Chock Valerie Y, Goel Veena V, Palma Jonathan P, Luh Thomas M, Wang Nichole A, Gaskari Shabnam, Punn Rajesh, Silverman Norman H, Benitz William E
Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California.
Am J Perinatol. 2017 Aug;34(10):990-995. doi: 10.1055/s-0037-1601442. Epub 2017 Apr 4.
This historical cohort study investigated how a shift toward a more conservative approach of awaiting spontaneous closure of the patent ductus arteriosus (PDA) in preterm infants has affected neonatal outcomes and resource utilization. We retrospectively studied very low birth weight infants diagnosed with a PDA by echocardiogram (ECHO) in 2006-2008 (era 1), when medical or surgical PDA management was emphasized, to those born in 2010-2012 (era 2) when conservative PDA management was encouraged. Multiple regression analyses adjusted for gestational age were performed to assess differences in clinical outcomes and resource utilization between eras. More infants in era 2 (35/89, 39%) compared with era 1 (22/120, 18%) had conservative PDA management ( < 0.01). Despite no difference in surgical ligation rate, infants in era 2 had ligation later (median 24 vs. 8 days, < 0.0001). There was no difference in clinical outcomes between eras, while number of ECHOs per patient was the only resource measure that increased in era 2 (median 3 vs. 2 ECHOs, = 0.003). In an era of more conservative PDA management, no increase in adverse clinical outcomes or significant change in resource utilization was found. Conservative PDA management may be a safe alternative for preterm infants.
这项历史性队列研究调查了在早产儿中，向更保守的等待动脉导管未闭（PDA）自然闭合的方法转变如何影响新生儿结局和资源利用情况。我们回顾性研究了2006 - 2008年（第1阶段）通过超声心动图（ECHO）诊断为PDA的极低出生体重儿，当时强调药物或手术治疗PDA，以及2010 - 2012年（第2阶段）鼓励保守治疗PDA的出生婴儿。进行了调整胎龄的多元回归分析，以评估不同阶段临床结局和资源利用的差异。与第1阶段（22/120，18%）相比，第2阶段更多婴儿（35/89，39%）接受了PDA保守治疗（P < 0.01）。尽管手术结扎率没有差异，但第2阶段婴儿的结扎时间更晚（中位数24天对8天，P < 0.0001）。不同阶段的临床结局没有差异，而每位患者的ECHO检查次数是第2阶段唯一增加的资源指标（中位数3次对2次ECHO，P = 0.003）。在更保守的PDA治疗时代，未发现不良临床结局增加或资源利用有显著变化。PDA保守治疗可能是早产儿的一种安全替代方法。
