Heuchan Anne Marie, Clyman Ronald I
Department of Neonatology, Royal Hospital for Sick Children, Glasgow, UK.
Department of Pediatrics, Cardiovascular Research Institute, University of California, San Francisco, USA.
Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):F431-6. doi: 10.1136/archdischild-2014-306176. Epub 2014 Jun 5.
Optimal management of the patent ductus arteriosus (PDA) in the premature infant remains controversial. Despite considerable historical and physiological data indicating that a persistent PDA may be harmful, robust evidence of long-term benefits or harms from treatment is lacking. This has been equated to a lack of benefit but is also a reflection of the fact that most clinical trials were designed to assess the effects of short-term (2-8 days) rather than prolonged exposure to a PDA. No clinical trials have been designed to assess the effects of prolonged exposure of persistent PDA on morbidity and mortality of very premature infants in the era of antenatal corticosteroids, surfactant and non-invasive respiratory support. Further research is required, but new insights and novel therapies are evolving, which will allow greater individual patient assessment, understanding of risk and optimisation of treatment. In this paper, we review the current literature, evidence for treatment options, including a non-interventional approach, and research directions for infants <28 weeks' gestational age.
早产儿动脉导管未闭（PDA）的最佳管理仍存在争议。尽管有大量历史和生理学数据表明持续存在的PDA可能有害，但缺乏关于治疗长期益处或危害的确凿证据。这被等同于缺乏益处，但也反映了这样一个事实，即大多数临床试验旨在评估短期（2 - 8天）而非长期暴露于PDA的影响。在产前使用皮质类固醇、表面活性剂和无创呼吸支持的时代，尚无临床试验设计用于评估持续存在的PDA长期暴露对极早产儿发病率和死亡率的影响。需要进一步研究，但新的见解和新疗法正在不断发展，这将使对个体患者的评估更加完善，对风险的理解更加深入，并优化治疗。在本文中，我们回顾了当前的文献、治疗选择的证据，包括非介入性方法，以及针对孕周小于28周婴儿的研究方向。
