吲哚美辛治疗极早产儿动脉导管未闭相关的肾功能损害——治疗开始时的出生后年龄重要吗？

Renal impairment associated with indomethacin treatment for patent ductus arteriosus in extremely preterm neonates--is postnatal age at start of treatment important?

作者信息

Srinivasjois R M, Nathan E A, Doherty D A, Patole S K

机构信息

Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia.

出版信息

J Matern Fetal Neonatal Med. 2006 Dec;19(12):793-9. doi: 10.1080/14767050600922610.

DOI:10.1080/14767050600922610

PMID:17190690

Abstract

OBJECTIVE

To study serum creatinine (SCr) levels following indomethacin for patent ductus arteriosus (PDA) closure in extremely preterm neonates in relation to postnatal age at the start of treatment.

METHODS

This was a retrospective (January 2000-December 2002) analysis of data on preterm neonates (gestation <29 weeks) who received indomethacin for PDA. Pre-existing renal malformation and/or impairment and high serum levels of nephrotoxic drugs were criteria for exclusion.

RESULTS

Indomethacin was commenced at postnatal age <7 days and >or=7 days in 60 (group 1) and 30 (group 2) neonates, respectively. The median (Q1, Q3) gestational age and birth weight for group 1 and group 2 neonates were 25 (23, 27) vs. 25 (24, 26) weeks and 740 (620, 909) vs. 780 (663, 966) grams, respectively. Postnatal age <7 days at start of indomethacin was associated with higher baseline (0.083 (0.074, 0.090) vs. 0.073 (0.054, 0.083) mmol/L, p=0.001) and peak SCr levels (0.099 (0.089,0.109) vs. 0.090 (0.064, 0.104) mmol/L, p=0.015). Logistic regression analysis controlling for gestational age and baseline SCr level indicated that postnatal age >or=7 days was a risk factor for elevated SCr after indomethacin (OR=13.4, 95% CI: 3.8-46.6, p < 0.001).

CONCLUSION

Postnatal age >or=7 days at the start of indomethacin is a predictor of a significant rise in SCr in extremely preterm neonates.

摘要

目的

研究吲哚美辛用于极早产儿动脉导管未闭（PDA）封堵术后血清肌酐（SCr）水平与治疗开始时的出生后年龄之间的关系。

方法

这是一项对接受吲哚美辛治疗PDA的早产儿（孕周<29周）数据的回顾性分析（2000年1月至2002年12月）。排除标准为既往存在肾脏畸形和/或损害以及血清肾毒性药物水平高。

结果

分别有60例（第1组）和30例（第2组）新生儿在出生后<7天和≥7天开始使用吲哚美辛。第1组和第2组新生儿的中位（Q1，Q3）孕周和出生体重分别为25（23，27）周对25（24，26）周以及740（620，909）克对780（663，966）克。吲哚美辛开始时出生后<7天与更高的基线SCr水平（0.083（0.074，0.090）对0.073（0.054，0.083）mmol/L，p = 0.001）和峰值SCr水平（0.099（0.089，0.109）对0.090（0.064，0.104）mmol/L，p = 0.015）相关。控制孕周和基线SCr水平的逻辑回归分析表明，出生后≥7天是吲哚美辛治疗后SCr升高的危险因素（OR = 13.4，95%CI：3.8 - 46.6，p < 0.001）。