Madeleneau Doriane, Aubelle Marie-Stephanie, Pierron Charlotte, Lopez Emmanuel, Patkai Juliana, Roze Jean-Christophe, Jarreau Pierre-Henri, Gascoin Geraldine
Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France.
Department of Neonatal Medicine, Nantes University Hospital, Nantes, France.
PLoS One. 2015 Apr 13;10(4):e0124804. doi: 10.1371/journal.pone.0124804. eCollection 2015.
Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns.
This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.
The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003).
There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.
极早产儿动脉导管未闭（PDA）的治疗策略仍存在争议。为了确定可能从治疗中获益的婴儿，我们分析了首剂布洛芬治疗对小于胎龄（SGA）新生儿的疗效。
这项单中心回顾性研究纳入了185例孕24+0-27+6周出生、患有血流动力学显著意义PDA的婴儿，这些婴儿接受静脉注射布洛芬（佩德亚）治疗：第1天10mg/kg，第2天和第3天5mg/kg。根据与奥尔森生长曲线的标准差分析出生体重和胎龄（GA），以确定出生体重的GA特异性Z评分。在最后一剂布洛芬后48小时通过超声心动图评估治疗效果。主要结局是首剂布洛芬治疗失败，并伴有最严重结局的综合标准。
SGA新生儿的治疗失败风险根据持续梯度增加。多因素回归分析观察到更高的风险（粗OR：3.8；95%CI[1.2-12.3]，p=0.02；校正OR：12.8；95%CI[2.3-70.5]，p=0.003）。
婴儿出生体重与PDA治疗之间存在线性关系：首剂布洛芬的失败率随着生长受限程度的增加而增加。
