초극소저출생체중아 (extremely low birth weight infant) 에서의 화농성 관절염 치료 경험 -8 년 추시 결과 - 성균관의대 심종섭.

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Presentation transcript:

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)/male MRSA sepsis 7 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 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 g Extremely low birth weight infant < 1000g Discussion

Extremely low birth weight infant(< 1000g) Mortality rate: 13.0% % ( 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