Department of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao-Tung University, Hsinchu, Taiwan; Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Pediatr Neonatol. 2023 Jul;64(4):411-419. doi: 10.1016/j.pedneo.2022.12.004. Epub 2023 Jan 2.
The patent ductus arteriosus (PDA) treatment in very preterm infants is controversial. This study focused on preterm infants born at 28-32 weeks of gestation and analyzed the association between various PDA treatments and clinical outcomes.
We conducted a retrospective cohort study of infants born at 28-32 weeks of gestation between 2016 and 2019 at 22 hospitals in the Taiwan Premature Infant Follow-up Network. We categorized the infants into four groups according to treatment strategies: medication, primary surgery, medication plus surgery, or conservative treatment.
A total of 1244 infants presented with PDA, and 761 (61.1%) were treated. Medication was the predominant treatment (50.0%), followed by conservative treatment (38.9%), medication plus surgery (7.6%), and primary surgery (3.5%). The risk of mortality was not reduced in the active treatment group compared to the conservative treatment group. There was a higher prevalence of severe intraventricular hemorrhage, necrotizing enterocolitis (NEC), and any degree of bronchopulmonary dysplasia (BPD) in both the primary surgery and medication plus surgery groups than in the conservative treatment group. After adjustment, both the primary surgery and medication plus surgery groups still had higher odds ratios for the occurrence of NEC and any degree of BPD.
Compared with active PDA treatment, conservative treatment for PDA did not increase the risk of mortality and morbidity in very preterm infants born at 28-32 weeks of gestation. The risks and benefits of surgery (PDA ligation) in these infants must be considered cautiously.
动脉导管未闭（PDA）在极早产儿中的治疗存在争议。本研究聚焦于 28-32 周出生的早产儿，分析了不同的 PDA 治疗方法与临床结局之间的关系。
我们对 2016 年至 2019 年期间在台湾早产儿随访网络的 22 家医院出生的 28-32 周早产儿进行了回顾性队列研究。我们根据治疗策略将婴儿分为四组：药物治疗、初次手术、药物治疗加手术或保守治疗。
共有 1244 例婴儿出现 PDA，其中 761 例（61.1%）接受了治疗。药物治疗是最主要的治疗方法（50.0%），其次是保守治疗（38.9%）、药物治疗加手术（7.6%）和初次手术（3.5%）。与保守治疗组相比，积极治疗组的死亡率并未降低。初次手术和药物治疗加手术组的严重颅内出血、坏死性小肠结肠炎（NEC）和任何程度的支气管肺发育不良（BPD）发生率均高于保守治疗组。调整后，初次手术和药物治疗加手术组发生 NEC 和任何程度 BPD 的比值比仍较高。
与积极的 PDA 治疗相比，28-32 周出生的极早产儿保守治疗 PDA 不会增加死亡率和发病率。必须谨慎考虑手术（PDA 结扎）对这些婴儿的风险和获益。
