and estimated insensible water loss(IWL). The measurements from three days after birth were compared to those obtained during period 1 (P1), in which conventional support was applied to infants and period 2 (P2), in which new clinical strategies including 1. Elevation of the environmental temperature of the delivery room 2. NICU baby-wrapping, 3. Decreased delays in time intervals from delivery to admission, and 4. Initiation of procedures following the stabilization of body temperature. Results: The body temperature upon admission was significantly higher in P2 than P1 (P1 34.7±0.9 vs. P2 35.3±0.6℃, P=0.011). After the initial procedure, following NICU admission, the body temperature was also significantly higher in P2 than in P1 (P1. 34.9±0.8 vs. P2 35.5±0.4, P<0.001). The IWL of the first and second day was significantly decreased in infants in the P2 group. Subjects in the P2 group demonstrated significantly improved initial blood gas results of base deficits and bicarbonate concentration,as compared to the P1 group. Conclusion: New strategies for the prevention of hypothermia were beneficial for decreasing the recorded incidence of hypothermia and improving the IWL, and base deficits of the initial blood gas analysis in 23/24W.
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