日本未熟児新生児学会雑誌　第23巻　第1号　83～87頁（2011年）

日本未熟児新生児学会雑誌　23(1)：83-87；2011　

受付日：平成22．02．15

受理日：平成22．07．15

極低出生体重児で出生した21トリソミーの臨床的検討

Clinical Characteristics of Very Low Birth Weight Infants with Trisomy 21

日本赤十字社医療センター　新生児科

Department of Neonatology, Japanese Red Cross Medical Center

熊坂　栄・与田仁志・石田史彦・溝上雅恵・兒玉祥彦・斉藤敬子・竹田知洋・川上　義

Sakae KUMASAKA，Hitoshi YODA，Fumihiko ISHIDA，Masae MIZOGAMI，Hirohiko KODAMA，Keiko SAITO，Tomohiro TAKEDA，Tadashi KAWAKAMI

Key Words：chromosomal abnormalities，trisomy21，Down syndrome，very low birth weight，congenital heart disease

　1994年から2008年に日本赤十字社医療センター新生児科に入院した21トリソミーの極低出生体重児（VLBW）10例を，臨床的特異性を調べるため後方視的に検討した。対象例の在胎週数は34（27～36）週，出生体重は1,192（702～1,498）g，9例が帝王切開で，このうち6例は胎児適応によるものであった。合併症は，心疾患9例，血液疾患4例，呼吸器疾患2例，頭蓋内疾患2例，消化器疾患2例であった。合併心疾患の内訳は，動脈管開存（PDA）8例，心室中隔欠損4例，房室中隔欠損3例，大動脈縮窄1例，肺動脈弁狭窄2例で，4例に手術を施行した。また，同期間に当院へ入院した正常体重の21トリソミー児との比較検討を行った。帝王切開例，人工呼吸管理例，PDA治療例，心臓手術例はVLBWで有意に多く，Apgar Score 1分値は有意に低かった。心疾患合併例，死亡率に有意差は認めなかった。未熟児特有の病態に加えて心疾患の合併で呼吸循環管理に難渋しており，治療の困難さはより増強していると認識することが重要であると考えられた。

　Ten very low birth weight（VLBW）infants with trisomy 21 who were admitted to our hospital from 1994 to 2008 （median gestational age：34 weeks, range 27-36 weeks；median birth weight：1,192g, range 702-1,498g）were reviewed. Caesarean sections were performed in nine cases, six due to the infant’s condition. The infants’ complications included： heart disease in nine, blood disease in four, pulmonary disease in two, brain disease in two, and gastrointestinal tract disease in one. Heart disease included：patent ductus arteriosus（PDA）in eight, ventricular septal defect in three, coarctation of the aorta in one, and pulmonary stenosis in one. Four infants underwent cardiac surgery.
　The clinical characteristics of the VLBW infants and normal birth weight infants with trisomy 21 who were admitted to our hospital during the same period were compared. The rates of Caesarean section, mechanical ventilation, PDA treatment, and cardiac operations were significantly higher and 1-minute Apgar Scores were lower in VLBW infants than in normal birth weight infants. The rate of heart disease and the survival rate did not differ.
　The present findings emphasize the importance of the proper assessment of heart disease in VLBW infants with trisomy 21, which, in addition to the particular complications attributed to prematurity, makes the management of respiration and circulation more challenging.