초극소저출생체중아 (extremely low birth weight infant)에서의 화농성 관절염 치료 경험

-8 년 추시 결과 -

성균관의대 심종섭

Birth History

Male/ 26 ges.wks

- premature delivery d/t placenta previa

- emergency C/S delivery

- 860g/ 33cm

- respiratory distress syndrome

(apnea & bradycardia & cyanosis)

Past Medical History

At NICU

- 3days

Neonatal sepsis

Blood, respiratory tract

- 7days

DIC –throboembolism on right L/E

Pseudoparalysis of right L/E

26wks(860g, 33cm)/maleMRSA sepsis7 days/685 g – DIC, right L/E paralysis

8days/Male/ 685g

Operation was performed I&D Right Hip Right Knee Isolated organism: MRSA

Postop. 2wks

Right hip & Knee

Swelling & Pseudoparalysis

- reoperation was performed.

(under local anesthesia) IV Vancomycin for 6 weeks Discharged at 4 months old (2.5 kg)

Extremely low birth weight Birth asphyxia Respiratory distress syndrome Apnea & bradycardia and cyanosis Neonatal sepsis (MRSA) DIC and throboembolism of Right L/E Retinopathy Preterm PDA Hyperbilirubinemia Hydrocele Septic arthritis and pathologic hip dislocation

Pavlik harness for 3 months

4weeks 8 weeks

6 months 1 yr

1 yr

Postop 2 yr

Postop 3 yr

Open Reduction & VDRO

Age 3

Postop 6 mo Postop 1 yr

(Night abduction brace for 2 yrs)

Postop 1 yr (age 4)

Postop 2 yr (age 5)

Postop 2 yr ( age 5)

Postop 3 yr (age 6)

Postop 4 yr (age 7) Postop 5 yr (age 8)

Postop 4 yr (Age 7)

Postop 5yr 6 mo (age 8 yr 6 mo)

At age 8 yr 6mo P/E

- Flexion 130/ 140, F/D 10/0, ABD 50/70

- IR 30/60, ER 80/60 X-ray

- Coxa vara, hypoplasia of femoral head

- LLD (2cm)

- Acetabular dysplasia

Prematurity

Low birth weight infant (7-8%)

< 2500 g Very low birth weight infant

1000 -1500g Extremely low birth weight infant

< 1000g

Discussion

Extremely low birth weight infant(< 1000g)

Mortality rate: 13.0% - 21.5%

(lower gestational age, lower birth weight, male gender) Complication of low birth weight- Bronchopulmonary dysplasia- Patent ductus arteriosus- Gastrointestinal immaturity & Necrotizing enterocolitis- Neurosensory complication intraventricular hemorrhage, retinopathy

Discussion

Neurodevelopmental and functional outcomes of ELBWI (Pediatrics, 2000)

1480 infants (more than 48 months F/U)

- 25%: Abnormal neurologic examination

- 37%: Mental retardation

- 29%: Delayed psychomotor development

- 9%: Vision impairment

- 11% : Hearing impairment

Outcome of extreme prematurity: as information increases so do the dilemmas !!

(Watts et al, Arch. Dis. Child Fetal Neonatal, 2006)

Discussion