Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Cardiology, Amsterdam, The Netherlands.
The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands.
J Neonatal Perinatal Med. 2020;13(1):39-45. doi: 10.3233/NPM-180152.
Management of a patent ductus arteriosus (PDA) after pharmacological therapy failure in preterm neonates is controversial and shows marked practice variation. To evaluate which factors motivate the decision to ligate a PDA in clinical practice we examined several clinical and echocardiographic variables.
We conducted a retrospective single center cohort study. We included infants born at less than 37 weeks of gestation, admitted to our neonatal intensive care between 01.01.2008 and 31.12.2015 with a PDA detected on echocardiography after two or three courses of medical therapy. Logistic regression analyses were used to predict surgical ligation for twelve clinical and nine echocardiographic variables separately. We used the multiple imputation technique for missing values.
A total of 89 neonates were included of which forty (45%), underwent surgical ligation of their PDA. In our final multivariate regression model, invasive respiratory support (OR 3.6, 95% CI 1.29-10.03), left atrial/aortic root ratio (OR 5.48, 95% CI 1.66-18.11) and presence of ductal steal (OR 3.82, 95% CI 1.47-9.91) were significant predictors for surgical ligation. The prediction model using clinical and echocardiographic variables explained 9% and 24% of the variability to ligate respectively, indicating significant residual variation due to unmeasured factors.
Our results indicate that invasive respiratory support, increased left atrial/aortic root ratio and the presence of ductal steal were important predictors for surgical ligation in our center. However, this explained only a small proportion of the variability, which emphasizes the need for evidence-based guidelines in the management of preterm neonates after failed pharmacological therapy for a PDA.
在早产儿中，药物治疗失败后对动脉导管未闭（PDA）的管理存在争议，且表现出明显的实践差异。为了评估哪些因素促使我们在临床实践中决定结扎 PDA，我们检查了几个临床和超声心动图变量。
我们进行了一项回顾性单中心队列研究。我们纳入了在 2008 年 1 月 1 日至 2015 年 12 月 31 日期间出生于小于 37 周胎龄的婴儿，这些婴儿在接受两到三疗程药物治疗后通过超声心动图检查发现存在 PDA，且在新生儿重症监护病房住院。我们分别使用逻辑回归分析来预测 12 个临床和 9 个超声心动图变量与手术结扎的相关性。我们使用多重插补技术处理缺失值。
共有 89 名新生儿被纳入研究，其中 40 名（45%）接受了 PDA 的手术结扎。在我们的最终多变量回归模型中，有创性呼吸支持（OR 3.6，95%CI 1.29-10.03）、左心房/主动脉根比值（OR 5.48，95%CI 1.66-18.11）和导管盗血（OR 3.82，95%CI 1.47-9.91）是手术结扎的显著预测因素。使用临床和超声心动图变量的预测模型分别解释了 9%和 24%的结扎可变性，表明由于未测量的因素存在显著的剩余变异性。
我们的结果表明，有创性呼吸支持、增加的左心房/主动脉根比值和导管盗血是我们中心进行手术结扎的重要预测因素。然而，这仅解释了可变性的一小部分，这强调了在药物治疗失败后管理早产儿 PDA 时需要基于证据的指南。
