Ito Satoko, Matsuda Tadashi, Usuda Haruo, Watanabe Shimpei, Kitanishi Ryuta, Hanita Takushi, Watanabe Tatsuya, Adachi Osamu
Center for Perinatal-Neonatal Medicine, Tohoku University Hospital.
Tohoku J Exp Med. 2016 Sep;240(1):7-13. doi: 10.1620/tjem.240.7.
Surgical ligation for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBWIs) has been shown a possible association with neurodevelopmental impairment (NDI) because of its invasiveness. However, we have undergone surgical ligation for ELBWIs immediately after cyclooxygenase inhibitor failed to close a hemodynamically significant PDA (hsPDA) to maintain proper systemic circulation. We aimed to determine the effect of surgical ligation for hsPDA on NDI in ELBWIs. In enrolled 71 ELBWIs, the clinical parameters, including the developmental quotient (DQ), were collected and compared among three groups that were divided by closure mode: spontaneous closure (n = 11), cyclooxygenase inhibitor therapy (n = 37) and surgical ligation (n = 23). No significant differences in DQ at the age of 36 months among the three groups were found: Median (interquartile range): 92.0 (31.0), 89.0 (22.0) and 92.0 (24.5), respectively. In a comparison between groups of DQ < 70 (n = 15) and DQ ≥ 70 (n = 56), a significant difference was found in the parameters related to prematurity (p < 0.05 for each): gestational age [23.9 (1.70) vs. 25.4 (2.50) weeks], birth weight [595 (183) vs. 714 (192) g], Apgar score < 5 (1 min) (67% vs. 36%), and laser photocoagulation for retinopathy of prematurity (73% vs. 43%), but there was no significant association with hsPDA. Therefore, we propose that surgical ligation for hsPDA in ELBWIs should be immediately carried out for preventing future neurodevelopmental deterioration if the cyclooxygenase inhibitor failed to close hsPDA.
由于具有侵入性，极低出生体重儿（ELBWIs）动脉导管未闭（PDA）的手术结扎已被证明可能与神经发育障碍（NDI）有关。然而，在环氧化酶抑制剂未能闭合血流动力学显著的PDA（hsPDA）后，我们立即对ELBWIs进行了手术结扎，以维持适当的体循环。我们旨在确定hsPDA手术结扎对ELBWIs中NDI的影响。在纳入的71例ELBWIs中，收集了包括发育商（DQ）在内的临床参数，并在按闭合方式划分的三组之间进行比较：自然闭合（n = 11）、环氧化酶抑制剂治疗（n = 37）和手术结扎（n = 23）。三组在36个月龄时的DQ无显著差异：中位数（四分位间距）分别为92.0（31.0）、89.0（22.0）和92.0（24.5）。在DQ < 70（n = 15）和DQ≥70（n = 56）的组间比较中，发现与早产相关的参数存在显著差异（每项p < 0.05）：胎龄[23.9（1.70）对25.4（2.50）周]、出生体重[595（183）对714（192）g]、1分钟时Apgar评分< 5（67%对36%）以及早产儿视网膜病变的激光光凝治疗（73%对43%），但与hsPDA无显著关联。因此，我们建议，如果环氧化酶抑制剂未能闭合hsPDA，应立即对ELBWIs的hsPDA进行手术结扎，以防止未来神经发育恶化。
