Rutledge Austin D, Wahlquist Amy E, Patel Ekta U, Hlavacek Anthony M, Ryan Rita M, Steflik Heidi J
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Am J Perinatol. 2024 May;41(S 01):e1759-e1768. doi: 10.1055/s-0043-1768962. Epub 2023 May 18.
The objective of this study is to examine patent ductus arteriosus (PDA) response by treatment course and investigate associations with postmenstrual age (PMA), chronological age (CA), gestational age (GA), antenatal steroid exposure (ANS), birthweight (BW), weight at treatment initiation (WT), and PDA/left pulmonary artery (LPA) ratio.
This is a single-center retrospective cohort study of preterm infants less than 37 weeks' GA born January 1, 2016 to December 31, 2018 who received acetaminophen and/or indomethacin for PDA treatment. Cox proportional hazards regression models were used to determine whether factors of interest were associated with PDA response to medical treatment.
In total, 289 treatment courses were administered to 132 infants. Thirty-one (23%) infants experienced treatment-associated PDA closure. Ninety-four (71%) infants had evidence of PDA constriction following any treatment course. Ultimately, 84 (64%) infants experienced definitive PDA closure. For each 7-day increase in CA at the time of treatment initiation, the PDA was 59% less likely to close ( = 0.04) and 42% less likely to respond (i.e., constrict or close) to treatment ( < 0.01). PDA/LPA ratio was associated with treatment-associated PDA closure ( = 0.01). For every 0.1 increase in the PDA/LPA ratio, the PDA was 19% less likely to close in response to treatment.
In this cohort, PDA closure is independent of PMA, GA, ANS, BW, and WT; however, CA at treatment initiation predicted both treatment-associated PDA closure and PDA response (i.e., constriction or closure), and PDA/LPA ratio was associated with treatment-associated closure. Most infants experienced PDA constriction rather than closure, despite receiving up to four treatment courses.
· Detailed PDA responses for up to four treatment courses provide a novel perspective.. · Chronological age at the start of treatment predicted treatment-associated PDA closure and response.. · For each 7-day increase in chronological age, the PDA was 59% less likely to close..
本研究的目的是按治疗疗程检查动脉导管未闭（PDA）的反应，并调查其与孕龄（PMA）、实足年龄（CA）、胎龄（GA）、产前类固醇暴露（ANS）、出生体重（BW）、开始治疗时的体重（WT）以及PDA/左肺动脉（LPA）比值之间的关联。
这是一项单中心回顾性队列研究，研究对象为2016年1月1日至2018年12月31日出生的胎龄小于37周的早产儿，这些早产儿接受了对乙酰氨基酚和/或吲哚美辛治疗PDA。采用Cox比例风险回归模型来确定感兴趣的因素是否与PDA对药物治疗的反应相关。
总共对132名婴儿进行了289个疗程的治疗。31名（23%）婴儿经历了与治疗相关的PDA闭合。94名（71%）婴儿在任何治疗疗程后都有PDA收缩的证据。最终，84名（64%）婴儿实现了明确的PDA闭合。在开始治疗时，CA每增加7天，PDA闭合的可能性降低59%（P = 0.04），对治疗有反应（即收缩或闭合）的可能性降低42%（P < 0.01）。PDA/LPA比值与治疗相关的PDA闭合有关（P = 0.01）。PDA/LPA比值每增加0.1，PDA对治疗产生闭合反应的可能性降低19%。
在该队列中，PDA闭合与PMA、GA、ANS、BW和WT无关；然而，开始治疗时的CA可预测治疗相关的PDA闭合和PDA反应（即收缩或闭合），且PDA/LPA比值与治疗相关的闭合有关。尽管接受了多达四个疗程的治疗，但大多数婴儿经历的是PDA收缩而非闭合。
· 对多达四个治疗疗程的详细PDA反应提供了一个新视角。· 开始治疗时的实足年龄可预测治疗相关的PDA闭合和反应。· 实足年龄每增加7天，PDA闭合的可能性降低59%。
