미숙아의 건강관리 요구 조사

Abstract

[한글]본 연구는 미숙아 및 그 어머니를 대상으로 이들의 보건 사회학적 특성과 건강관리 요구사항을 파악함으로써 효과적이고 효율적인 미숙아 등록관리 프로그램 개발의 기초자료를 생산하기 위하여 시도되었다.

본 연구의 대상은 2000. 1. 1∼2000. 9. 30 기간 중에 태어난 출생아 중 출생시 체중이 2,500ｇ미만의 저체중아 또는 임신 37주 미만의 미숙아를 대상으로 하였으며, 자료수집 및 분석은 전국 242개 보건소 당 3명씩 개월별로 할당하여 비확률 추출한 726명 중 연구참여에 협조한 534명으로 하였다.

미숙아 건강관리 요구에 대한 측정도구는 미숙아를 출산한 어머니를 대상으로 구조화된 조사표를 활용하였으며 이를 모자보건담당자가 직접면접 조사하였다. 수집된 자료는 SPSS 통계프로그램을 이용하여 분석하였으며, 그 분석결과는 다음과 같다.

첫째, 조사대상 미숙아 중 선천성이상아는 55명으로 전체의 10.4%이었으며, 쌍태아 이상 분만 산모는 17.0%, 분만시 이상분만인 경우는 59.7%이었다.

둘째, 미숙아와 어머니의 보건의료 관리실태 중 미숙아의 평균 입원기간은 35.2일, 입원비용은(본인부담) 179만원, 외래진료가 6회 이상인 경우는 전체의 28.4%, 미숙아의 현재 질환 및 유병증상을 보유한 경우는 18.6%, 미숙아 어머니의 출산경험은 경산이 75.0%, 유산경험은 29.0%, 미숙아 출산경험은 27.4%, 신생아 사망경험은 2.7%, 선천성이상아 출산경험은 1.7%, 임신전 질병을 앓았던 산모는 12.7%이었다. 첫 산전진찰 시기는 임신 9주 이후가 17.6%, 임신중 이상증상은 부종과 질출혈이 각각 29.9%, 21.9%, 임신중 합병증이 있었던 산모는 32.6%, 임신중 약물복용은 52.5%, 임신중 위험상태 경험은 24.3%, 음주비율은 9.7%, 흡연비율은 1.3% 수준이었다.

셋째, 미숙아 어머니 애로사항은, 출생직후와 병원 입원 중에는 '가족의 심리적·경제적 고통'이었으며, 퇴원직후에는 '육아의 어려움'이었다. 조사시점 기준 가장 염려하고 있었던 사항은 모든 월령에서 '신체 및 지능의 정상적 발달 여부'이었다.

넷째, 미숙아의 건강관리 요구사항 중 요구가 가장 많았던 것은 '이유식방법' 62.1%, '예방접종 부작용·금기사항·유의사항' 60,6%, '질식사 돌연사증후군 예방' 57.4%, '미숙아 의료비 지원' 55.5%, '육아스트레스 상담요구' 51.6%이었다. 지역별로 보면 대도시의 경우는 '이유식 방법', 시지역에서는 '예방접종 부작용 금기사항 유의사항', 농촌지역에서는 '아기 영양제 보급'이 가장 요구가 많았다. 월령별 가장 요구가 많았던 사항은 생후 1∼2개월과 3∼4개월에서는 '예방접종 부작용', 5∼6개월과 7개월 이상에서는 '이유식 방법'이었다.

다섯째, 건강관리 요구가 높은 군(상위75%이상)과 낮은 군(하위25%이내)의 미숙아와 어머니의 특성을 비교한 결과, 건강관리 요구가 높은 군이 출생시 평균체중이 낮았고(p<0.05), 재태기간이 짧았으며(p<0.005), 경제수준이 낮고(p<0.005), 어머니의 산후건강상태가 낮은 집단에서(p<0.005) 건강관리요구가 높았으며 이는 모두 통계적으로 유의한 차이가 있었다.

미숙아 및 어머니의 특성별 요구내용을 전체 요구내용 중 요구가 가장 많은 상위 5개 항목인 '이유식 방법', '예방접종 부작용 금기사항', '질식사 돌연사증후군 예방', '의료비 지원', '육아스트레스 상담' 각각에 대해 요구군과 비요구군으로 나누어 미숙아와 어머니의 특성을 비교한 결과 '질식사 돌연사증후군 예방'에 대한요구는 어머니의 산후 건강상태가 양호한 집단에서 비요구군 비율이 높았으며(p<0.005), '미숙아 의료비 지원'에 대한 요구는 출생시 체중과 재태기간이 각각 낮고(p<0.005), 선천성 이상이 있으며(p<0.05), 경제수준이 낮은 집단에서 요구비율이 높았다(p<0.005). 이는 모두 통계적으로 유의한 차이가 있었다. '육아스트레스에 대한 상담'요구는 아기 월령이 낮고(3개월 미만), 재 입원한 경우와 현재질환이 있는 경우에 요구비율이 각각 높았으며 이는 모두 통계적으로 유의한 차이가 있었다(p<0.05).

이상의 연구결과를 고려하여 볼 때 미숙아는 발생 후 지속적인 관리가 요구되는 고위험 집단이므로 지역사회내의 보건소는 이들이 병원에서 퇴원 시 지역사회병원, 전문가 집단과 긴밀한 협조체계를 구축하여 퇴원 후에도 전문가의 체계적인 관리가 이루어지도록 해야 할 것이다. 또한 미숙아와 어머니의 특성을 고려하여 어머니의 인지정도나 미숙아의 건강상태에 따라 다르게 제공하는 다단계의 프로토콜이 개발되어야 할 것이다.

[영문]The purpose of this study is to obtain data to develop an effective management and health care program for premature babies by identifying health and social characteristics and health care service needs of premature babies and their mothers.

The subjects of this study were babies born between January 1 and September 30, 2000 whose weights at birth were less than 2,500 grams or who were prematurely born prior to 37th week of gestation. The data was gathered from 534 subjects out of 726 babies who were randomly selected from 242 public heath centers(3 samples from each health center) located nationwide.

The instrument used to measure the health care services needs of premature babies was questionnaire presented to the mothers of premature babies. The questionnaires were completed in accordance with face-to-face interviews conducted by health center workers. The collected data was analyzed by employing SPSS statistical program. The result of the study is as follows:

First, among the premature babies, 55 babies(10.4%) were afflicted by congenital abnormality. Some 17% of the mothers had twins or more and abnormal delivery accounted for 59.7%.

Second, regarding health and medical management of premature babies and their mothers, the average period of hospitalization was 35.2 days; the average medical cost(charged to patients) was 1,790,000 won; the proportion those who made of the cases 6 or more outpatient hospital visits was 28.4%; the proportion of premature babies with sickness or symptoms of disorder was 18.6%; some 75% of the mothers had a experience of with normal parturation; those with experience of miscarriage were 29.0%; those with a experiences of premature baby accounted for 27.4%; experiences with neonatal death were 2.7%; experiences with congenitally abnormal babies were 1.7%; the mothers who had experienced illness prior to pregnancy were 12.7%; the percentage of initial hospital visit made on after 9th week of gestation was 17.6%.

Regarding the abnormal symptoms during pregnancy, cases of edema and virginal bleeding accounted for 29.9% and 21.9% respectively, cases of complication during pregnancy were 32.6%, the medicated during pregnancy were 52.5%, 24.3% had a experience of being in critical condition during pregnancy. Cases of drinking during pregnancy accounted for 9.7%, and cases of smoking during pregnancy were 1.3%.

Third, the most difficult of the premature care at the time of birth and during hospitalization was psychological and financial burden of the family, and infant care was the most burdensome problem at the time of hospital discharge. All mothers were concerned as to whether the babies would have normal development physically and mentally.

Fourth, among the health care service needs of premature babies, the most frequently needs were ; weaning method(62,1%), complication from vaccination, contraindication and caution(60.6%), prevention from asphyxia/sudden infant death syndrome(57.4%), financial support of medical expenses for premature babies(55.5%), consultation request for stress from premature care(51.6%).

Based on mothers living in region, what was needed most for metropolitan mothers was weaning method, small and medium sized cities called for ways to prevent complication from vaccination, contraindication and caution, and rural community mothers were in need of nutritional supplies for their premature babies. Based on the age of infants, they want to prevent complication from vaccination in case of 1-2 months and 3-4 months and to learn weaning method in case of 5-6 months and more over.

Fifth, based on the comparison of characteristics of premature babies and their mothers between the group with high level of needs in health care(upper 75% and higher) and low level of needs in health care(lower 25% and lower), for the group with high level of needs in health care, the average weight of babies at birth was low(p<0.005), gestation period was short(p<0.005), financial condition was low(p<0.005), and the group with poor postpartum health condition of the mothers(p<0.005) showed high level of needs for health care. There were significant statistical differences across these findings.

The top five needs were learning weaning method, complication prevention from vaccination/ contraindication, prevention from asphyxia/ sudden infant death syndrome, financial support, and consultation for stress from premature care. This particular part of the research is devoted to find out characteristic differences of premature babies and their mothers between "request group" and "no-request group" on the basis of the five needs mentioned. For the need of prevention from asphyxia/sudden infant death syndrome, the proportion of no-request group was high in the group with good postpartum health condition of the mothers. For the request for financial support for premature babies, the proportion of request group was high(p<0.005) in the group with low weight at birth, short gestation period(p<0.005), congenital abnormality(p<0.05), and low financial status. For the request for consultation for stress from infant care, the proportion of request group was high in the cases of mothers with newly born babies(less than 3 months), cases of readmission to hospital and of current illness. Significant statistical differences were shown(p<0.05).

Considering the results of this study, Local Health Centers(LHC) should build a cooperative system with community hospitals, medical specialists because premature babies are high risk groups who need special management care. LHC should provide special services to them when they discharge from hospitals. LHC also should develop a comprehensive protocol about various services considering the characteristics of premature babies and their mothers. It should be based on the mothers needs and health condition of premature babies.