Neonatal Intensive Care Unit, White Memorial Medical Center, Los Angeles, California, USA.
Am J Perinatol. 2010 Jan;27(1):83-90. doi: 10.1055/s-0029-1239492. Epub 2009 Sep 26.
This study sought to determine whether early treatment of premature infants with ibuprofen would result in a reduced incidence of surgical ligation of patent ductus arteriosus. Secondary outcomes included duration of hospitalization, assisted ventilation and supplemental oxygen, mortality rate, persistent patent ductus arteriosus (PDA), hypotension, intraventricular hemorrhage, and intestinal perforation. Outcomes among 105 very low-birth-weight (VLBW) infants managed by clinical use of indomethacin were compared with outcomes of 80 infants treated under a standardized protocol for ibuprofen therapy on the first day of life among infants <25 weeks estimated gestational age (EGA) and among infants of 25 to 28 weeks EGA with respiratory distress syndrome or history of antenatal steroids. The incidence of PDA ligation was significantly lower among the early ibuprofen group than among the clinical indomethacin group (0/80 versus 9/105, P = 0.0056). No differences were found in secondary outcomes. The effect persisted (P = 0.0100 to 0.0153) when corrected for birth weight, EGA, gender, Apgar scores, initial pH and base deficit, transport from another hospital, surfactant treatment, and need for assisted ventilation. In our neonatal intensive care unit, the incidence of PDA ligation among VLBW infants decreased after adoption of an early ibuprofen treatment protocol.
本研究旨在确定早期使用布洛芬治疗早产儿是否会降低动脉导管未闭（PDA）的手术结扎发生率。次要结局包括住院时间、辅助通气和补充氧气、死亡率、持续性 PDA、低血压、颅内出血和肠穿孔。通过临床使用吲哚美辛治疗的 105 名极低出生体重（VLBW）婴儿的结局与在出生第一天根据标准化布洛芬治疗方案治疗的 80 名婴儿的结局进行了比较，这些婴儿的估计胎龄（EGA）<25 周，有呼吸窘迫综合征或产前类固醇使用史。与临床使用吲哚美辛治疗的婴儿相比，早期使用布洛芬的婴儿 PDA 结扎发生率显著降低（0/80 与 9/105，P = 0.0056）。次要结局无差异。当校正出生体重、EGA、性别、Apgar 评分、初始 pH 值和碱缺失、从其他医院转运、表面活性剂治疗和需要辅助通气后，该效果仍然存在（P = 0.0100 至 0.0153）。在我们的新生儿重症监护病房，采用早期布洛芬治疗方案后，VLBW 婴儿的 PDA 结扎发生率降低。
