Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Dasman Diabetes Institute, Kuwait City, Kuwait.
BMJ Paediatr Open. 2022 Mar;6(1). doi: 10.1136/bmjpo-2022-001424.
To describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks' gestational age (GA) in England and Wales between 2010 and 2017.
Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.
Among 58 108 infants born at <32 weeks' GA, 28.3% (n=16 440) had a PDA diagnosed clinically or with echocardiographic confirmation. Of these, 34.8% (n=5721; 9.8% of total <32 weeks' infants included) had PDA treatment including 7.6% (n=1255) with indomethacin, 23.5% (n=3857) with ibuprofen and 5.6% (n=916) with surgical closure. The highest incidence of PDA was among infants born at 24 and 25 weeks' GA (70.2% and 70.8%, respectively), decreasing to 6.1% among infants born at 31 weeks' GA. The percentage of infants with a PDA increased over the study period (25.5% in 2010 to 28.5% in 2017). The percentage of infants who received ibuprofen or indomethacin or had PDA surgery decreased from 41.3% in 2010 to 33.7% in 2017, with an increase in use of ibuprofen from 20.2% to 27.3% while use of indomethacin decreased from 20.0% to 8.8%. Surgical closure of PDA decreased from 9.1% to 3.0%. Indomethacin was used for median (IQR) 3 (2-5) days while ibuprofen was given for 3 (2-4) days, at a median of 8 and 10 days after birth, respectively; surgical treatment was used later at 33 (24-45) days after birth.
Ibuprofen is the preferred drug and surgical interventions are becoming less frequent for PDA closure among very preterm infants in England and Wales.
NCT03773289.
描述 2010 年至 2017 年间英格兰和威尔士胎龄<32 周的婴儿中动脉导管未闭（PDA）的诊断和治疗情况。
这是一项回顾性队列研究，使用了来自英格兰和威尔士新生儿单位<32 周胎龄新生儿的国家新生儿研究数据库中的常规记录数据。
在胎龄<32 周的 58108 名婴儿中，28.3%（n=16440）临床诊断或超声心动图确诊患有 PDA。其中，34.8%（n=5721；占包括所有<32 周婴儿在内的总数的 9.8%）接受了 PDA 治疗，包括 7.6%（n=1255）使用吲哚美辛、23.5%（n=3857）使用布洛芬和 5.6%（n=916）进行手术闭合。胎龄为 24 周和 25 周的婴儿 PDA 发生率最高（分别为 70.2%和 70.8%），胎龄为 31 周的婴儿 PDA 发生率降至 6.1%。在研究期间，患有 PDA 的婴儿比例有所增加（2010 年为 25.5%，2017 年为 28.5%）。接受布洛芬或吲哚美辛治疗或行 PDA 手术的婴儿比例从 2010 年的 41.3%下降到 2017 年的 33.7%，同时布洛芬的使用率从 20.2%增加到 27.3%，而吲哚美辛的使用率从 20.0%下降到 8.8%。PDA 的手术闭合率从 9.1%下降到 3.0%。吲哚美辛的中位（IQR）使用时间为 3（2-5）天，而布洛芬的中位使用时间为 3（2-4）天，分别在出生后 8 天和 10 天开始使用；手术治疗在出生后 33（24-45）天进行。
在英格兰和威尔士，布洛芬是治疗极早产儿 PDA 的首选药物，而手术干预的应用频率正在降低。
NCT03773289。
