日本新生児成育医学会雑誌　第33巻　第3号　79 ～ 86頁（2021年）

日本新生児成育医学会雑誌　33(3)：555-562；2021　

受付日：2020．12．18

受理日：2021．02．17

在胎22 週3 日・体重246g で出生し，通常学級に就学した6 歳男児例

Six-year Developmental Outcome of a Boy Born at 22 Weeks, 3 Days Gestation and 246 g Birth Weight

＊ 1 東京都立墨東病院周産期センター　新生児科，＊ 2 国立病院機構九州医療センター　小児科

＊ 1 Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital，＊ 2 Department of Pediatrics, National Hospital Organization Kyushu Medical Center

九島令子＊ 1・高野由紀子＊ 2・近藤雅楽子＊ 1・大森意索＊ 1

Reiko KUSHIMA ＊ 1，Yukiko TAKANO ＊ 2，Utako KONDO ＊ 1，Isaku OMORI ＊ 1

Key Words：extremely low birth weight infant，birth weight ＜ 250 gram，22 weeks of gestational age， chronic lung disease，developmental outcome

在胎22 週3 日，体重246g で出生した男児の就学までの詳細経過を報告した。母体は36 歳3 産，HELLP 症候群のため緊急帝王切開で出生した。HFO を含む人工呼吸管理94 日間，肺サーファクタント投与12 回，胸腔穿刺，ヒドロコルチゾンの長期・大量投与（日齢14 ～ 131，ヒドロコルチゾン総量173mg/kg）を要した。腸管合併症，重症感染症，頭蓋内出血はなかった。修正3 か月に体重4,602g，在宅酸素で退院し，修正13 か月に在宅酸素を離脱した。体重は3 歳，身長は6 歳で－2SD 内に追いつき，修正1 歳3 か月で独歩と有意語獲得，修正1 歳6 か月の全発達指数（DQ）は90 であった。2 歳頃より自閉スペクトラム症（ASD）特性を認め療育開始したが，発達の伸びに伴い6 歳ではASD の診断基準は満たさなくなった。WISC-Ⅳ検査による全知能指数（IQ）は88 であり，地域小学校の通常学級に就学した。

We report a boy who was born at 22 weeks and 3 days gestation with a birth weight of 246 g. The boy was born to a 36-year-old mother. An emergency caesarean section was performed after a diagnosis of HELLP syndrome. He had severe chronic lung disease, which was challenging to treat. He required 94 days of mechanical ventilation. We gave him long-term administration of hydrocortisone from day 14 to 131, in total 173 mg per kg. He had no complications of sepsis or intracranial hemorrhage. Retinopathy of prematurity required intraocular bevacizumab therapy. He was discharged on low-flow oxygen at 3 months corrected chronological age（ c-CA） with 4,602 g weight. He withdrew from home oxygen at 13 months c-CA. His weight caught up within －2 standard deviations at 3 years of age and height at 6 years. At around 2 years of age, he showed signs of autism spectrum disorder, such as hyperactivity and hypersensitivity to sounds, and therefore intervention was initiated. After entering kindergarten, he gradually gained social skills. His intellectual ability was judged normal, with an IQ score（WISC- Ⅳ）of 88 at 6 years of age. He entered a regular primary school class in the spring of 2020.