극저출생체중아에서 뇌성마비 및 발달지연 관련 고위험요인의 분석

Abstract

Although the recent development of prenatal and neonatal intensive care have increased the survival rate of premature infants, the incidence of cerebral palsy(CP) is increasing due to the increased survival of very tiny, initially ill. infants. Screening criteria for cerebral palsy and delayed development(DD) is needed to perform an early diagnosis and treatment for CP in high risk infants. The purpose of this study is to identify the risk factors of cerebral palsy and delayed development in VLBW infants. We performed a case-control study in 19 VL-BW infants who developed cerebral palsy and delayed development at 1 year of post-conceptional age. For control group, we selected 59 VLBW infants who showed normal development at 1 year of postconceptional age. In univariate analysis, factors associated with an increased risk of CP and DD were chorioamnionitis/premature rupture of membrane (PROM) (OR 3.03, p=0.04), resuscitation after birth(OR 3.19, p=0.03), and periventricular leukomalacia(PVL)(OR 12.85, p=0.01). In multivariate logistic regression analysis, a significant factor associated with an increased risk of CP and DD was PVL(OR 13.2 ; 95 % CI 2.5-69.5, p =0.002). In multivariate logistic regression analysis after adjustment for gestational age and birth weight, a factor associated with an increased risk of CP and DD was PVL(OR 9.4 ; 95% Cl 2.0-44.9, p=0.005). In conclusion, the only significant risk factor of cerebral palsy and delayed development in VLBW infants is periventricular leukomalacia. The VLBW infants with PVL should be on the careful follow-tip program after hospital discharge from neonatal intensive care unit to evaluate the early diagnosis and possible early treatment for CP and DD.