Mohamed M A, El-Dib M, Alqahtani S, Alyami K, Ibrahim A N, Aly H
Division of Newborn Services, The George Washington University Hospital, Washington, DC, USA.
Department of Newborn Services, Brigham and Women's Hospital, Boston, MA, USA.
J Perinatol. 2017 Jun;37(6):652-657. doi: 10.1038/jp.2017.4. Epub 2017 Feb 16.
Closing patent ductus arteriosus (PDA) is a widely accepted approach in the management of very low birth weight (VLBW) infants. Our objective is to test the hypothesis that conservative management (no treatment) of PDA will not affect survival without chronic lung diseases (CLD).
This retrospective study utilizes a prospectively collected database to compare two cohorts of VLBW infants. Infants in the first group (2001 to 2009) had their PDA treated with pharmacological and if necessary with surgical ligation. PDA in the second group (2010 to 2014) was not treated with medical or surgical intervention. The primary outcome was survival without oxygen requirement at 36 weeks. Pulmonary and non-pulmonary morbidities were also compared. Logistic regression analyses were performed to control for confounders.
This study included 643 VLBW infants, of them 415 infants in the Treat group and 228 in the No-Treat group. The rate of survival without CLD did not differ between Treat and No-Treat groups (78.4% vs 83.9%, respectively; adjusted odds ratio (aOR)=1.72, confidence interval (CI): 0.92 to 3.23, P=0.09). Mortality declined in No-Treat group (15.2% vs 10.5%, aOR=0.51, CI: 0.25 to 0.99, P=0.049), but the two groups did not differ in the incidence of CLD among survivors (5.8% vs 5.0%,=P0.47). Pulmonary complications and non-pulmonary morbidities did not differ between groups.
Conservative management (no treatment) of PDA may not compromise survival without CLD and is not associated with increased morbidities in VLBW infants. Prospective physiological studies are needed to determine the sector of VLBW infants, if any, who could benefit from PDA treatment.
闭合动脉导管未闭（PDA）是极低出生体重（VLBW）婴儿管理中一种广泛接受的方法。我们的目的是检验以下假设：对PDA进行保守治疗（不治疗）不会影响无慢性肺部疾病（CLD）的生存率。
这项回顾性研究利用一个前瞻性收集的数据库来比较两组VLBW婴儿。第一组（2001年至2009年）的婴儿的PDA采用药物治疗，必要时进行手术结扎。第二组（2010年至2014年）的PDA未进行药物或手术干预。主要结局是36周时无需吸氧的生存率。还比较了肺部和非肺部疾病的发生率。进行逻辑回归分析以控制混杂因素。
本研究纳入了643例VLBW婴儿，其中治疗组415例，未治疗组228例。治疗组和未治疗组无CLD的生存率无差异（分别为78.4%和83.9%；调整后的优势比（aOR）=1.72，置信区间（CI）：0.92至3.23，P=0.09）。未治疗组的死亡率有所下降（15.2%对10.5%，aOR=0.51，CI：0.25至0.99，P=0.049），但两组幸存者中CLD的发生率无差异（5.8%对5.0%，P=0.47）。两组之间的肺部并发症和非肺部疾病无差异。
对PDA进行保守治疗（不治疗）可能不会影响无CLD的生存率，且与VLBW婴儿发病率增加无关。需要进行前瞻性生理学研究，以确定哪些VLBW婴儿（如果有的话）可以从PDA治疗中获益。
