학술논문
조산 또는 만삭 분만 후 진단된 뇌성마비의 임상적 양상
Clinical characteristics of cerebral palsy following preterm or term birth; 10 years` experience
Clinical characteristics of cerebral palsy following preterm or term birth; 10 years` experience
Document Type
Article
Author
구영아 / Young Ah Koo; 최동석 / Dong Seok Choi; 최석주 / Suk Joo Choi; 오수영 / Soo Young Oh; 장윤실 / Yun Sil Chang; 박원순 / Won Soon Park; 김현숙 / Hyeon Sook Kim; 노정래 / Cheong Rae Roh; 김종화 / Jong Hwa Kim
Source
Obstetrics & Gynecology Science. Dec 15, 2006 49(12):2544
Subject
Language
Korean
ISSN
2287-8572
Abstract
목적: 조산 또는 만삭에 출생한 이후 뇌성마비 진단을 받은 환아의 주산기 병력과 뇌성마비의 임상 양상을 비교하고자 하였다. 연구 방법: 1994년 10월부터 2004년 12월까지 본원에서 출생 후 뇌성마비 진단을 받은 총 75명의 환아의 의무기록을 후향적으로 분석하였다. 주요 기형이 동반된 다섯 명을 제외한 총 70명을 대상으로 조산군과 만삭군으로 분류하여 각 군의 주산기 병력과 뇌성마비의 형태, 침범 부위 및 중증도를 비교하였다. 결과: 뇌성마비의 발생 빈도는 0.23%이었고, 출생 시 재태 연령이 증가할수록 감소하였다. 다태 임신에서의 뇌성마비 발생 빈도는 단태 임신보다 6.7배 높았고, 남아가 여아보다 1.5배 많았다. 조산군은 55명 (79%), 만삭군은 15명 (21%)이 포함되었다. 조산군에서 유의한 신생아 합병증이 동반된 경우는 86%였고, 만삭군에서는 15명 중 6명에서 저산소성 허혈성 뇌손상, 태변흡입증후군, 또는 원인 불명의 경련을 보였다. 조산군의 뇌성마비 형태의 대부분은 경직형 (95%)임에 반해 만삭군에서는 경직형이 67%, 무정위 운동형이 20%, 근긴장 이상형이 7%, 저긴장형이 7%로 다양하게 나타났다. 뇌성마비의 침범 부위는 조산군에서 하지 마비가 가장 많았고, 만삭군에서는 사지마비가 가장 많았다. 결론: 만삭아의 뇌성마비는 조산아에 비해 신생아 합병증 동반이 유의하게 적은 반면 뇌성마비의 형태와 침범부위는 다양하게 나타났다. 이는 만삭아의 뇌성마비가 보다 다양한 원인과 임상 양상을 가짐을 시사한다.
Objective: To investigate the perinatal and clinical characteristics of cerebral palsy (CP) following preterm or term birth. Methods: A total of 75 infants born and diagnosed as CP in our hospital from October 1994 to December 2004 were recruited retrospectively. Their maternal and perinatal outcomes and the type, involved lesion and severity of CP were analyzed. Results: The incidence of CP was 0.23%, which showed decreasing pattern according to advancing gestational age at birth. CP was more frequent (6.7-times) in multifetal pregnancy. Male to female ratio was 1.5: 1. After excluding five infants with major congenital anomalies, 55 (79%) infants were born before 37 weeks` gestation (preterm CP) and 15 (21%) infants were born beyond 37 weeks` gestation (term CP). Eighty-six percent of preterm CP had significant neonatal morbidities, but only 6 out of 15 infants in term CP had significant perinatal events including hypoxic ischemic encephalopathy, meconium aspiration syndrome, and seizure of unknown origin. The most common type of preterm CP was spastic (95%), whereas the types of term CP were more diverse; spastic in 67%, athetoid in 20%, dystonic in 7%, and hypotonic in 7%. Regarding the involved lesions, the most common type was diplegic in preterm CP and quadriplegic in term CP. Conclusion: In contrast to preterm CP, term CP had significantly less perinatal risk factors, and their type and involved lesion showed more diverse patterns. These findings may implicate that more heterogenous etiologies are involved in pathogenesis of term CP.
Objective: To investigate the perinatal and clinical characteristics of cerebral palsy (CP) following preterm or term birth. Methods: A total of 75 infants born and diagnosed as CP in our hospital from October 1994 to December 2004 were recruited retrospectively. Their maternal and perinatal outcomes and the type, involved lesion and severity of CP were analyzed. Results: The incidence of CP was 0.23%, which showed decreasing pattern according to advancing gestational age at birth. CP was more frequent (6.7-times) in multifetal pregnancy. Male to female ratio was 1.5: 1. After excluding five infants with major congenital anomalies, 55 (79%) infants were born before 37 weeks` gestation (preterm CP) and 15 (21%) infants were born beyond 37 weeks` gestation (term CP). Eighty-six percent of preterm CP had significant neonatal morbidities, but only 6 out of 15 infants in term CP had significant perinatal events including hypoxic ischemic encephalopathy, meconium aspiration syndrome, and seizure of unknown origin. The most common type of preterm CP was spastic (95%), whereas the types of term CP were more diverse; spastic in 67%, athetoid in 20%, dystonic in 7%, and hypotonic in 7%. Regarding the involved lesions, the most common type was diplegic in preterm CP and quadriplegic in term CP. Conclusion: In contrast to preterm CP, term CP had significantly less perinatal risk factors, and their type and involved lesion showed more diverse patterns. These findings may implicate that more heterogenous etiologies are involved in pathogenesis of term CP.