极早产儿持续性动脉导管未闭中体循环动脉盗血的临床有效性。
Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus.
机构信息
Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
出版信息
J Perinatol. 2021 Jan;41(1):84-92. doi: 10.1038/s41372-020-0663-8. Epub 2020 May 11.
OBJECTIVE
Investigate relevance of diastolic flow abnormalities in celiac trunk (aCT) and middle cerebral artery (aMCA) among preterms with persistent hemodynamically significant patent ductus arteriosus (phsPDA, diameter ≥ 1.5 mm, and age ≥ 7 days).
STUDY DESIGN
Five hundred fifteen echocardiograms from 156 neonates born <28 weeks gestation age (GA) were analyzed retrospectively. Infants with aCT or aMCA at any time were compared with the rest. Separate comparisons were performed for aCT and aMCA. Primary outcome was composite of death, chronic lung disease (CLD), or necrotizing enterocolitis ≥ stage 2. Logistic regression was used to adjust for confounders.
RESULT
Mean (SD) weight and GA were 820(214) g and 25.2(1.3) weeks. aMCA, but not aCT, was associated with primary outcome [adjusted odds ratio 2.17, 95% CI: 1.01-4.67] and CLD [2.20 (0.99-4.87)].
CONCLUSION
aMCA may be a valid marker for defining the clinical significance of phsPDA in preterm neonates. aCeT may be of limited value in selecting patients for treatment.
目的
研究在持续存在血流动力学意义重大的动脉导管未闭（phsPDA，直径≥1.5mm，且年龄≥7 天）的早产儿中，腹腔干（aCT）和大脑中动脉（aMCA）舒张期血流异常的相关性。
研究设计
回顾性分析了 156 名胎龄<28 周的新生儿的 515 次超声心动图。将任何时间存在 aCT 或 aMCA 的婴儿与其余婴儿进行比较。分别对 aCT 和 aMCA 进行了比较。主要结局是死亡、慢性肺病（CLD）或≥2 期坏死性小肠结肠炎（NEC）的复合结局。采用逻辑回归调整混杂因素。
结果
平均（SD）体重和胎龄分别为 820（214）g 和 25.2（1.3）周。aMCA 与主要结局[校正比值比 2.17，95%可信区间：1.01-4.67]和 CLD[2.20（0.99-4.87)]相关，但 aCT 与两者均无关。
结论
aMCA 可能是定义早产儿 phsPDA 临床意义的有效标志物。aCeT 可能在选择治疗患者方面价值有限。
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