재태연령별 성장과 주산기 사망율에 대한 임상통계학적 연구

Abstract

[한글]

Clinical and Statistical Study on Intrauterine Growth and Perinatal Mortality Rate

Dong Gwan Han

Department of Medical Science, The Graduate School, Yonsei, University

(Directed by Professor Duk Jin Yun, M.D.)

Classification of newborns at birth by weight alone was not satisfactory for

predicting mortality risks, congenital anomalies, intrauterine retardation,

malnutrition, or other morbidities due to intrauterine environments and growths

after birth, because various types of problems in the neonatal and infant periods

were dependent in part upon a birth weight for gestational age. Present interest in

perinatal biology has demanded standards of intrauterine growth as reliable and

useful as the standards for growth of children after birth. Various studies of the

relationship between birth weight and gestational age have been reported during

past several years, but none have entirely succeeded.

The extreme variability in the manner in whish data were collected has made

interpretation and comparison between studies difficult. For this reason and

because important determinants of birth weight such as age, parity, race, altitude,

soci-economic status, nutrition, intercurrent disease. and pregnancy interval all

vary from one community to another. I believed it necessary to derive birth

weight-gestational age data applicable to our population.

Lubchenco et al. (1963, 1966) constructed a percentile curve for birth weight and

other portions of the body against gestational age.

Gruenwald(1966) proposed the "Minus two Score" of birth weight for normal and

abnormal growth against gestational age.

Usher and McLean(1969) measured the body proportion in 7 dimensions against

gestational age and body weight group.

Freeman et al. (1970) and Ghosh et al. (1971) reported the birth

weight-gestational age tables which indicated the breeding characteristics of their

particular population.

The purpose of this study was to determine the intrauterine growth data against

gestational age and body weight, and to estimate the perinatal mortality rate in 3

areas of Korea, and to compare them with similar reports by Western workers.

1. Fetal Growth Data

For 3 years from Jan. 1970 through Dec. 1972, there were 11,880 births over 20

weeks of gestation at Severance, Chonju Presbyterian and Wonju Union Christian

Hospitals. The data for physical measurements, prenatal care, parity and

gestational ages, etc. were collected from hospital records of babies and mothers.

Birth weight-gestational age data have been calculated for 10,495 Korean single

newborns, 271 twin, and 217 Korean-Caucasian babies between 28 and 44 weeks of

gestational age. In this study for growth curves, 897 cases were excluded due to

incomplete records, fetal deaths, revere congenital malformations, maternal

diabetes, triplets, or less than 28 weeks and over 44 weeks gestational age.

Mean, standard deviation, standard error and the t-test for physical measurements

were calculated for each week from 28-44 weeks to the nearest week and at each 250

gm weight group.

Measurement of fetal growth rate must be regarded only as an approximation

because of potential errors in calculation of gestational age, births prior to 37

weeks and births beyond 43 weeks which probably were related to unfavorable

physiologic stales affecting birth weight.

1. The fetal growth curve between 28-38 weeks gestation followed a straight-line

course, which showed birth weight gained steadily according to gestational age, and

then flattened after 38 weeks gestation. Birth weight increased up to 42 weeks and

then decreased. The mean of birth weight at 40 weeks gestation was 3,270±402 gm.

2. Head circumference grew rapidly between 28-37 weeks gestation, chest

circumference and height grew between 28-38 weeks gestation. Biparietal diameter

increased between 28-35 weeks gestation. The means of physical measurments at 40

weeks gestation were as follows:

Head circumference: 34.4±1.35cm

Cheat circumference: 33.2±1.66cm

Body length: 50.6±2.17cm

Biparietal diameter: 9.7±0.47cm

3. The means of physical measurements significantly increased according to birth

weight. In general, those rapidly increased up to 2,500gm of birth weight(P<0.05)

and decreased beyond 4,500gm of birth weight.

4. Males were 90-l60gm heavier than females, which was significant at 37-43 weeks

gestation (P<0.05).

5. The birth weights from Severance Hospital were heaviest and those from Chonju

Presbyterian Hospital and Wonju Union Christian Hospital were in order. Weights at

37-43 weeks gestation from Severance Hospital were 100-150gm heavier than those

from Woniu Union Christian Hospital, which also were significant(P<0.05).

6. The birth weights from multipara were 140gm heavier than primipara at 40 weeks

gestation (P<0.05), and there was considerable difference after 36 weeks gestation.

7. At 37-42 weeks gestation, body weights from mothers who had antenatal cares

were considerably different( P <7.05) from those who did not.

8. Twins were much smaller than singletons after 35 weeks gestation(P<0.01), and

the difference was 590gm at 40 weeks geatation.

9. There were no differences of birth weights between Korean-Caucasian babies and

Korean single newborns(P>0.05).

10. The average body weights of middle class Korean babies were quite similar to

those of lower class Caucasians compared against gestational age.

11. Compared to those reported from Canada, the chest circumferences of Korean

babies were larger, but heights were shorter.

Ⅱ. Perinatal Mortality Rate

1. We had 544 deaths out of 11,336 single births, and the perinatal mortality

rate came to 48.0±2.01. In twin births, we had 49 deaths out of 312 and the

mortality rate was 157.1±20.59. In Korean-Caucasian births, 6 deaths out of 232

and mortality rate was 25.9±10.45. Above all, 599 out of 11,880 births whose

perinatal mortality rate was 50.4±2.00. We had 293 neonatal deaths and the

mortality rate was 24.66. Fetal deaths were 306 cases and the mortality rate was

25.76.

2. The perinatal mortality rate was almost twice as much as that of well

developed countries.

3. We had more male than female among perinatal deaths, but it was not

statistically significant(P>0.05)

4. Among 11,050 single live births, we had 878 cases of low birth weight babies,

which were 7.9%, 21% of whom died. Full term babies were 92.1% and 0.7% of them

died. The mortality rate of low birth weights was 30 times that full term babies.

Among 258 cases of neonatal deaths, low birth weight cases were 71.3% which were

2/3 of all neonatal deaths.

5. The perinatal mortality rate of babies from mothers without antenatal care was

4 times that of mothers who had. That was statistically significant(P<0.01).

6. The perinatal mortality rate of hospitals were Severance Hospital: 42.2,

Chonju Presbyterian Hospital: 52.1 and Wonju Union Christian Hospital: 68.0. There

were significant differences between Severance Hospital and Wonju Union Christian

Hospital(P<0.05).

From a clinical viewpoint, I think. it was because there were more cases without

antenatal care at Wonju Union Christian Hospital, compared with Severance Hospital.

[영문]

Classification of newborns at birth by weight alone was not satisfactory for predicting mortality risks, congenital anomalies, intrauterine retardation, malnutrition, or other morbidities due to intrauterine environments and growths

after birth, because various types of problems in the neonatal and infant periods were dependent in part upon a birth weight for gestational age. Present interest in perinatal biology has demanded standards of intrauterine growth as reliable and

useful as the standards for growth of children after birth. Various studies of the relationship between birth weight and gestational age have been reported during past several years, but none have entirely succeeded.

The extreme variability in the manner in whish data were collected has made interpretation and comparison between studies difficult. For this reason and because important determinants of birth weight such as age, parity, race, altitude, soci-economic status, nutrition, intercurrent disease. and pregnancy interval all vary from one community to another. I believed it necessary to derive birth weight-gestational age data applicable to our population.

Lubchenco et al. (1963, 1966) constructed a percentile curve for birth weight and other portions of the body against gestational age.

Gruenwald(1966) proposed the "Minus two Score" of birth weight for normal and abnormal growth against gestational age.

Usher and McLean(1969) measured the body proportion in 7 dimensions against gestational age and body weight group.

Freeman et al. (1970) and Ghosh et al. (1971) reported the birth weight-gestational age tables which indicated the breeding characteristics of their particular population.

The purpose of this study was to determine the intrauterine growth data against gestational age and body weight, and to estimate the perinatal mortality rate in 3 areas of Korea, and to compare them with similar reports by Western workers.

1. Fetal Growth Data

For 3 years from Jan. 1970 through Dec. 1972, there were 11,880 births over 20 weeks of gestation at Severance, Chonju Presbyterian and Wonju Union Christian Hospitals. The data for physical measurements, prenatal care, parity and gestational ages, etc. were collected from hospital records of babies and mothers.

Birth weight-gestational age data have been calculated for 10,495 Korean single newborns, 271 twin, and 217 Korean-Caucasian babies between 28 and 44 weeks of gestational age. In this study for growth curves, 897 cases were excluded due to incomplete records, fetal deaths, revere congenital malformations, maternal diabetes, triplets, or less than 28 weeks and over 44 weeks gestational age.

Mean, standard deviation, standard error and the t-test for physical measurements were calculated for each week from 28-44 weeks to the nearest week and at each 250 gm weight group.

Measurement of fetal growth rate must be regarded only as an approximation because of potential errors in calculation of gestational age, births prior to 37 weeks and births beyond 43 weeks which probably were related to unfavorable physiologic stales affecting birth weight.

1. The fetal growth curve between 28-38 weeks gestation followed a straight-line course, which showed birth weight gained steadily according to gestational age, and then flattened after 38 weeks gestation. Birth weight increased up to 42 weeks and

then decreased. The mean of birth weight at 40 weeks gestation was 3,270±402 gm.

2. Head circumference grew rapidly between 28-37 weeks gestation, chest circumference and height grew between 28-38 weeks gestation. Biparietal diameter increased between 28-35 weeks gestation. The means of physical measurments at 40 weeks gestation were as follows:

Head circumference: 34.4±1.35cm

Cheat circumference: 33.2±1.66cm

Body length: 50.6±2.17cm

Biparietal diameter: 9.7±0.47cm

3. The means of physical measurements significantly increased according to birth weight. In general, those rapidly increased up to 2,500gm of birth weight(P<0.05) and decreased beyond 4,500gm of birth weight.

4. Males were 90-l60gm heavier than females, which was significant at 37-43 weeks gestation (P<0.05).

5. The birth weights from Severance Hospital were heaviest and those from Chonju Presbyterian Hospital and Wonju Union Christian Hospital were in order. Weights at 37-43 weeks gestation from Severance Hospital were 100-150gm heavier than those from Woniu Union Christian Hospital, which also were significant(P<0.05).

6. The birth weights from multipara were 140gm heavier than primipara at 40 weeks gestation (P<0.05), and there was considerable difference after 36 weeks gestation.

7. At 37-42 weeks gestation, body weights from mothers who had antenatal cares were considerably different( P <7.05) from those who did not.

8. Twins were much smaller than singletons after 35 weeks gestation(P<0.01), and the difference was 590gm at 40 weeks geatation.

9. There were no differences of birth weights between Korean-Caucasian babies and Korean single newborns(P>0.05).

10. The average body weights of middle class Korean babies were quite similar to those of lower class Caucasians compared against gestational age.

11. Compared to those reported from Canada, the chest circumferences of Korean babies were larger, but heights were shorter.

Ⅱ. Perinatal Mortality Rate

1. We had 544 deaths out of 11,336 single births, and the perinatal mortality rate came to 48.0±2.01. In twin births, we had 49 deaths out of 312 and the mortality rate was 157.1±20.59. In Korean-Caucasian births, 6 deaths out of 232 and mortality rate was 25.9±10.45. Above all, 599 out of 11,880 births whose

perinatal mortality rate was 50.4±2.00. We had 293 neonatal deaths and the mortality rate was 24.66. Fetal deaths were 306 cases and the mortality rate was 25.76.

2. The perinatal mortality rate was almost twice as much as that of well developed countries.

3. We had more male than female among perinatal deaths, but it was not statistically significant(P>0.05)

4. Among 11,050 single live births, we had 878 cases of low birth weight babies, which were 7.9%, 21% of whom died. Full term babies were 92.1% and 0.7% of them died. The mortality rate of low birth weights was 30 times that full term babies.

Among 258 cases of neonatal deaths, low birth weight cases were 71.3% which were 2/3 of all neonatal deaths.

5. The perinatal mortality rate of babies from mothers without antenatal care was 4 times that of mothers who had. That was statistically significant(P<0.01).

6. The perinatal mortality rate of hospitals were Severance Hospital: 42.2, Chonju Presbyterian Hospital: 52.1 and Wonju Union Christian Hospital: 68.0. There were significant differences between Severance Hospital and Wonju Union Christian

Hospital(P<0.05).

From a clinical viewpoint, I think. it was because there were more cases without antenatal care at Wonju Union Christian Hospital, compared with Severance Hospital.