极低出生体重儿动脉导管未闭手术闭合后的神经感觉障碍：早产儿吲哚美辛预防试验的结果

Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms.

作者信息

Kabra Nandkishor S, Schmidt Barbara, Roberts Robin S, Doyle Lex W, Papile Luann, Fanaroff Avroy

机构信息

Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

出版信息

J Pediatr. 2007 Mar;150(3):229-34, 234.e1. doi: 10.1016/j.jpeds.2006.11.039.

DOI:10.1016/j.jpeds.2006.11.039

PMID:17307535

Abstract

OBJECTIVES

To determine whether surgical closure of a patent ductus arteriosus (PDA) is a risk factor for bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP), and neurosensory impairment in extremely low birth weight (ELBW) infants.

STUDY DESIGN

We studied 426 infants with a symptomatic PDA, 110 of whom underwent PDA ligation and 316 of whom received medical therapy only. All infants participated in the multicenter Trial of Indomethacin Prophylaxis in Preterms (TIPP) and were observed to a corrected age of 18 months.

RESULTS

Of the 95 infants who survived after PDA ligation, 50 (53%) had neurosensory impairment, compared with 84 of the 245 infants (34%) who survived after receiving only medical therapy (adjusted odds ratio, 1.98; 95% CI, 1.18-3.30; P = .0093). BPD (adjusted odds ratio, 1.81; 95% CI, 1.09-3.03; P = .023) and severe ROP (adjusted odds ratio, 2.20; 95% CI, 1.19-4.07; P = .012) were also more common after surgical PDA closure.

CONCLUSIONS

PDA ligation may be associated with increased risks of BPD, severe ROP, and neurosensory impairment in ELBW infants.

摘要

目的

确定动脉导管未闭（PDA）手术闭合是否为极早产儿（ELBW）发生支气管肺发育不良（BPD）、重度早产儿视网膜病变（ROP）及神经感觉功能障碍的危险因素。

研究设计

我们研究了426例有症状性PDA的婴儿，其中110例行PDA结扎术，316例仅接受药物治疗。所有婴儿均参与了早产儿吲哚美辛预防多中心试验（TIPP），并观察至矫正年龄18个月。

结果

PDA结扎术后存活的95例婴儿中，50例（53%）有神经感觉功能障碍，而仅接受药物治疗后存活的245例婴儿中有84例（34%）出现此情况（校正比值比为1.98；95%可信区间为1.18 - 3.30；P = 0.0093）。手术闭合PDA后，BPD（校正比值比为1.81；95%可信区间为1.09 - 3.03；P = 0.023）和重度ROP（校正比值比为2.20；95%可信区间为1.19 - 4.07；P = 0.012）也更常见。