Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

초극소저출생체중아에서 출생체중별 발관시기 및 첫 발관 시의 성공/실패 예측인자

Extubation Time by Birth Weight and the Predictors for Success/Failure at the First Extubation in Extremely Low Birth Weight Infants

  • 최창원 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 박성은 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 전가원 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 유은정 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 황종희 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아과)
  • Choi, Chang Won (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Park, Sung Eun (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Jeon, Ga Won (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Yoo, Eun Jung (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Hwang, Jong Hee (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center, College of Medicine, Sungkyunkwan University)
  • 투고 : 2004.12.28
  • 심사 : 2005.03.07
  • 발행 : 2005.05.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 본 연구는 초극소저출생체중아에서 출생체중에 따른 발관 양상을 알아보고 첫 발관에서의 성공/실패를 예측할 수 있는 인자들을 찾아보고자 하였다. 방 법 : 2000년 1월부터 2004년 6월까지 삼성서울병원 신생아 중환자실에 입원하였던 113명의 출생체중 1,000 g 미만의 초극소저출생체중아들을 대상으로, 첫 발관 성공군과 실패군 간에 첫 발관 성공과 관련이 있을 것이라고 생각되는 인자들의 차이를 비교하여 보았다. 결 과 : 출생체중이 작아질수록 발관 성공일은 유의하게 지연되었다 : 900-999 g에서 $16{\pm}3$일; 800-899 g에서 $20{\pm}3$일; 700-799 g에서 $35{\pm}4$일; 600-699 g에서 $37{\pm}9$일; 599 g 이하에서 $49{\pm}12$일. 113명의 대상환아들 중 25명(22%)이 첫 발관에 실패하였다. 경계역의 유의성으로 조기양막파수는 발관 성공과 관련이 있었고, 공기 누출 증후군은 발관 실패와 관련이 있었다. 첫 발관 시도 시의 출생 후 나이, 교정연령, 체중, 영양상태와 인공환기기 설정은 발관 성공/실패 여부와 관련이 없었다. 첫 발관에 실패한 환아들은 첫 발관에 성공한 환아들에 비해 발관 성공일이 유의하게 지연되었고, 후발 패혈증의 빈도와 사망률도 유의하게 높았다. 결 론 : 저자들은 첫 발관 성공/실패를 예측할 수 있는 인자들을 찾지 못하였다. 첫 발관에 실패한 경우에는 후발 패혈증과 사망의 위험이 증가하였다. 향후 발관 성공/실패를 예측할 수 있는 인자들을 찾아내기 위한 지속적인 연구가 필요하다.

Purpose : To outline the aspects of extubation by birth weight and find the predictors for success/failure at the first extubation in extremely low birth weight infants. Methods : One hundred thirteen extremely low birth weight infants(<1,000 g) who were admitted to NICU at Samsung Seoul Hospital between Jan. 2000 and Jun. 2004 were enrolled. Clinical characteristics that are thought to be related with extubation success or failure were compared with the success and the failure of the first extubation. Results : As the birth weight decreased, extubation success day was significantly delayed : $16{\pm}3day(d)$ in 900-999 g; $20{\pm}3d$ in 800-899 g; $35{\pm}4d$ in 700-799 g; $37{\pm}9d$ in 600-699 g; $49{\pm}12d$ in ${\leq}599g$. 25 out of 113 infants(22%) failed the first extubation. Preterm premature rupture of membrane was associated with extubation success, and air leak was associated with extubation failure, with a borderline significance. Postnatal and corrected age and body weight at the first extubation, nutritional status, and ventilator settings were not associated with extubation success or failure. Extubation success day was significantly delayed, and the incidence of late-onset sepsis and mortality was significant higher in the failure of the first extubation. Conclusion : We could not find significant predictors for success/failure at the first extubation. The failure of the first extubation had an increased risk of late-onset sepsis and death. Further studies are needed to find the predictors for extubation success/failure.

키워드

참고문헌

  1. Rodriguez RJ. Management of respiratory distress syndrome : an update. Respir Care 2003;48:279-86
  2. Lee HY, Chung SH, Ko SY, Chang YS, Park WS. A study on the incidence and risk factors of nosocomial sepsis in very low birth weight infants. J Korean Soc Neonatol 1999; 6:90-7
  3. Hwang JH, Choi CW, Chang YS, Choe YH, Park WS, Shin SM, et al. The efficacy of clinical strategies to reduce nosocomial sepsis in extremely low birth weight infants. J Korean Med Sci, In press 2005
  4. Sharek PJ, Baker R, Litman F, Kaempf J. Burch K, Schwarz E, et al. Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates. Pediatrics 2003;111:e426-31 https://doi.org/10.1542/peds.111.2.426
  5. Higgins RD, Richter SE, Davis JM. Nasal continuous positive airway pressure facilitates extubation of very low birth weight neonates. Pediatrics 1991;88:999-1003
  6. Jackson JK, Vellucci J, Johnson P, Kilbride HW. Evidence- based approach to change in clinical practice: introduction of expanded nasal continuous positive airway pressure use in an intensive care nursery. Pediatrics 2003;111:e542-7
  7. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratorydistress syndrome among preterm infants <30 weeks' gestation. Pediatrics 2004;113:e560-31 https://doi.org/10.1542/peds.113.6.e560
  8. Vasiliki K, Greenough A, Dimitriou G. Prediction of extubation failure in preterm neonates. Eur J Pediatr 2000;159: 227-31 https://doi.org/10.1007/s004310050059
  9. Dimitriou G, Greenough A, Endo A, Cherian S, Rafferty GF. Prediction of extubation failure in preterm infants. Arch Dis Child 2002:86;F32-5 https://doi.org/10.1136/fn.86.1.F32
  10. Gillespie LM, White SD, Sinha SK, Donn SM. Usefulness of the minute ventilation test in predicting successful extubation in newborn infants: a radomized controlled trial. J Perinatol 2003;23:205-7 https://doi.org/10.1038/sj.jp.7210886
  11. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34 https://doi.org/10.1016/S0022-3476(78)80282-0
  12. Khan N, Brown A, Venkataraman ST. Predictors of extubation success and failure in mechanically ventilated infants and children. Crit Care Med 1996;24:1568-79 https://doi.org/10.1097/00003246-199609000-00023
  13. Shim SS, Romero R, Hong JS, Park CW, Jun JK, Kim BI, et al. Clinical significance of intra-amniotic inflammation in patients with preterrn premature rupture of membranes. Am J Obstet Gynecol 2004;191:1339-45 https://doi.org/10.1016/j.ajog.2004.06.085
  14. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996;97:210-5
  15. Knox WF, Barson AJ. Pulmonary hypoplasia in a regional perinatal unit. Early Hum Dev 1986;14:33-42 https://doi.org/10.1016/0378-3782(86)90167-2
  16. Jantz MA, Pierson DJ. Pneumothorax and barotrauma. Clin Chest Med 1994;15:75-91
  17. Heldt GP. The effect of gavage feeding on the mechanics of the lung, chest wall, and diaphragm of preterrn infants. Pediatr Res 1988;24:55-8 https://doi.org/10.1203/00006450-198807000-00014
  18. Blondheim O, Abbasi S, Fox WW, Bhutani VK. Effect of enteral gavage feeding rate on pulmonary functions of very low birth weight infants. J Pediatr 1993;122:751-5 https://doi.org/10.1016/S0022-3476(06)80021-1