Chorne Nancy, Leonard Carol, Piecuch Robert, Clyman Ronald I
Department of Pediatrics, University of California, San Francisco, CA, USA.
Pediatrics. 2007 Jun;119(6):1165-74. doi: 10.1542/peds.2006-3124.
The purpose of this work was to determine whether the reported association between neonatal morbidities and a patent ductus arteriosus is because of the left-to-right patent ductus arteriosus shunt itself, the therapies used to treat it, or the immaturity of the infants who are likely to develop a patent ductus arteriosus.
A total of 446 infants (<28 weeks' gestation) were treated with the same patent ductus arteriosus care-oriented protocol, and logistic regression analysis was used to examine the effects of several patent ductus arteriosus-related variables (presence of a symptomatic patent ductus arteriosus, the number of indomethacin doses used, the ductus response to indomethacin, and the use of surgical ligation) on the incidence of retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment.
Most of the predictive effects that the presence of a patent ductus arteriosus and its treatment had on neonatal morbidity could be accounted for by the infants' immature gestation. Use of surgical ligation, however, was significantly associated with the development of chronic lung disease and was independent of immature gestation, other patent ductus arteriosus-related variables, or other perinatal and neonatal risk factors known to be associated with chronic lung disease.
These findings add to the growing uncertainty about the benefits and risks of surgical ligation during the neonatal period.
本研究旨在确定所报道的新生儿发病率与动脉导管未闭之间的关联是由于动脉导管未闭的左向右分流本身、用于治疗它的疗法，还是可能发生动脉导管未闭的婴儿的不成熟。
总共446例孕周小于28周的婴儿接受了相同的以动脉导管未闭护理为导向的方案治疗，并使用逻辑回归分析来检验几个与动脉导管未闭相关的变量（有症状的动脉导管未闭的存在、吲哚美辛的使用剂量、导管对吲哚美辛的反应以及手术结扎的使用）对早产儿视网膜病变、坏死性小肠结肠炎、慢性肺病、死亡和神经发育障碍发生率的影响。
动脉导管未闭的存在及其治疗对新生儿发病率的大多数预测作用可由婴儿的不成熟孕周来解释。然而，手术结扎的使用与慢性肺病的发生显著相关，并且独立于不成熟孕周、其他与动脉导管未闭相关的变量或已知与慢性肺病相关的其他围产期和新生儿风险因素。
这些发现增加了新生儿期手术结扎的益处和风险方面日益增加的不确定性。
