Madan Juliette C, Kendrick Douglas, Hagadorn James I, Frantz Ivan D
aDivision of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA 02111, USA.
Pediatrics. 2009 Feb;123(2):674-81. doi: 10.1542/peds.2007-2781.
OBJECTIVE: The purpose of this work was to evaluate therapy for patent ductus arteriosus as a risk factor for death or neurodevelopmental impairment at 18 to 22 months, bronchopulmonary dysplasia, or necrotizing enterocolitis in extremely low birth weight infants. METHODS: We studied infants in the National Institute of Child Health and Human Development Neonatal Research Network Generic Data Base born between 2000 and 2004 at 23 to 28 weeks' gestation and at <1000-g birth weight with patent ductus arteriosus. Patent ductus arteriosus therapy was evaluated as a risk factor for outcomes in bivariable and multivariable analyses. RESULTS: Treatment for subjects with patent ductus arteriosus (n = 2838) included 403 receiving supportive treatment only, 1525 treated with indomethacin only, 775 with indomethacin followed by secondary surgical closure, and 135 treated with primary surgery. Patients who received supportive therapy for patent ductus arteriosus did not differ from subjects treated with indomethacin only for any of the outcomes of interest. Compared with indomethacin treatment only, patients undergoing primary or secondary surgery were smaller and more premature. When compared with indomethacin alone, primary surgery was associated with increased adjusted odds for neurodevelopmental impairment and bronchopulmonary dysplasia in multivariable logistic regression. Secondary surgical closure was associated with increased odds for neurodevelopmental impairment and increased adjusted odds for bronchopulmonary dysplasia but decreased adjusted odds for death. Risk of necrotizing enterocolitis did not differ among treatments. Indomethacin prophylaxis did not significantly modify these results. CONCLUSIONS: Our results suggest that infants treated with primary or secondary surgery for patent ductus arteriosus may be at increased risk for poor short- and long-term outcomes compared with those treated with indomethacin. Prophylaxis with indomethacin in the first 24 hours of life did not modify the subsequent outcomes of patent ductus arteriosus therapy.
目的：本研究旨在评估动脉导管未闭的治疗方法对极低出生体重儿在18至22个月时死亡或神经发育障碍、支气管肺发育不良或坏死性小肠结肠炎等危险因素的影响。 方法：我们研究了2000年至2004年在国立儿童健康与人类发展研究所新生儿研究网络通用数据库中出生的妊娠23至28周、出生体重<1000克且患有动脉导管未闭的婴儿。在双变量和多变量分析中，将动脉导管未闭的治疗方法作为结局的危险因素进行评估。 结果：动脉导管未闭患者（n = 2838）的治疗方法包括仅403例接受支持性治疗，1525例仅接受吲哚美辛治疗，775例先接受吲哚美辛治疗后进行二期手术闭合，135例接受一期手术治疗。接受动脉导管未闭支持性治疗的患者与仅接受吲哚美辛治疗的患者在任何感兴趣的结局方面均无差异。与仅接受吲哚美辛治疗相比，接受一期或二期手术的患者体型更小且早产程度更高。在多变量逻辑回归分析中，与单独使用吲哚美辛相比，一期手术与神经发育障碍和支气管肺发育不良的调整后比值增加相关。二期手术闭合与神经发育障碍的比值增加以及支气管肺发育不良的调整后比值增加相关，但死亡的调整后比值降低。不同治疗方法之间坏死性小肠结肠炎的风险无差异。吲哚美辛预防性用药并未显著改变这些结果。 结论：我们的结果表明，与接受吲哚美辛治疗的婴儿相比，接受动脉导管未闭一期或二期手术治疗的婴儿短期和长期预后不良的风险可能增加。出生后24小时内使用吲哚美辛预防性用药并未改变动脉导管未闭治疗的后续结局。
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