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