초음파를 이용한 분만 체중 백분율과 과체중아의 조기 예측

임영구(Young Goo Lim),김세련(Se Ryun Kim),오관영(Gwan Young Oh),박지현(Jee Hyun Park),노인화(In Hwa Noh),송은섭(Eun Sub Song),임문환(Moon Hwan Lim),이병익(Byung Ik Lee),김종화(Jong Hwa Kim),이우영(Woo Young Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.11

Objective : To evaluate the accuracy of predicted birth weight percentile and large for gestational age(LGA) fetuses by the gestation-adjusted projection method using estimated fetal weight. Methods : From 462 low-risk pregnancies with singleton fetus, fetal biometry including fetal biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC), and femur length(FL) was made from 30 weeks of gestation until term. Estimated fetal weight(EFW) by combinations of fetal biometry were made by Campbell, Hadlock1, Hadlock2, and Shepard formulas respectively. The diagnostic accuracy according to 4 formulas was assessed by correlation between EFW percentile and birth weight percentile, prediction of LGA fetuses, and prediction error(percentile difference between birth weight and EFW). Results : The mean gestational age on ultrasound and on birth, and birth weight were 33.21 ± 2.08(30-40) weeks, 38.43 ± 1.72(30-42) weeks, and 3.14 ± 0.47(0.99-4.38) Kg, respectively. The diagnostic accuracies of gestation-projection method using EFW were similar result to predict birth weight percentile and LGA fetuses according to 4 formulas. Correlation between EFW percentile and birth weight percentile(correlation coefficient, r) were Campbell: 0.644(p〈0.001), Hadlock 1: 0.682(p〈0.001), Hadlock 2: 0.681(p〈0.001), Shepard: 0.638(p〈0.001), respectively. Youden's index(sensitivity + specificity - 1) in prediction of LGA fetuses were Campbell: 0.532, Hadlock1: 0.525, Hadlock2: 0.520, Shepard: 0.549, respectively. Prediction error were Campbell: 18.14±16.56, Hadlock1: 16.19±14.35, Hadlock2: 16.10±14.29, Shepard: 19.68±17.00, respectively. The prediction error was increased according to increasing of lapse time(p〈0.001), gestational weeks on ultrasound, and estimated fetal weight percentile, and decreasing birth weight percentile(p〈0.001)(R square=0.411, p〈0.001). But, amniotic fluid index did not affect to prediction error(p=0.199). Conclusion : Our study presented relatively accurate prediction for birth weight percentile and LGA fetuses from remote sonographic examination. If LGA fetuses was suspected by antenatal ultrasound, adequate therapy and periodic observation are recommended for good perinatal outcome.

Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants

Baldassarre, Maria Elisabetta,Di Mauro, Antonio,Salvatore, Silvia,Tafuri, Silvio,Bianchi, Francesco Paolo,Dattoli, Enzo,Morando, Lucia,Pensabene, Licia,Meneghin, Fabio,Dilillo, Dario,Mancini, Valentin The Korean Society of Pediatric Gastroenterology 2020 Pediatric gastroenterology, hepatology & nutrition Vol.23 No.4

Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants

Maria Elisabetta Baldassarre,Antonio Di Mauro,Silvia Salvatore,Silvio Tafuri,Francesco Paolo Bianchi,Enzo Dattoli,Lucia Morando,Licia Pensabene,Fabio Meneghin,Dario Dilillo,Valentina Mancini,Valentina 대한소아소화기영양학회 2020 Pediatric gastroenterology, hepatology & nutrition Vol.23 No.4

Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10–90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

Delayed diagnosis of gestational diabetes mellitus and perinatal outcomes in women with large for gestational age fetuses during the third trimester

( Jeenah Sohn ),( Hyun Ji Lim ),( Sohee Kim ),( Tae Hun Kim ),( Byoung Jae Kim ),( Kyu Ri Hwang ),( Taek Sang Lee ),( Hye Won Jeon ),( Sun Min Kim ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.5

Objective We evaluated the incidence of newly diagnosed gestational diabetes mellitus (GDM) during the 3rd trimester in women with suspected large for gestational age (LGA) fetuses on ultrasound and assessed their perinatal outcomes. Methods A retrospective cohort study was performed. Singleton pregnant women with suspected LGA on the 3rd trimester ultrasound and whose results of GDM screening at midpregnancy had been normal were enrolled. All participants were retested with 100-g oral glucose tolerance test (OGTT) within 2 days after diagnosis of LGA. We compared perinatal outcomes between the newly diagnosed with GDM group and the non-GDM group. Results Among 169 pregnant women, 13% (23/169) were newly diagnosed with GDM. The women in the GDM group had a higher HbA1c level at diagnosis (5.8 vs. 5.3, P<0.01) and earlier gestational age at delivery (38.0 vs 38.9 weeks of gestation, P=0.003) than those in the non-GDM group. The rate of cesarean delivery (CD) was significantly higher in the GDM group than that in the non-GDM group (73.9%, vs. 49.3%, P=0.028) with similar proportions for the indications of CD except CD on maternal request (CDMR). The CDMR rate was higher in the GDM group than non- GDM group (41.2% vs. 23.6%) but it did not reach statistical significance. There were no significant differences in the obstetrical and neonatal complications between the two groups. Conclusion Among pregnant women with suspected LGA, 13% were newly diagnosed with GDM in late pregnancy. Nonetheless, there were no differences in the perinatal outcomes between women with newly diagnosed GDM and those without GDM. However, concerns over shoulder dystocia appear to increase CD rates in the GDM group.

미숙아, 부당 경량아 및 과체중아에서 생후 2개월까지의 철상태에 관한 연구

윤신원,임인석,김철하,이동근,최응상,유병훈 중앙대학교 의과대학 의과학연구소 1995 中央醫大誌 Vol.20 No.2

The iron status of neonatal perioand shows variable changes dependent upon gestational age and birth weight. In general, compared with TAGA(term appropriate for gestational age), prematurity has been known to have exacerbated from of physiologic anemia and one of the possible contributable factor have been thought to e the lowered iron storage. But the iron status of TSGA(term small for gestational age) and TLGA(term large for gestational age) in early few months of life has not been clearly known yet. The purpose of this study was to compare the changes four groups. The iron status of the newborn was assessed cord blood hemogloin, corrected reticulocyte count, iron, TIBC, ferritin in TAGA(n=20), TSGA(n=11), TLGA(n=22) and prematurity(n=50) that were admitted to the Department of pediatrics, Chung-Ang University Hospital from June 1994 to February 1995. The follow up examinations were performed at 1, 2 months of postnatal period. The results are as follows 1) Mean cord blood hemoglobin levels in TAGA, prematurity, TSGA, TLGA at birth were 15.6±1.4 g/dl, 16.3±1.4 g/dl, 17.8±2.2 g/dl, 16.4±1.5 g/dl. There was statistical significances between TAGA and other three groups(P<0.05). 2) Mean cord blood iron level in TAGA, prematurity, TSGA, TLGA at birth were 229±48㎍/dl, 194±14㎍/dl. But there was no statistical significances. 3) mean cord blood TIBC levels in TAGA, prematurity, TSGA, TLGA at birth were 194±71㎍/dl,, 210±60㎍/dl, 280±80㎍/dl, 304±96㎍/dl. There was statistical significances between TAGA and other three groups(P<0.05). 4) Mean cord blood ferritin levels in TAGA, prematurity, TSGA, TLGA at birth were 170±48㎍/dl, 107±87㎍/dl, 108±68㎍/dl, 170±48㎍/dl. There was statistical significances TAGA and other three groups(P,0.05). 5) As a results of 2 months follow-up examination, the hemoglobin, corrected reticulocyte count, iron, ferritin levels were decreased and TIBC levels were increased in all groups and compared with TAGA, there was significant differences the othere three groups(P<0.05). In conclusion, blood hemoglobin, corrected reticulocyte count, iron, ferritin levels were significantly decreased and TIBC levels were significantly increased not only prematurity but also in TSGA, TLGA, so the marked impaired iron storage was noted in these groups in early few months of life. Further studies need to assess the postnatal affect of prolonged iron redistribution on fetal tissue, to prevent the exacervated form of iron storage and metabolic derangement, we speculate that this particular group of infant may be candidates for early few months of life iron supplementation.

임신성 당뇨병 임신부에서 과체중아의 예측 및 예방

김민형 ( Min Hyoung Kim ) 대한주산의학회 2016 Perinatology Vol.27 No.1

Gestational diabetes mellitus (GDM) is an important disease which complicates pregnant woman and fetus. Large for gestational age (LGA) is one of the primary complications and is closely associated with the hyperglycemia of pregnant woman. Although strict control of blood glucose can decrease the occurrence of LGA, the rate of LGA in GDM pregnancy is higher than that of normal pregnancy. Understanding of the difference of fetal growth between LGA and adequate for gestational age in GDM pregnancy and consideration about the time and marker for prediction and prevention of LGA in GDM pregnancy are helpful for prenatal care of GDM pregnancy. In this article, the prediction and prevention of LGA in GDM pregnancy will be discussed.

당뇨병 산모아에서 출생 체중군에 따른 합병증 및 주산기 인자

손경란,백희조,조창이,최영륜,송태복,박천학,Son, Kyung-Ran,Back, Hee-Jo,Cho, Chang-Yee,Choi, Young-Youn,Song, Tae-Bok,Park, Chun-Hak 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.5

목 적 : 당뇨병 산모의 빈도가 증가함에 따라 이들에서 태어난 신생아에서 거대아, 대사성 합병증, 선천성 기형 및 분만 손상 등의 주산기 유병률이 높아 문제가 되고 있다. 본 연구는 당뇨병 산모아에서 출생 체중에 따른 주산기 합병증 및 주산기 인자에 차이가 있는지 알아보고자 하였다. 방 법: 1996년 1월부터 2002년 3월까지 전남대학교병원에서 입원하였던 단태 임신의 당뇨병 산모와 그 신생아 중, 부당 경량아와 재태 연령 30주 미만의 환아를 제외한 301례를 대상으로 하여 산모에서는 체중과 신장, 분만력, 당화 혈색소치, 당뇨병의 분류 및 치료를, 그리고 신생아에서는 대사성 합병증, 분만 손상 및 심기형을 포함한 선천성 기형에 대해 의무 기록지를 통하여 후향적으로 분석하였으며, 대상아를 부당 중량아군(1군, 162명)과 적정 체중아군(2군, 139명)으로 나누어 합병증 및 주산기 인자의 차이를 조사하였다. 결 과: 대사성 합병증은 저마그네슘혈증(37.5%), 황달(21.3%), 저혈당증(11.0%) 및 저칼슘혈증(7.0%) 순이었으며, 분만 손상은 59명(19.6%), 동반된 선천성 기형은 동맥관 개존을 포함하여 75명(24.9%)이었고 심기형이 가장 많았다. 부당 중량아군(1군)과 적정 체중아군(2군) 두 군간의 주산기 합병증을 비교해 본 결과, 1군에서 2군에 비해 황달의 빈도(27.7% vs. 16.7%, P<0.05)와 저혈당증 빈도(15.6% vs. 7.4%, P=0.02), 빈호흡의 빈도(10.6% vs. 3.6%, P<0.05) 및 분만 손상의 빈도(24.1% vs. 14.5%. P<0.05)가 의의 있게 높았으며, 심실 중격이 두터웠다($5.5{\pm}3.1mm$ vs. $4.7{\pm}1.1mm$, P<0.05). 당뇨병 산모아의 출생 체중에 영향을 줄 수 있는 주산기 인자를 비교해 본 결과, 1군에서 산모의 키와 임신 전 체중 및 임신 기간 중 체중 증가가 의의 있게 컸고(모두 P<0.01), 산모가 임신 기간 동안 임신성 당뇨를 인지하지 못했던 경우가 더 많았다(21.7% vs. 6.6%, P<0.01). 결 론 : 당뇨병 산모아에서 출생 체중군에 따른 주산기 합병증은 부당 중량아군에서 적정 체중아군에 비해 황달, 저혈당증 및 분만 손상의 빈도가 의의 있게 높았고 심실 중격 두께가 두터웠으며, 산모의 키가 더 크고 임신 전 체중 및 임신 기간 동안 체중 증가가 컸으므로, 부당 중량아를 분만할 수 있는 고위험 임산부에 대한 주의 깊은 검사와 관리가 필요하리라 사료된다. Purpose : This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). Methods : Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. Results : Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. Conclusion : In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.

A comparison of post vaccination hepatitis B surface antibody level on the large and appropriate for gestational age infants

Abdoulreza Esteghamati,Shirin Sayyahfar,Hossein Ghaemi,Mohammadamin Joulani,Yousef Moradi,Atefeh Talebi 대한백신학회 2021 Clinical and Experimental Vaccine Research Vol.10 No.1

Purpose: The aim of this study was to compare the hepatitis B surface antibody (HBs Ab) titer 1 month after the 4th dose of hepatitis B vaccine administration on the large and appropriate for gestational age infants. Materials and Methods: This cross-sectional study was conducted on 7-month-old cases (n=132) divided into two groups of 2–4 kg (group 1: appropriate for gestational age, 63 cases) and >4 kg (group 2: large for gestational age, 69 cases), whom were vaccinated with a four-dose schedule of hepatitis B vaccine in 2016, Tehran, Iran. Results: Mean birth weight of the groups was 2.98±0.528 and 4.19±0.190 kg, respectively. Hepatitis B surface antigen and hepatitis B core antibody were negative in all cases. HBs Ab level in group 1 and 2 was 13,701.00±11,744.439 and 8,997.15±2,827.191, respectively (95% confidence interval of difference, -7,607.44 to -1,800.25). There was a significant difference between the two groups in antibody titration and antibody logarithm level (p=0.002, p=0.0001). Conclusion: Birth weight may affect the response to the hepatitis B virus vaccine administration.

신생아 출생체중 결정요인 분석

고경심 ( Kyung Sim Koh ) 대한주산의학회 1997 大韓周産醫學會雜誌 Vol.8 No.2