John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle, NSW, Australia.
Randwick Children's Hospital Department of Neonatology, Sydney, NSW, Australia.
Semin Fetal Neonatal Med. 2021 Apr;26(2):101219. doi: 10.1016/j.siny.2021.101219. Epub 2021 Feb 24.
The published literature on patent ductus arteriosus (PDA) management is challenging to interpret due to poorly designed trials with high rates of open label treatments, homogenisation of patients with varying physiological subtypes, poor treatment efficacy, and spontaneous closure in more mature infants. The perceived lack of clinical benefit has led to a drift away from medical and surgical treatment of all infants with a PDA. This therapeutic nihilism as a default response to PDA management fails to recognise the physiological relevance of a left-to-right shunt with early haemodynamic instability after birth and subsequent pulmonary volume overload with prolonged exposure. Clinicians need to know if therapeutic nihilism is safe. This review will provide an overview of the available data on the efficacy of known PDA treatments, conservative management and supportive care measures that are currently applied.
由于设计不佳的试验中存在高比例的开放性治疗、不同生理亚型的患者同质化、治疗效果不佳以及更成熟婴儿的自发性闭合，动脉导管未闭（PDA）管理的已发表文献难以解读。人们认为缺乏临床益处导致所有患有 PDA 的婴儿都避免进行药物和手术治疗。这种对 PDA 管理的治疗虚无主义，未能认识到出生后早期血流动力学不稳定和随后的肺容量超负荷与长时间暴露相关的左向右分流的生理相关性。临床医生需要知道治疗虚无主义是否安全。本综述将概述目前应用的已知 PDA 治疗、保守管理和支持性护理措施的疗效的现有数据。
