Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia.
J Pediatr. 2009 Dec;155(6):819-822.e1. doi: 10.1016/j.jpeds.2009.06.013. Epub 2009 Jul 29.
To determine whether the duration of indomethacin administration could be shortened in infants with good early constrictive response of patent ductus arteriosus (PDA).
Infants born at< 30 weeks' gestational age were assessed with echocardiography in the first 12 hours of life and treated with indomethacin (0.1 mg/kg) if the PDA was >2 mm in diameter. Randomization occurred before the second dose to either standard treatment (2 more doses of indomethacin at 0.1 mg/kg irrespective of echocardiographic findings) or to echocardiographically directed duration of indomethacin treatment (ECHO; further doses only if the PDA was>1.6 mm). Serial echocardiography was performed to day 28 of age. The primary outcome was failure of PDA closure.
The infants were randomized to either the ECHO arm (n=34) or the standard treatment arm (n=40). No differences between the arms were seen in terms of failure of PDA closure, PDA reopening, need for further doses of indomethacin, or need for surgical ligation. More doses of indomethacin were given in the standard treatment arm (median, 3 doses [range, 1 to 12] vs 1 dose [range, 1 to 15]; P < .0001).
Echocardiographically directed duration of indomethacin treatment is effective in achieving PDA closure and offers the potential for dose minimization.
确定吲哚美辛治疗早产儿动脉导管未闭（PDA）的时间能否缩短。
<30 周胎龄的新生儿在生命的前 12 小时内进行超声心动图评估，如果 PDA 直径>2mm，则给予吲哚美辛（0.1mg/kg）治疗。在第二次剂量前进行随机分组，分为标准治疗组（不论超声心动图结果如何，均给予 2 次 0.1mg/kg 的吲哚美辛治疗）或超声心动图指导的吲哚美辛治疗时间组（ECHO；仅在 PDA>1.6mm 时给予进一步剂量）。至 28 天龄时进行连续超声心动图检查。主要结局是 PDA 关闭失败。
婴儿被随机分配到 ECHO 臂（n=34）或标准治疗臂（n=40）。在 PDA 关闭失败、PDA 再开放、需要进一步剂量的吲哚美辛或需要手术结扎方面，两组之间没有差异。标准治疗组给予更多剂量的吲哚美辛（中位数 3 剂[范围 1 至 12]比 1 剂[范围 1 至 15]；P<0.0001）。
超声心动图指导的吲哚美辛治疗时间可有效实现 PDA 关闭，并有可能减少剂量。
