Universitat de Barcelona, Hospital Clínic, Hospital Sant Joan de Déu, BCNatal - Centre de Medicina Maternofetal i Neonatologia de Barcelona, Departament de Neonatologia, Barcelona, Spain.
Universitat de Barcelona, Hospital Clínic, Hospital Sant Joan de Déu, BCNatal - Centre de Medicina Maternofetal i Neonatologia de Barcelona, Departament de Neonatologia, Barcelona, Spain.
J Pediatr (Rio J). 2020 Mar-Apr;96(2):177-183. doi: 10.1016/j.jped.2018.10.004. Epub 2018 Nov 10.
Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation.
Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared.
This study included 188 patients (27±2 weeks, 973±272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p<0.001) and surgical closure (34.5% P1 versus 16.1% P2, p<0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p=0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p=0.403), necrotizing enterocolitis (15.5% versus 6.9%, p=0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p=0.264), mortality (17.5% versus 15.2%, p=0.690) or survival-without-morbidity adjusted OR=1.10 (95% CI: 0.55-2.22); p=0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n=82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p=0.019) and more survival-without-morbidity (20% versus 45.6%, p=0.028) were found.
A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated.
动脉导管未闭的治疗仍存在争议。本研究旨在描述更保守的治疗方法对早产儿，尤其是 26 周以下早产儿的主要结局的影响。
对 2009 年至 2016 年间在两家中心就诊的胎龄≤30 周伴动脉导管未闭的婴儿进行临床病历回顾。2011 年，作者改变了动脉导管未闭的治疗方法：在第一阶段（2009-2011 年），药物治疗失败的患者行手术结扎；在第二阶段（2012-2016 年），仅心肺功能受损的患者行手术结扎。比较了药物治疗、手术结扎、死亡率和无并发症存活率。
本研究共纳入 188 例患者（27±2 周，973±272 克）；P1 组 63 例，P2 组 125 例。在 P2 组，药物治疗（85.7% P1 与 56% P2，p<0.001）和手术结扎（34.5% P1 与 16.1% P2，p<0.001）的比例显著降低。慢性肺疾病（28.8% vs. 13.9%，p=0.056）、重度早产儿视网膜病变（7.5% vs. 11.8%，p=0.403）、坏死性小肠结肠炎（15.5% vs. 6.9%，p=0.071）、严重脑室出血（25.4% vs. 18.4%，p=0.264）、死亡率（17.5% vs. 15.2%，p=0.690）或无并发症存活率调整后的 OR=1.10（95% CI：0.55-2.22）；p=0.783。P2 组 24.5%的患者出院时仍存在动脉导管未闭。胎龄在 23-26 周的亚组（n=82）差异显著：慢性肺疾病发生率（50% vs. 19.6%，p=0.019）和无并发症存活率（20% vs. 45.6%，p=0.028）均较低。
对于早产儿伴动脉导管未闭，采用保守治疗方法可以避免药物和手术治疗，且对无并发症存活率无显著影响。然而，仍有三分之二的胎龄<26 周的早产儿需要治疗。
