학술논문
임상 ; 초극소 미숙아(<1,000 g)에서 분만 형식 (제왕절개 vs. 질식분만)에 따른 예후
Mode of Delivery and Outcome in Extremely Low Birth Weight Infants
Mode of Delivery and Outcome in Extremely Low Birth Weight Infants
Document Type
Article
Author
성세인 / Se In Sung; 김진규 / Jin Kyu Kim; 유혜수 / Hye Soo Yoo; 안소윤 / So Yoon Ahn; 김은선 / Eun Sun Kim; 최석주 / Suk Joo Choi; 장윤실 / Yun Sil Chang; 박원순 / Won Soon Park
Source
PERINATOLOGY (구 대한주산의학회잡지). Dec 25, 2010 21(4):388
Subject
Language
Korean
ISSN
2508-4887
Abstract
목적: 최근 미숙아와 저체중 출생아의 생존율이 급격히 증가하고 있으며, 일부에서 제왕절개가 이들의 생존율을 향상시킨다고 주장한다. 본 연구는 단일기관에서 초극소 미숙아의 제왕절개 비율과 이들의 예후에 대해 알아보고자 하였다. 방법: 2000년 1월부터 2008년 12월까지 9년간 삼성서울병원에서 출생하여 신생아 집중치료실에 입원하였던 초극 소미숙아(<1,000 g) 415명 중 제왕절개를 시행 받은 325명의 특징, 예후를 조사하여 이들을 대조군인 질식분만을 통해 출생한 90명과 비교하였다. 결과: 초극소 미숙아 415명 중 325명(78%)이 제왕절개로 출생하였으며, 재태주수가 높을수록 제왕절개 비율도 상 승하였다. 재태주수, 부당경량아, 산모의 임신성 고혈압 유무, 산모의 산전 스테로이드 투여 여부가 초극소 미숙아의 예후와 연관이 있었으며 이들 교란 요인은 이후의 분석에서 교정되었다. 교란요인에 따라 층화분석하였을때, 제왕절 개군과 질식분만군에서 28일 이내 생존율의 차이가 없었다. 다중 로지스틱 분석에서도 두 군(제왕절개군과 질식분만군) 간의 생존율과 이환율(뇌실 내출혈, 기관지폐 이형성증 등)의 차이가 없었다. 결론: 단일기관 연구 결과 초극소 미숙아(<1,000 g)에서 제왕절개가 이들의 단기 예후를 향상시키지는 않았다.
Objective: Some studies have suggested that delivery by Cesarean section is associated with a better prognosis for the extremely low birth weight infants (ELBWIs). The purpose of this study is to review neonatal outcomes according to the mode of delivery in ELBWIs. Methods: Medical records of 415 ELBWIs (<1,000 g) who were born and admitted to the neonatal intensive care unit (NICU) at Samsung Medical Center (SMC) from January 2000 to December 2008 were reviewed retrospectively. Clinical characteristics and outcomes of the ELBWIs delivered by Cesarean section (C-group, N=325) were compared with those of vaginally delivered infants (V-group, N=90). Logistic regression was performed to verify the significance of outcome difference, and to obtain odds ratios for mortality and morbidities according to the mode of delivery. Potential confounders were adjusted in this multivariate logistic regression analysis. Results: Among the 415 ELBWIs, 325 (78%) were delivered by C-section. Gestational age and the rate of Cesarean section delivery showed positive correlation. Gestational age, small-for-gestational age status, pregnancy-induced hypertension and antenatal steroid administration were found to interact with the outcomes of ELBWIs and were corrected in the subsequent analysis. The analysis was stratified by confounders, and comparison between the two groups showed no differences in mortality within 28 days. Multivariate logistic regression also showed no significant differences in mortality and morbidities according to the mode of delivery. Conclusions: In our study, Cesarean section was not associated with better outcomes for the extremely low birth weight infants.~
Objective: Some studies have suggested that delivery by Cesarean section is associated with a better prognosis for the extremely low birth weight infants (ELBWIs). The purpose of this study is to review neonatal outcomes according to the mode of delivery in ELBWIs. Methods: Medical records of 415 ELBWIs (<1,000 g) who were born and admitted to the neonatal intensive care unit (NICU) at Samsung Medical Center (SMC) from January 2000 to December 2008 were reviewed retrospectively. Clinical characteristics and outcomes of the ELBWIs delivered by Cesarean section (C-group, N=325) were compared with those of vaginally delivered infants (V-group, N=90). Logistic regression was performed to verify the significance of outcome difference, and to obtain odds ratios for mortality and morbidities according to the mode of delivery. Potential confounders were adjusted in this multivariate logistic regression analysis. Results: Among the 415 ELBWIs, 325 (78%) were delivered by C-section. Gestational age and the rate of Cesarean section delivery showed positive correlation. Gestational age, small-for-gestational age status, pregnancy-induced hypertension and antenatal steroid administration were found to interact with the outcomes of ELBWIs and were corrected in the subsequent analysis. The analysis was stratified by confounders, and comparison between the two groups showed no differences in mortality within 28 days. Multivariate logistic regression also showed no significant differences in mortality and morbidities according to the mode of delivery. Conclusions: In our study, Cesarean section was not associated with better outcomes for the extremely low birth weight infants.~