ElHassan N O, Bird T M, King A J, Ambadwar P B, Jaquiss R D B, Kaiser J R, Robbins J M
University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA.
Department of Health Policy & Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Neonatal Perinatal Med. 2014 Jan 1;7(3):229-35. doi: 10.3233/NPM-14814015.
Patent ductus arteriosus (PDA) occurs in 70% of extremely low birth weight (ELBW, birth weight <1000 g) infants. Approximately 34% of ELBW infants with a PDA have spontaneous closure. Failure of the ductus arteriosus to close has been associated with multiple morbidities.
To examine variability over time and across hospitals in early therapeutic (2-7 day) use of indomethacin (INDO) vs ibuprofen (IBU) for PDA treatment in outborn ELBW infants and examine the outcomes and side effects of both pharmacological agents in this population.
Data were extracted from the Pediatric Health Information System. ELBW infants born between January 1, 2007 and December 31, 2010 and admitted on day of life 0 were eligible for inclusion. 732 infants had a PDA diagnosis and met inclusion criteria. We explored the variability in PDA pharmacotherapy over time and across hospitals. We compared outcomes of both agents for in-hospital mortality, need for surgical ligation, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. Statistical methods included chi square and multivariable regression analysis. Instrumental variable analysis was used to control for selection bias and omitted variables.
There was large variability in PDA pharmacotherapy over time and across hospitals. INDO use declined as IBU use grew from 12.8 to 38.9%. There was no difference in hospital or NICU characteristics between high and low IBU using NICUs. Renal failure was more common in infants receiving INDO compared to IBU.
We noted large variability in PDA pharmacotherapy. Renal failure was more common with INDO use. Until further studies to compare the long-term effects of both drugs, our data support IBU as the preferred medication for PDA pharmacotherapy in ELBW infants.
动脉导管未闭（PDA）发生于70%的极低出生体重（ELBW，出生体重<1000g）婴儿中。约34%患有PDA的ELBW婴儿会出现动脉导管自行闭合。动脉导管未闭与多种疾病相关。
研究院外出生的ELBW婴儿在早期（2 - 7天）使用吲哚美辛（INDO）与布洛芬（IBU）治疗PDA时，不同时间及不同医院之间的差异，并研究这两种药物在此类人群中的疗效及副作用。
数据取自儿科健康信息系统。纳入2007年1月1日至2010年12月31日出生、出生当日入院的ELBW婴儿。732名婴儿被诊断为PDA并符合纳入标准。我们探讨了不同时间及不同医院间PDA药物治疗的差异。我们比较了两种药物在院内死亡率、手术结扎需求、脑室内出血、坏死性小肠结肠炎、支气管肺发育不良、脑室周围白质软化、肾衰竭及持续性肺动脉高压方面的疗效。统计方法包括卡方检验和多变量回归分析。使用工具变量分析来控制选择偏倚和遗漏变量。
不同时间及不同医院间PDA药物治疗差异很大。随着IBU使用率从12.8%增长至38.9%，INDO的使用量下降。使用高剂量和低剂量IBU的新生儿重症监护病房（NICU）在医院或NICU特征方面无差异。与使用IBU的婴儿相比，使用INDO的婴儿肾衰竭更为常见。
我们注意到PDA药物治疗存在很大差异。使用INDO时肾衰竭更为常见。在进一步研究比较两种药物的长期效果之前，我们的数据支持将IBU作为ELBW婴儿PDA药物治疗的首选药物。
