Boghossian Nansi S, Do Barbara T, Bell Edward F, Dagle John M, Brumbaugh Jane E, Stoll Barbara J, Vohr Betty R, Das Abhik, Shankaran Seetha, Sanchez Pablo J, Wyckoff Myra H, Bethany Ball M
Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, USA.
Early Hum Dev. 2017 Oct;113:10-17. doi: 10.1016/j.earlhumdev.2017.07.011. Epub 2017 Jul 8.
Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed.
We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment.
STUDY DESIGN, SUBJECTS, AND OUTCOME MEASURES: We studied infants 23-28weeks' gestation born 2006-2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<-2, -2 to -0.5, and >-0.5) and PDA surgery following pharmacologic treatment.
5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>-0.5, PDA surgery was increased among infants with z-score -2 to -0.5 (OR=1.23; 95% CI 1.02-1.47) but not among infants with z-score<-2.
Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.
早产儿动脉导管未闭（PDA）的最佳管理仍存在争议。因此，需要开展研究来确定最有可能从PDA治疗中获益的婴儿。
我们试图研究出生体重z评分所定义的显著宫内生长受限是否会降低吲哚美辛或布洛芬关闭PDA的疗效，从而增加药物治疗后PDA手术关闭的需求。
研究设计、研究对象和观察指标：我们研究了2006年至2013年在国立儿童健康与人类发展研究所新生儿研究网络中心出生的妊娠23 - 28周的婴儿。我们检查了对吲哚美辛和/或布洛芬治疗PDA的反应，以及PDA随后是否通过手术关闭。逻辑回归得出了z评分组（<-2、-2至-0.5和>-0.5）与药物治疗后PDA手术之间关联的调整优势比（OR）。
5606例婴儿被诊断为PDA；3587例（64.0%）接受了吲哚美辛或布洛芬或两者治疗，909例（25.3%）接受了PDA手术。PDA未关闭婴儿的母亲患高血压的可能性较小（19%对28%）。未关闭的婴儿更可能为女性（53%对49%），胎龄和出生体重较低，且发生败血症的可能性更大（42%对31%）。与z评分>-0.5的婴儿相比，z评分为-2至-0.5的婴儿PDA手术率增加（OR = 1.23；95%CI 1.02 - 1.47），但z评分<-2的婴儿中未增加。
出生体重z评分为-2至-0.5的婴儿在药物治疗后比正常生长的婴儿更有可能需要进行PDA手术。
