重复使用环氧化酶抑制剂未能关闭动脉导管未闭（PDA）是极低出生体重儿（ELBW）发生慢性肺部疾病的危险因素。
Failure of a repeat course of cyclooxygenase inhibitor to close a PDA is a risk factor for developing chronic lung disease in ELBW infants.
机构信息
Mount Sinai Kravis Children's Hospital and Department of Pediatrics, Mount Sinai School of Medicine, One Gustave L, Levy Place, New York, NY 10029-6574, USA.
出版信息
BMC Pediatr. 2012 Jan 27;12:10. doi: 10.1186/1471-2431-12-10.
BACKGROUND
The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. This study was aimed at evaluating the failure rate of a cyclooxygenase (COX) inhibitor (COI) for PDA closure and to determine the incidence of a PDA requiring ligation in ELBW infants. We examined the clinical characteristics and risk factors that may predict the clinical consequences of failure of PDA closure by COI.
METHODS
Medical information on 138 infants with birth weight (BW) < 1000 gm who survived for > 48 hours was retrieved. Clinical characteristics and outcomes of patients whose PDAs closed with COI were compared with those who did not close.
RESULTS
Of the 138 patients, 112 survived to discharge. Eighty (71.4%) of those who survived received 1-3 courses of COI treatment for a symptomatic PDA. A total of 32 (40%) failed COI treatment and underwent PDA ligation. Multivariable logistic regression analysis suggests that the observed differences in the outcomes in infants with or without symptomatic PDA can be explained by the babies with symptomatic PDA being more immature and sicker. No significant difference was seen in the incidence of chronic lung disease (CLD) in infants whose PDA was treated medically versus those who failed medical treatment and then underwent ligation. However, after adjusting for disease severity and other known risk factors, the odds ratio of developing CLD for surviving babies with a persistent PDA compared to those whose PDA was successfully closed with 1-2 courses of COI is 3.24 (1.07-9.81; p = 0.038).
CONCLUSIONS
When successfully treated, PDA in ELBW infants did not contribute significantly to the adverse outcomes such as CLD, retinopathy of prematurity (ROP) and age at discharge. This suggests that it is beneficial for a hemodynamically significant PDA to be closed. The failure of a repeat course of COI to close a PDA is a major risk factor for developing CLD in ELBW infants.
背景
极低出生体重儿（ELBW）持续性动脉导管未闭（PDA）的最佳治疗方案尚未得到很好的确立。本研究旨在评估环氧化酶（COX）抑制剂（COI）用于关闭 PDA 的失败率，并确定 ELBW 婴儿中需要结扎 PDA 的发生率。我们检查了可能预测 COI 关闭失败后临床后果的临床特征和危险因素。
方法
检索了 138 名存活超过 48 小时、出生体重（BW）<1000 克的婴儿的医疗信息。比较了接受 COI 治疗后 PDA 闭合的患者与未闭合的患者的临床特征和结局。
结果
在 138 名患者中，有 112 名存活至出院。其中 80 名（71.4%）存活者接受了 1-3 个疗程的 COI 治疗以治疗有症状的 PDA。共有 32 名（40%）COI 治疗失败并接受了 PDA 结扎。多变量逻辑回归分析表明，有症状和无症状 PDA 婴儿的结局差异可以用更不成熟和更病重的婴儿来解释。在接受药物治疗和药物治疗失败后接受结扎的婴儿中，慢性肺病（CLD）的发生率无显著差异。然而，在调整了疾病严重程度和其他已知危险因素后，与成功接受 1-2 个疗程 COI 治疗关闭 PDA 的存活婴儿相比，持续 PDA 存活婴儿发生 CLD 的比值比为 3.24（1.07-9.81；p=0.038）。
结论
在 ELBW 婴儿中，成功治疗 PDA 并不会显著导致 CLD、早产儿视网膜病变（ROP）和出院时年龄等不良结局。这表明，对有血流动力学意义的 PDA 进行关闭是有益的。重复 COI 治疗未能关闭 PDA 是 ELBW 婴儿发生 CLD 的主要危险因素。
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