초저체중 환아 동맥관개존증의 조기 결찰술의 성과

Abstract

1. 목적 혈역학적으로 의미있는 동맥관개존증의 치료에 있어 생후 15일 이내의 조기 결찰술이 생후 15일 이후의 지연 결찰술과 비교했을 때 미숙아 유병률의 감소에 어느 정도의 효과가 있는지를 평가하고자 하였다.

2. 대상 및 방법 2007년 3월부터 2013년 5월까지 한양대학교 서울병원 신생아중환자실의 1500g 미만 초저체중 환아 320명 중 혈역학적으로 의미있는 동맥관개존증 환아 125명에서 약물 치료만 시행한 61명을 제외하고 결찰술을 시행받은 64명을 대상으로, 조기 결찰술 환아 28명, 지연 결찰술 36명간의 미숙아 유병률에 있어서의 임상적 성과를 후향적 연구를 통해 접근 및 비교하였다. 의미있는 선천성 심기형이 동반된 환아는 연구에서 제외되었다.

3. 결과 주산기 요인으로 지연 폐쇄군에서 제태주령이 짧았다 (27.1±2.2주 vs 25.7±1.6주, p=0.010). 제태주령을 보정한 후, 조기 폐쇄군과 지연 폐쇄군에서 기관지 폐 이형성증 등에서는 유의한 차이가 없었다. 그러나, 지연 폐쇄군에서 괴사성 장염의 발병률이 높고 (14.3% vs 41.7%, p=0.037), 총비경구영양의 기간이 증가되는 (36일 vs 75일, p=0.046) 통계학적으로 유의한 차이를 보였다.

4. 결론 약물 치료 실패 및 절대적 금기에 해당된 미숙아의 동맥관개존증에 있어 조기 수술적 치료는 괴사성 장염의 발병 및 경구 영양 곤란의 개선에 바람직하므로 출생 15일 이내에 적극적인 수술적 치료가 필요할 것으로 사료된다. |1. Background We performed a retrospective study over 6 years in our hospital, with the hypothesis that early surgical ligation (within 15 days of age) to treat symptomatic patent ductus arteriosus (PDA) would decrease preterm morbidity, compared with late surgical ligation (after 15 days of age), and that early ligation would be safe.

2. Patients and Methods We retrospectively reviewed all of the medical records in the neonatal intensive care unit (NICU) at Hanyang University Seoul Hospital, from March 1, 2007, to May 31, 2013, to identify VLBW infants (< 1,500 g) who underwent surgical PDA ligation due to failure of medical treatment or contraindications to indomethacin and ibuprofen. Infants with other congenital anomalies or other congenital heart diseases and infants who died within 15 days of birth were excluded.

3. Results The gestational age in the LL group was significantly younger than in the EL group (27.1±2.2 weeks (wk) vs. 25.7±1.6 wk, p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (9.1±4.5 days vs. 18.2±9.4 days, p < 0.001) and age at surgery (10.2±3.6 days vs. 24.5±7.6 days, p < 0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in BPD, sepsis, or mortality between the EL and LL groups. The incidence of ROP was significantly different before adjusting for gestational age (GA), but after adjusting for GA, it was not significantly different (p=0.163). However, the LL group was significantly associated with an increased risk of NEC (odds ratio 0.25; p=0.037) and with prolonged duration of total parenteral nutrition (odds ratio 0.23; p=0.046) after adjusting for GA.

4. Conclusion Early surgical ligation for the treatment of PDA that failed to close after medical treatment or in cases contraindicated for medical treatment might be desirable, to reduce the incidence of NEC and to improve feeding intolerance in preterm infants.; 1. Background We performed a retrospective study over 6 years in our hospital, with the hypothesis that early surgical ligation (within 15 days of age) to treat symptomatic patent ductus arteriosus (PDA) would decrease preterm morbidity, compared with late surgical ligation (after 15 days of age), and that early ligation would be safe.

2. Patients and Methods We retrospectively reviewed all of the medical records in the neonatal intensive care unit (NICU) at Hanyang University Seoul Hospital, from March 1, 2007, to May 31, 2013, to identify VLBW infants (< 1,500 g) who underwent surgical PDA ligation due to failure of medical treatment or contraindications to indomethacin and ibuprofen. Infants with other congenital anomalies or other congenital heart diseases and infants who died within 15 days of birth were excluded.

3. Results The gestational age in the LL group was significantly younger than in the EL group (27.1±2.2 weeks (wk) vs. 25.7±1.6 wk, p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (9.1±4.5 days vs. 18.2±9.4 days, p < 0.001) and age at surgery (10.2±3.6 days vs. 24.5±7.6 days, p < 0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in BPD, sepsis, or mortality between the EL and LL groups. The incidence of ROP was significantly different before adjusting for gestational age (GA), but after adjusting for GA, it was not significantly different (p=0.163). However, the LL group was significantly associated with an increased risk of NEC (odds ratio 0.25