Warnock A, Szatkowski L, Lakshmanan A, Lee L, Kelsall W
Neonatal Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
BMC Pediatr. 2021 Jun 9;21(1):270. doi: 10.1186/s12887-021-02734-9.
This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 - 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome.
Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge.
This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.
本研究旨在提供英国新生儿动脉导管未闭（PDA）手术发生率的数据，包括：结扎前管理以及出院前的结局。我们采用了英国儿科监测单位（BPSU）的方法；通过问卷收集2012年9月1日至2013年9月30日期间接受PDA结扎术（PDAL）的早产儿的数据。纳入妊娠少于37周、出院前接受PDAL且无其他结构性心脏异常的婴儿。收集的信息包括：患者人口统计学资料、术前和术后临床特征、术前药物治疗、术后并发症及结局。
在研究期间，263例婴儿接受了PDAL，发生率为每10000例活产3.07例。88%为极早产儿（<28周），60%为男性。结扎的最常见原因是无法撤机（83.7%）和血流动力学显著的PDA（87.8%）。术前65.7%接受了药物治疗。手术中位年龄为33天（范围9 - 260天，四分位间距24 - 48天）；PDAL时50.6%婴儿的矫正年龄小于31 + 6周。大多数手术（90%）为开放结扎；仅9例（3.4%）为导管封堵（PDACO）。20.5%的患者有术后并发症。30天死亡率为3%，93.5%存活至出院。
本研究表明，对于PDA的药物和手术管理或手术时机几乎没有共识。
