Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
Medical University of South Carolina, Charleston, SC, USA.
J Perinatol. 2021 Jun;41(6):1441-1447. doi: 10.1038/s41372-021-01054-1. Epub 2021 Apr 19.
Investigate relationship between management of patent ductus arteriosus (PDA) and acute kidney injury (AKI) in very low birthweight neonates.
Retrospective cohort study of neonates, <1500 g, admitted to 24 NICUs, 1/1/14 - 3/31/14. AKI diagnosed using the neonatal modified KDIGO definition; diagnosis and treatment of PDA extracted from the medical record. Demographics, clinical characteristics, and AKI stage compared using chi-square and analysis of variance. A general estimating equation logistic regression used to estimate adjusted odds ratios.
Of 526 neonates with sufficient data to diagnose AKI, 157 (30%) had PDA (61 conservative management, 62 pharmacologic treatment only, 34 surgical ligation). In analyses adjusted for sex, birthweight, gestational age, caffeine, nephrotoxin exposure, vasopressor and mechanical ventilation use, with conservative management as reference, there were no differences among treatment cohorts in the odds of AKI.
The underlying physiology of PDA, not management strategy, may determine the likelihood of AKI in neonates <1500 g.
探讨极低出生体重儿动脉导管未闭（PDA）的管理与急性肾损伤（AKI）之间的关系。
这是一项对 2014 年 1 月 1 日至 2014 年 3 月 31 日期间在 24 家 NICU 住院的体重<1500g 的新生儿进行的回顾性队列研究。采用新生儿改良 KDIGO 定义诊断 AKI；从病历中提取 PDA 的诊断和治疗信息。采用卡方检验和方差分析比较人口统计学、临床特征和 AKI 分期。采用一般估计方程逻辑回归估计调整后的优势比。
在 526 例有足够数据诊断 AKI 的新生儿中，157 例（30%）存在 PDA（61 例采用保守治疗，62 例仅采用药物治疗，34 例采用手术结扎）。在调整了性别、出生体重、胎龄、咖啡因、肾毒性物质暴露、血管加压素和机械通气使用等因素后，与保守治疗组相比，药物治疗组和手术治疗组的 AKI 发生风险无差异。
在体重<1500g 的新生儿中，可能是 PDA 的潜在病理生理学而非治疗策略决定了 AKI 的发生几率。
