Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

우리나라 신생아의 재태 연령에 따른 출생체중의 정상치 : Finite Mixture Model을 이용하여

Birth Weight Distribution by Gestational Age in Korean Population : Using Finite Mixture Modle

  • 이정주 (울산대학교 의과대학 강릉아산병원 소아과) ;
  • 박창기 (시카고대학병원 소아과) ;
  • 이광선 (시카고대학병원 소아과)
  • Lee, Jung-Ju (Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital) ;
  • Park, Chang Gi (Section of Neonatology, Department of Pediatrics, University of Chicago) ;
  • Lee, Kwang-Sun (Section of Neonatology, Department of Pediatrics, University of Chicago)
  • 투고 : 2005.06.01
  • 심사 : 2005.08.09
  • 발행 : 2005.11.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 재태 연령에 따른 신생아 출생체중의 정상치를 아는 것은 자궁내 발육부전과 과출생 체중아를 진단하여 의사들은 고위험 신생아를 조기에 진단하고 치료하여 이들의 유병률과 사망률을 줄일 수 있고, 의료정책 입안자들은 이들에 대한 적절한 의료서비스의 개발과 건강관리 프로그램을 개발하고 시행하는데 도움을 줄 수 있다. 이에 저자들은 우리나라의 재태 연령에 따른 출생체중의 기준치를 구하고자 본 연구를 시행하였다. 방 법 : 2001년 1월 1일부터 2003년 12월 31일까지 3년간 통계청의 인구동태자료 중 출생 자료에 기록되어 있는 1,552,375명 중 재태 연령이 24주에서 44주 사이의 단태아 1,509,763명을 대상으로 재태 연령에 따른 평균값과 표준편차를 구하고 10, 25, 50, 75, 90 백분위수를 구하였다. 또한 각 재태 연령별 분포곡선이 정규분포를 따르는지 알아보았다. 이중 정규분포를 따르지 않거나 쌍봉형을 나타내는 재태 연령에서 유한 혼합 모델을 이용하여 오류의 값을 제거하고 다시 평균과 표준편차 그리고 10, 25, 50, 75, 90 백분위수를 구하고 이에 따른 곡선을 그렸다. 결 과 : 원시자료를 통해 얻은 재태 연령에 따른 출생체중 곡선은 27주에서 32주 사이에 심한 혹이 나타난다. 이에 따라 재태 연령별 출생체중의 분포를 그렸을 때 24주에서 27주까지는 우측으로 긴 꼬리를 가지는 치우친 곡선을 보였고 28주에서 32주까지는 상봉형의 곡선을 보였다. 그리고 그 이후에는 거의 정규 분포를 따르는 곡선을 보였다. 이는 33주 미만에서 재태 연령의 기록에 오류가 있음을 나타내는 것으로 저자들은 유한 혼합 모델을 이용해서 재태 연령별 출생체중 분포를 분석한 후 오류의 부분을 제거 후 재태 연령에 따른 출생체중 곡선을 완성하였다. 이렇게 완성된 출생체중 곡선은 Lubchenco 등의 결과에 비해 10 백분위수에서 높은 값을 보였고 노르웨이나 북미의 연구 결과에 비해서는 전반적으로 낮은 값을 보였다. 결 론 : 본 연구에서 얻은 재태 연령에 의한 출생체중의 기준치와 곡선은 3년간 우리나라의 출생아 전수를 대상으로 오류를 객관적인 기준에 의해 제거하여 만든 것이다. 그러므로 우리나라를 대표하난 신생아의 재태 연령에 의한 출생체중의 기준 및 자궁내 발육부전이나 과출생 체중아의 진단의 기준으로 사용 할 수 있으리라 생각된다.

Purpose : A universal standard of the birth weight for gestational age cannot be made since girth weight distribution varies with race and other sociodemographic factors. This report aims to establish the birth weight distribution curve by gestational age, specific for Korean live births. Methods : We used the national birth certificate data of all live births in Korea from January 2001 to December 2003; for live births with gestational ages 24 weeks to 44 weeks(n=1,509,763), we obtained mean birth weigh, standard deviation and 10th, 25th, 50th, 75th and 90th percentile values for each gestational age group by one week increment. Then, we investigated the birth weight distribution of each gestational age group by the normal Gaussian model. To establish final standard values of Korean birth weight distribution by gestational age, we used the finite mixture model to eliminate erroneous birth slights for respective gestational ages. Results : For gestational ages 28 weeks 32 weeks, birth weight distribution showed a biologically implausible skewed tail or bimodal distribution. Following correction of the erroneous distribution by using the finite mixture model, the constructed curve of birth weight distribution was compared to those of other studies. The Korean birth weight percentile values were generally lower than those for Norwegians and North Americans, particularly after 37 weeks of gestation. The Korean curve was similar to that of Lubchenco both 50th and 90th percentiles, but generally the Korean curve had higher 10th percentile values. Conclusion : This birth weight distribution curve by gestational age is based on the most recent and the national population data compared to previous studies in Korea. We hope that for Korean infants, this curve will help clinicians in defining and managing the large for gestational age infants and also for infants with intrauterine growth retardation.

키워드

참고문헌

  1. Eisner V, Brazie JV, Patt MW, Hexter AC. The risk of low birth weight. Am J Public Health 1979;69:887-93 https://doi.org/10.2105/AJPH.69.9.887
  2. Goldenberg RL, Cutter GR, Hoffmann HJ, Foster JM, Melson KG, Hauth JC. Intrauterine growth retardation : Standard for diagnosis. Am J Obstet Gynecol 1998;161:271-7
  3. Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963:32:793-800
  4. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996;87:163-8 https://doi.org/10.1016/0029-7844(95)00386-X
  5. Zhang J, Bowes WA Jr. Birth-weight-for-gestational-age patterns by race, sex, and parity in the United States population. Obstet Gynecol 1995;86:200-8 https://doi.org/10.1016/0029-7844(95)00142-E
  6. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abahamowicz M, et al. A new and improved populationbased canadian reference for birth Weight for gestational age. Pediatrics 2001;108:e35 https://doi.org/10.1542/peds.108.2.e35
  7. Gruenwald P. Growth of the human fetus. 1. Normal growth and its variation. Am J Obstet Gynecol 1966;94: 1112-9
  8. Skjaerven R, Gjessing HK, Bakketig LS. Birth weight by gestational age in Norway. Acta Obstet Gynecol Scand 2000:440-9
  9. Tentoni S, Astolfi P, Pasquale AD, Zonta LA. Birth weight by gestational age in preterm babies according to a Gaussian mixture model. BJOG 2004;111:31-7 https://doi.org/10.1046/j.1471-0528.2003.00006.x
  10. Fok TF, So HK, Wong E, Ng PC, Chang A, Lau J, et al. Updated gestational age specific birth weight, crown-heel length, and head circumference of Chinese newborns. Arch Dis Child Fetal Neonatal Ed 2003;88:F229-36 https://doi.org/10.1136/fn.88.3.F229
  11. Shin SM, Chang YP, Lee ES, Lee YA, Son DW, Kim MH, et al. Low birth weight, very low birth weight rates and gestational age-specific birth weight distribution of Korean newborn infants. J Korean Med Sci 2005;20:182-7 https://doi.org/10.3346/jkms.2005.20.2.182
  12. Lee GH, Kim YW, Lee KB, Seo EJ, Son MS, Ahn HG, et al. Change of birth weight-gestational age table. Korean J Obstet Gynecol 2001;44:1851-6
  13. Baek MK, Ahn HI, Hwang YH, Seo SS. Consideration of birth weight by gestational age. Korean J Obstet Gynecol 1998;41:1882-8
  14. Kim SK, Chung TH, Lee K, Cho DJ, Lee YH. Fetal growth in weight as estimated from normal single livebirths between 27 to 43 weeks gestation. Korean J Obstet Gynecol 1993;36:1127-324
  15. Kim KY, Seo JS, Lee EG, Cho YK, Choi H, Kim BR, et al. A study on birth weight of newborn infants for gestational age. Inje Medical J 1993;14:393-9
  16. Park NH, Yoon BH, Shin HC, Kim SW. Growth pattern of the newborn infants by gestational age. Korean J Obstet Gynecol 1991;34:322-30
  17. Kim HS, Park JH, Cho YK, Kim YB, Park SK. A Study on fetal growth for gestational age. Korean J Obstet Gynecol 1991;34:192-7
  18. Jung GY, Lee K. Intrauterine growth of Korean infants from 25 weeks to 44 weeks gestation. J Korean Pediatr Soc 1990;33:887-99
  19. Seo K, Park YW, Park TK. Birthweight distribution by gestational age and construction cut-off value for fetal growth retardation(FGR) : their statistical consideration. Korean J Obstet Gynecol 1989;32:530-40
  20. Kim YH, Han DG. A study on intrauterine growth standard. J Korean Pediatr Soc 1984;27-531-42
  21. Shin YW, Key YS, Kim SW, Moon H, Kim DS. Nomogram of the anthropometric measurement in Korean newborn infants. Korean J Obstet Gynecol 1983;25:667-78
  22. Park JY, Kim JG, Lee K. Estimation of fetal growth by measurement of birth weight for gestational age in newborn. J Korean Pediatr Soc 1982;25:649-55
  23. Hong JS. A Study on mortality level of newborns and birthwight by gestational age : Based on intrauterine growth percentile curve in Korean 1999 birth cohort(thesis). Seoul : Univ. of Yonsei, 2003
  24. Nam CH, Park SH. A study on the birth weight using vital statistics in Korea. J Kyeung San Univ 1990;13:77-85
  25. Lee SB, Yoon BJ. Effects of demographic variables on birthweight. J Institute Hlth Environ Sci 1997;7:26-35
  26. Usher R, McLean F. Intrauterine growth of live-born Caucasian infants at sea level : standards obtained from measurements in 7 dimensions of infants born between 25-44 weeks of gestation. Pediatrics 1969:74:901-10 https://doi.org/10.1016/S0022-3476(69)80224-6
  27. David RJ. Population-based intrauterine growth curves from computerized birth certificates. South Med J 1983;76: 1401-6 https://doi.org/10.1097/00007611-198311000-00020
  28. Platt RW, Abrahamowicz M, Kramer MS, Joseph KS, Mery L, Blondel B, et al. Detecting and eliminating erroneous gestational ages : a normal mixture model. Statist Med 2001;20:3491-503 https://doi.org/10.1002/sim.1095
  29. Oja H, Koiranen M, Rantaallio P. Fitting mixture models to birth weight data : A case study. Biometrics 1991;47:883-97 https://doi.org/10.2307/2532646
  30. Alexander GR, Kogan M, Bader D, Carlo W, Allen M, Mor J. US birth weight/gestational age-specific neonatal mortality : 1995-1997 rate for Whites, Hispanics, and Blacks. Pediatrics 2003;111:e61-6
  31. Arbuckle TE, Wilkins R, Sherman GJ. Birth weight percentiles by gestational age in Canada. Obstet Gynecol 1993; 81:39-48
  32. Seeds JW, Peng T. Impaired growth and risk of fetal death : is the tenth percentile the appropriate standard? Am J Obstet Gynecol 1998;178:658-69 https://doi.org/10.1016/S0002-9378(98)70475-2
  33. Williams RL, Creasy RK, Cunningham GC, Hawes WE, Norris FD, Tashiro M. Fetal growth and perinatal viability in California. Obstet Gynecol 1982;59:624-32
  34. Joseph KS, Kramer MS, Allen AC, Mery LS, Platt RW, Wen SW. Implausible birth weight for gestational age. Am J Epidemiol 2001;153:110-3 https://doi.org/10.1093/aje/153.2.110
  35. McLachlan GJ. Peel. Finite mixture models. New York, NY : Wiley, 2000
  36. Fryer JG, Hunt RG, Simon AM. Biostatistical considerations : The case on using models. Child Health 1984;3:9-30
  37. STAT/SE 8.0 for Windows(April 2003) Stata corporation college station, Texas
  38. Yip R, Li Z, Chong WH. Race and birth weight : The Chinese example. Pediatrics 1991;87:688-93
  39. Singh GK, Yu SM. Birth weight differential among Asian Americans. Am J Public Health 1994;84:1444-9 https://doi.org/10.2105/AJPH.84.9.1444
  40. Methodology for Estimating Infant Mortality KIHASA 1995