Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Death in the Neonatal Intensive Care Unit

신생아 중환자실의 사망에 관한 연구

  • Koo, So-Eun (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Hee-Young (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Kyoung-A (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Gin-A (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Hye-Won (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Byoung-Sop (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ellen Ai-Rhan (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ki-Soo (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine) ;
  • Pi, Soo-Young (Division of Neonatology, Department of Pediatrics Asan Medical Center, University of Ulsan College of Medicine)
  • 구소은 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김희영 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박경아 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 임진아 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박혜원 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 이병섭 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아과학교실)
  • Published : 2009.11.30

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Abstract

Purpose: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. Methods: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. Results: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. Conclusion: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.

목 적 : 최근 신생아집중치료술의 발전으로 신생아 중환자실의 생존률은 매우 향상되었으나 아직도 신생아 중환자실 입원환아들의 사망은 지속적으로 발생하고 있다. 본 연구는 지난 10년간 서울아산병원 신생아 중환자실에 입원한 환아들 중 사망한 환아들을 분석하여 사망률, 사망원인 및 사망의 특징에 대하여 알아보고자 하였다. 방 법 : 1998년 1월부터 2007년 12월까지 10년간 서울아산병원 신생아중환자실에 입원했던 환아들을 대상으로 의무기록을 후향적으로 조사하여 사망률, 사망원인질환 및 출생 후 사망까지의 시간을 분석하였다. 결 과 : 조사기간 동안 총 입원환아는 6,289명이었고 총 사망환아는 264명으로 사망률은 4.2%였다. 총 사망환아 중 극소 저출생 체중아는 103명, 초극소 저출생 체중아는 80명이 사망하여 사망률은 각각 10.6%, 21.4%였다. 10년간 연도별 사망률의 유의한 변화추세는 보이지 않았다. 사망관련 주요질환으로 미숙아 관련 사망이 102명(38.7%)으로 가장 많았고, 선청성 기형, 패혈증, 원발성 폐동맥 고혈압, 신생아가사 순으로 나타났다. 미숙아 관련 합병증 중에서는 패혈증이 가장 많은 수를 차지하였고, 선천성 기형 중에서는 선천성 심기형으로 인한 사망이 가장 많았다. 생후 첫 1주 이내에 66명(37.1%)이 사망하여 가장 높은 사망률을 보였고, 178명(67.4%)이 생후 28일 이내의 신생아기에 사망하였다. 결 론 : 신생아 중환자 치료의 방전에도 불구하고 지난 10년간 사망률은 크게 변화하지 않았다. 미숙아관련 합병증과 패혈증이 사망원인 중 많은 부분을 차지하므로 이를 줄이는 노력이 필요할 것으로 생각된다. 또한 생후 첫 1주 이내에 사망하는 경우가 많으므로 이 시기에 신생아 중환자 치료에 있어 세심한 주의 필요할 것으로 생각된다.

Keywords

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