만삭아 저산소성 허혈성 뇌증에서 신경학적 예후의 예측인자
Predicting Factors for Neurologic Outcome in Full-term Neonates with Hypoxic-Ischemic Encephalopathy
여채영, 송은송, 최영륜, 김선희, 우영종, 김도균,
소속 상세정보
여채영 ( Yeo Chae-Young )
전남대학교 의과대학 소아과학교실
송은송 ( Song Eun-Song )
전남대학교 의과대학 소아과학교실
최영륜 ( Choi Young-Youn )
전남대학교 의과대학 소아과학교실
김선희 ( Kim Sun-Hui )
전남대학교 의과대학 소아과학교실
우영종 ( Woo Young-Jong )
전남대학교 의과대학 소아과학교실
김도균 ( Kim Do-Kyun )
전남대학교 의과대학 소아과학교실
KMID : 0438520060130020226
Abstract
Purpose: Hypoxic injury during delivery and subsequent ischemic encephalopathy is still remained as one of the important cause of neonatal death and associated with neurologic complication. We investigated the predicting factors for neurologic outcome in full-term hypoxic-ischemic encephalopathy (HIE).
Methods: Twenty-two full-term neonates with HIE stage II or III from Jan. 2001 to Dec. 2004 were enrolled. We reviewed the medical records retrospectively including obstetric history, initial pH, creatine kinase (CK), ionized calcium, seizure type and duration, EEG, cranial sonography, CT or MRI, and neurologic outcome.
Results: Among 22 patients, outborn was 86.3%, vaginal delivery 68.2%, and male 72.7%. Regarding the obstetrical events, two-thirds had meconium staining or aspiration and prolonged rupture of membrane. Initial arterial pH, CK and ionized calcium were not significantly different between normal and abnormal neurologic outcome group. All of 5 patients recovered from seizure after more than 5 days had neurologic sequelae (P= 0.008). Eight of 16 cases with abnormal EEG showed abnormal development, and all of 4 cases with normal EEG showed normal development. Eight of 12 cases with abnormal imaging study showed neurologic sequelae, however, all of 10 cases with normal study showed normal outcome (P=0.005).
Conclusion: This study suggests that seizure duration and imaging study are the best predicting factors for prognosis in full-term HIE. Although the EEG finding was not signigicant, the normal finding is expected to have good prognosis. The initial laboratory findings had no prognostic significance because of delayed blood sampling in most patients, who transferred from other hospitals after immediate postnatal resuscitation. We encourage the maternal transport especially when the high-risk delivery is anticipated.
키워드
Hypoxic-ischemic encephalopathy;Neurologic sequelae
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