Kwinta Przemko, Rudziński Andrzej, Kruczek Piotr, Kordon Zbigniew, Pietrzyk Jacek Józef
Department of Pediatrics, Jagiellonian University, Cracow, Poland.
Neonatology. 2009;95(2):141-8. doi: 10.1159/000153098. Epub 2008 Sep 6.
Prophylactic treatment with prostaglandin synthetase inhibitors (PSI) is potentially harmful. Moreover, long-term benefits of prophylactic use of indomethacin or ibuprofen are not proven. Early treatment of a high-risk population is alternative to the routine prophylactic use of PSI, but it remains unclear which newborn is at greatest risk for patent ductus arteriosus (PDA).
Evaluation of the prognostic value of early echocardiographic studies with respect to PDA in later life.
Sixty preterm infants with a mean birth weight of 1,087 g and mean gestational age of 28.5 weeks were included in a prospective study. Cardiac scans were performed in all newborns on entry into the study (within 12-48 h after birth) and further in case of clinical suspicion of PDA or obligatorily on the 7th and 28th days of life. There was no prophylactic or treatment use of any PSI during the study period. Newborns were divided into 2 cohorts: with significant left to right shunt requiring surgical ligation of PDA (n = 16) or without significant PDA during follow-up (control group, n = 44).
On entry, the mean internal diameter of the ductus arteriosus (2.6 vs. 0.91 mm/kg; p < 0.01), mean cardiac index across aortic valve (2.96 vs. 2.37 l/min/m(2); p < 0.01) and early filling peak velocity (43.1 vs. 33.7; p = 0.01) were significantly higher in babies who later needed surgical ligation of PDA. There was no difference in the mean values of the other echocardiographic parameters studied. An early ductal diameter of >1.5 mm/kg predicted symptomatic PDA with a sensitivity of 94% and a specificity of 73%, and its positive predictive value equaled 57% and negative predictive value amounted to 97%.
Early echocardiographic studies possess negative predictive value and may decrease unnecessary surgical ligation of PDA in very low birth weight infants.
使用前列腺素合成酶抑制剂（PSI）进行预防性治疗可能有害。此外，吲哚美辛或布洛芬预防性使用的长期益处尚未得到证实。对高危人群进行早期治疗是常规预防性使用PSI的替代方法，但尚不清楚哪些新生儿患动脉导管未闭（PDA）的风险最大。
评估早期超声心动图检查对PDA在后期生活中的预后价值。
一项前瞻性研究纳入了60例平均出生体重为1087g、平均胎龄为28.5周的早产儿。所有新生儿在进入研究时（出生后12 - 48小时内）进行心脏扫描，若临床怀疑有PDA则进一步扫描，或在出生后第7天和第28天进行强制性扫描。研究期间未预防性或治疗性使用任何PSI。新生儿分为2组：有显著左向右分流需要手术结扎PDA的（n = 16），或随访期间无显著PDA的（对照组，n = 44）。
在进入研究时，后来需要手术结扎PDA的婴儿的动脉导管平均内径（2.6 vs. 0.91 mm/kg；p < 0.01）、经主动脉瓣的平均心脏指数（2.96 vs. 2.37 l/min/m²；p < 0.01）和早期充盈峰值速度（43.1 vs. 33.7；p = 0.01）显著更高。所研究的其他超声心动图参数的平均值无差异。早期导管直径>1.5 mm/kg预测有症状PDA的敏感性为94%，特异性为73%，其阳性预测值为57%，阴性预测值为97%。
早期超声心动图检查具有阴性预测价值，可减少极低出生体重儿不必要的PDA手术结扎。
