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

2. Birth History Male/ 26 ges.wks - premature delivery d/t placenta previa - emergency C/S delivery - 860g/ 33cm - respiratory distress syndrome (apnea & bradycardia & cyanosis)

3. Past Medical History At NICU - 3days Neonatal sepsis Blood, respiratory tract - 7days DIC –throboembolism on right L/E Pseudoparalysis of right L/E

4. 26wks(860g, 33cm)/male MRSA sepsis 7 days/685 g – DIC, right L/E paralysis

6. 8days/Male/ 685g Operation was performed I&D Right Hip Right Knee Isolated organism: MRSA

7. 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)

8. 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

9. Pavlik harness for 3 months 4weeks 8 weeks

10. 6 months 1 yr

11. 1 yr

12. Postop 2 yr

13. Postop 3 yr

15. Open Reduction & VDRO Age 3

16. Postop 6 mo Postop 1 yr (Night abduction brace for 2 yrs)

17. Postop 1 yr (age 4)

18. Postop 2 yr (age 5)

20. Postop 3 yr (age 6)

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

22. Postop 4 yr (Age 7)

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

24. 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

25. Prematurity Low birth weight infant (7-8%) < 2500 g Very low birth weight infant 1000 -1500g Extremely low birth weight infant < 1000g Discussion

26. 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

27. 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