de Klerk Johan C A, Engbers Aline G J, van Beek Floor, Flint Robert B, Reiss Irwin K M, Völler Swantje, Simons Sinno H P
Division of Neonatology, Department of Pediatrics, Erasmus UMC-Sophia Children's Hospital, Rotterdam, Netherlands.
Division of Systems Biomedicine and Pharmacology, Leiden Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, Netherlands.
Front Pediatr. 2020 Sep 11;8:541. doi: 10.3389/fped.2020.00541. eCollection 2020.
The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.
早产儿动脉导管未闭的最佳管理策略仍是一个有争议的话题。治疗策略的现有证据可能因早产儿动脉导管延迟自然闭合而存在偏差，这种延迟自然闭合似乎取决于患者特征。我们对所有关于动脉导管未闭研究的文献进行了系统综述，以收集患者特征以及报告的动脉导管未闭和自然闭合患者数量。自然闭合率显示出很大的变异性，但与也纳入了胎龄较大或出生体重较高婴儿的研究相比，仅纳入胎龄低于28周或出生体重低于1000克的早产儿的研究中自然闭合率最低（第4天为34%；第7天为41%）（在纳入胎龄较大或出生体重较高婴儿的研究中，第3天高达55%，第7天高达78%）。动脉导管自然闭合的概率在出生后至少1周内持续增加，这有利于仅对未出现自然闭合的婴儿进行延迟治疗。更好地预测个体新生儿动脉导管的自然闭合是找到早产儿动脉导管未闭最佳管理策略的关键因素。
