Clinical study on morbidity and mortality rate in newborns born to mothers with premature rupture of membrane

의학과/석사[한글] 신생아이환과 사망의 주요원인 중의 하나인 조기양막파수는 미숙아 및 신생아패혈증등 심각한 합병증을 초래하게된다. 저자는 1981년부터 1983년까지 3년동안 연세의대 세브란스병원에서 출생한 신생아의 병상일지를 분석하여 조기양막파수 산모에서 출생한 신생아 (시험군) 997례와, 조기양막파수가 없는 산모에서 출생한 신생아(대조군) 5,552례를 대상으로 성별, 성숙도별, 파수시간별로 신생아이환 (패혈증,가사(價死), 유리질막증) 률과 신생아사망률을 비교연구하여 다음과 같은 결과를 얻었다. 1) 조기파수의 발생빈도는 15.2%이며, 이환률중 패혈증은 5.4%, 가사는 9.5% 그리고 유리질막증은 0.8% 이었다. 2) 성별 이환률은 양군 모두에서 패혈증과 유리질막증은 남아가 높았으나, 가사는 차이가 없었다. 3) 성숙도별 이환률중 패혈증의 발생빈도는 시험군이 대조군보다 3배이상이었고, 미숙아뿐만 아니라 만삭아에서도 약3배이었다. 신생아가사는 시험군이 대조군보다 1.6배 이었고, 대조군의 미숙아가 만삭아보다 6배이상, 시험군에서 3.6배를 보였으나, 양군의 미숙아간에서는 차이가 없었다. 유리질막증은 대조군이 시험군보다 오히려 1.6배 많았고, 양군모두 미숙아에서 대부분 발생하였으며, 대조군의 미숙아에서 시험군의 3배이상 이었다. 신생아사망의 빈도는 시험군이 대조군의 2.3배 이었으며, 시험군의 미숙아는 1.2배 이었고, 대조군의 만삭아는 1.5배 이었으며, 양군의 대조군에서 미숙아사망률은 만삭아의 25배, 시험군에서는 45배 이었다. 4) 시힘군에서 양막파수시간별 신생아사망, 패혈증 및 가사의 발생빈도는 파수시간이 길수록 증가하였고, 미숙아 뿐만 아니라 만삭아에서도 같은 경향을 보였으며, 특히 파수후 24시간이후면 이전보다 3∼4배 높았으나, 유리질막증은 오히며 감소하였다. 5) 원인균별로는 양군의 만삭아에서 포도상구균이 많았고, 미숙아에서는 그람음성간균이 많았다. 양막파수후 24시간이후면 신생아패혈증·가사 및 사망률이 증가하므로 이러한 상태에서 출생한 신생아의 사망률을 저하시키기 위하여 적절한 소생술을 시행하고 초기에 항생제를 투여하여야할 것으로 결론을 얻었다. [영문] There are many important etiologies concerned with the morbidity and mortality rate in newborns of which premature rupture of membrane in pregnant women is common. Newborns born to these women may incur serious complications such as prematurity and sepsis . The author has reviewed and analyzed the clinical charts of 6.549 newborns and pregnant women at the Yonsei University College of Medicine affiliated Severance Hospital in the threeyear period from 1981 to 1983. 997 newborns born to mothers who had premature rupture of mem-brane (study group) and 5,552 newborns born to mothers without premature rupture of membrane (control group) were analysed by sex and maturity and compared for neonatal morbidity and mortality rates due to sepsis, asphyxia and RDS; and the duration of ruptured membrane in relation to morbidity and mortality due to sepsis, asphyxia and RDS. The following results were obtained . 1) Incidence of study group was 15.2% and morbidity incidence was 5.4% due to sepsis, 9.5% due to asphyxia and 0.8% due to RDS. 2) Higher male newborn morbidity for both groups in the case of sepsis and RDS with no sex preference in the case of neonatal asphyxia. 3) Morbidity incidence was more than 3 times higher in the study group with a 3 times higher incidence for premature and mature newborns in the study group. The incidence for neonatal asphyxia was 1.6 times higher in the study group with similar results for full -term newborns. The premature/mature ratio was above 6 in the control group and 3.6 times higher in the study group with no attributence to prematurity in both groups. to prematurity in both groups. On the other hand, the incideutable of RDS(mostly in premature for both groups) was 1.6 times higher in the control group with a 3 times higher incidence among premature newborns in the control group. The neonatal mortality rate was 2.3 times higher in the study group. 1.2 times higher among premature newborns in the study group and 1.5 times higher in mature newborns in the control group. Premature newborns and compared to full-term newborns for both control and study group were 25 times and 45 times higher, respectively 4) In the study group, the incidence of neonatal mortality with respect to duration of ruptured membrane and morbidity due to sepsis and neonatal asphyxia were higher with increasing duration of ruptured membrane . Similar results were obtained for the premature and full-term newborns especially when the duration of ruptured membrane was more than 24 hours (3-4 times higher than ruptured membrane of less than ??hours) how ever, decrease was noted in the cases of RDS. 5) With respect to etiological bacteria, Staphylococci were higher in full -term newborns while Gram negative bacilli were higher among the premature newborns. When the duration of ruptured membrane exeeds 24 hours, the incidence of neonatal sepsis, asphyxia and mortality are increased; therefore, ill newborns of premature rupture of membrane, initial antibiotics and other appropriate management can most likely reduce the neonatal mortality rate .restrictio