Dudley Sarah, Sen Shawn, Hanson Alison, El Khuffash Afif, Levy Philip T
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Division of Neonatology and Pediatric Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Perinatol. 2022 Dec;42(12):1703-1707. doi: 10.1038/s41372-022-01450-1. Epub 2022 Jul 15.
A patent ductus arteriosus (PDA) in infants born premature can present significant management challenges for neonatal providers. Quantifying a hemodynamically significant PDA (hsPDA) represents the first hurdle, however, identifying the best evidence-based approach amongst conservative, pharmacologic, and/or interventional management options has proven to be even more complicated. Within the conservative arm, furosemide to reduce pulmonary edema and improve lung function has spawned several discussions given the concerns for its upregulation of prostaglandin E in the kidneys and conflicting outcomes data. There remains no consensus regarding furosemide use in hsPDAs. In this perspective article, we summarize the approach to defining a hsPDA, review the current practice of furosemide use in the management of hsPDA, and suggest an approach to fluid management and diuresis to address the question: is the routine use of furosemide in hsPDA merited in current practice?
早产婴儿的动脉导管未闭（PDA）会给新生儿医护人员带来重大的管理挑战。量化具有血流动力学意义的动脉导管未闭（hsPDA）是首要障碍，然而，在保守治疗、药物治疗和/或介入治疗管理选项中确定最佳的循证方法已被证明更加复杂。在保守治疗方面，鉴于对其在肾脏中上调前列腺素E的担忧以及相互矛盾的结果数据，使用速尿来减轻肺水肿和改善肺功能引发了多次讨论。关于在hsPDA中使用速尿尚无共识。在这篇观点文章中，我们总结了定义hsPDA的方法，回顾了速尿在hsPDA管理中的当前使用情况，并提出一种液体管理和利尿方法，以解决以下问题：在当前实践中，hsPDA常规使用速尿是否合理？
