Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Pediatr Neonatol. 2020 Aug;61(4):399-405. doi: 10.1016/j.pedneo.2020.03.009. Epub 2020 Mar 24.
Patent ductus arteriosus (PDA) is frequently encountered in premature infants. Optimal management of PDA remains undefined. We aim to assess the national trend for PDA ligation over 18 years and evaluate mortality and associated morbidities.
We used data from the National Inpatient Sample (NIS) and KID of the Healthcare Cost and Utilization Project (HCUP) from 1998 to 2015. All infants with gestational age 24-32 weeks and birth weight <1500 g were included. Patients with PDA were classified into two groups: those who did and did not receive surgical ligation. Associated mortality and morbidities were compared.
A total of 429,900 neonatal admissions were identified. Of them, 149,473 (34.8%) infants had PDA. PDA-ligated infants were 27,364 (6.4%). PDA ligation was more likely in those with smaller gestational age and with birth weight <1000 g. A steady decline in PDA ligation was noticed since 2004. The mortality rate in PDA-ligated infants was less than in PDA-non-ligated infants (7.5% vs. 8.9%; OR = 0.82; 95% CI: 0.78-0.86; p < 0.001). However, the prevalence rates of pulmonary hemorrhage and necrotizing enterocolitis (NEC) were greater in PDA-ligated infants (OR = 1.58; 95% CI: 1.49-1.67; p < 0.001, and OR = 1.32; 95% CI: 1.26-1.38; p < 0.001, respectively).
Ligation of PDA has been steadily declining since 2004. Despite higher morbidities, PDA-ligated infants had less mortality.
动脉导管未闭（PDA）在早产儿中很常见。PDA 的最佳治疗方法仍未确定。我们旨在评估 18 年来 PDA 结扎的全国趋势，并评估死亡率和相关并发症。
我们使用了来自 1998 年至 2015 年国家住院患者样本（NIS）和医疗保健成本和利用项目（HCUP）的 KID 的数据。所有胎龄为 24-32 周且出生体重<1500g 的婴儿均包括在内。将患有 PDA 的患者分为两组：接受和未接受手术结扎的患者。比较了相关死亡率和发病率。
共确定了 429900 例新生儿入院。其中，149473 例（34.8%）婴儿患有 PDA。接受 PDA 结扎的婴儿为 27364 例（6.4%）。PDA 结扎更可能发生在胎龄较小和出生体重<1000g 的婴儿中。自 2004 年以来，PDA 结扎率稳步下降。接受 PDA 结扎的婴儿死亡率低于未接受 PDA 结扎的婴儿（7.5% vs. 8.9%；OR=0.82；95%CI：0.78-0.86；p<0.001）。然而，PDA 结扎婴儿的肺出血和坏死性小肠结肠炎（NEC）发生率更高（OR=1.58；95%CI：1.49-1.67；p<0.001，和 OR=1.32；95%CI：1.26-1.38；p<0.001，分别）。
自 2004 年以来，PDA 结扎率稳步下降。尽管发病率较高，但接受 PDA 结扎的婴儿死亡率较低。
