日本新生児成育医学会雑誌　第28巻　第1号　39 ～ 46頁（2016年）

日本新生児成育医学会雑誌 28(1)：39-46；2016　

受付日：平成26．07．10

受理日：平成27．07．08

極低出生体重児における慢性肺疾患の重症度と3 歳時の成長発達予後の関連

Severity of Chronic Lung Disease and Growth and Developmental Outcomes in Birth Weight at 3 Years of Age

自治医科大学　小児科学

Department of Pediatrics, Jichi Medical University

鈴木由芽・河野由美・渡邉知佳・下澤弘憲・俣野美雪・小池泰敬・矢田ゆかり

Yume SUZUKI，Yumi KONO，Chika WATANABE，Hironori SHIMOZAWA，Miyuki MATANO，Yasunori KOIKE，Yukari YADA

Key Words：chronic lung disease（CLD），VLBW，home oxygen therapy，follow-up

　当院に入院した慢性肺疾患（chronic lung disease：CLD）を合併した極低出生体重児で，脳性麻痺，視覚・聴覚障害例を除き，新版K 式発達検査を施行した69 例を対象とし，CLD の重症度と3 歳時の成長発達予後を後方視的に検討した。National Institutes of Health consensus definition の重症度分類（NIH 重症度分類）に基づき軽症群21 例，中等症群12 例，重症群36 例に分類された。在宅酸素療法（home oxygen therapy：HOT）は8 例に導入され全例重症群であった。周産期要因を調整した重回帰分析では，NIH 重症度分類に基づくCLD 重症度は，3 歳時の体重，身長のSD スコアとの関連は有意ではなく，姿勢・運動領域DQ 値と有意に関連し重症群でDQ 値の低下を認めた。全領域DQ 値はCLD 重症度との関連は有意ではなく，退院時のHOT 導入の有無と有意に関連しHOTありでDQ 値の低下を認めた。

　We retrospectively analyzed the relationship between severity of chronic lung disease （CLD） and growth and developmental outcomes at 3 years of age. The severity of CLD was categorized based on the National Institutes of Health（NIH）consensus definition. Excluding patients with cerebral palsy and visual and auditory disorders, a total of 69 subjects were diagnosed with CLD and developmental outcome was measured using the Kyoto scale of psychological development（KSPD） test at 3 years of corrected age. The numbers classified as mild, moderate and severe CLD were 21（30.4％）, 12（17.4％） and 36（52.2％）, respectively. Eight（11.6％） infants required home oxygen therapy （HOT） and all were in the severe CLD group. Multiple regression analyses showed no significant correlations between the average of the standard deviation score for body weight and height at 3 years of corrected age and the severity of CLD according to the NIH consensus definition. A significant association was found between the developmental quotient（DQ） score in the posture-motor area and the severe CLD group. The calculated partial regression coefficient（95％ confidence interval） for the severe CLD group was －6.73（－13.16 to －0.30）. Although there were no significant correlations between total DQ score for KSPD at 3 years of corrected age and severity of CLD according to the NIH consensus definition, a significant association was found between total DQ score and requirements for HOT. The calculated partial regression coefficient（ 95％ confidence interval） for the HOT requirement was －7.88（－12.73 to －3.04）.