Liu Chang, Shi Yuan
Department of Neonatology, Children's Hospital of Chongqing Medical University, 400014 Chongqing, China.
National Clinical Research Center for Child Health and Disorders, 400014 Chongqing, China.
Rev Cardiovasc Med. 2023 Mar 3;24(3):78. doi: 10.31083/j.rcm2403078. eCollection 2023 Mar.
Excessive fluid intake is a predictor of the development of patent ductus arteriosus (PDA) in preterm infants. Previous studies have examined the relationship between fluid intake and outcomes following ibuprofen for PDA. However, there is a lack of data to determine whether fluid balance has an effect on ibuprofen treatment for PDA. Therefore, this study sought to determine the relationship between fluid balance and outcomes following treatment with ibuprofen for PDA.
We conducted a retrospective study of 110 infants admitted to the Children's Hospital of Chongqing Medical University between January 2017 and April 2022, who were treated with ibuprofen for hemodynamically significant PDA (hsPDA). We calculated the average fluid balance before and during the two courses of ibuprofen treatment and whether they were significantly associated with outcomes in hsPDA patients.
In the first course of ibuprofen treatment (FIT), responders had lower fluid balance before FIT compared to non-responders [median 31.82 (18.01, 39.66) vs 34.68 (25.31, 43.56) mL/kg/day; = 0.049], while the fluid balance during FIT [median 40.61 (33.18, 63.06) vs 42.65 (30.02, 57.96) mL/kg/day; = 0.703] did not differ between responders and non-responders. Fluid balance before the second course of ibuprofen treatment (SIT) (mean 41.58 14.26 vs 35.74 10.99 mL/kg/day; = 0.322) and during SIT (mean 39.21 12.65 vs 37.00 21.38 mL/kg/day; = 0.813) was not found to have a significant association with SIT outcome. Multivariate logistic regression analysis showed fluid balance before FIT was a predictor for FIT success [Odds ratio (OR): 0.967; 95% confidence interval (CI): 0.935-0.999; 0.042]. Fluid balance within the first week of life had a greater association with the FIT outcome (OR: 0.967, 95% CI: 0.939-0.996, = 0.027). Gestational diabetes mellitus and higher Apgar scores decreased the possibility of PDA closure after FIT.
Lower fluid balance before FIT, especially within the first week of life appeared to be a predictor for closure of hsPDA after FIT in preterm infants.
液体摄入量过多是早产儿动脉导管未闭（PDA）发生的一个预测因素。既往研究探讨了液体摄入量与布洛芬治疗PDA后结局之间的关系。然而，缺乏数据来确定液体平衡是否对布洛芬治疗PDA有影响。因此，本研究旨在确定液体平衡与布洛芬治疗PDA后结局之间的关系。
我们对2017年1月至2022年4月期间入住重庆医科大学附属儿童医院的110例因血流动力学显著的PDA（hsPDA）接受布洛芬治疗的婴儿进行了一项回顾性研究。我们计算了布洛芬两个疗程治疗前及治疗期间的平均液体平衡情况，以及它们是否与hsPDA患者的结局显著相关。
在布洛芬第一疗程治疗（FIT）中，与无反应者相比，有反应者在FIT前的液体平衡较低[中位数31.82（18.01，39.66）vs 34.68（25.31，43.56）mL/kg/天；P = 0.049]，而FIT期间的液体平衡[中位数40.61（33.18，63.06）vs 42.65（30.02，57.96）mL/kg/天；P = 0.703]在有反应者和无反应者之间无差异。布洛芬第二疗程治疗（SIT）前（平均41.58±14.26 vs 35.74±10.99 mL/kg/天；P = 0.322）及SIT期间（平均39.21±12.65 vs 37.00±21.38 mL/kg/天；P = 0.813）的液体平衡与SIT结局无显著关联。多因素logistic回归分析显示，FIT前的液体平衡是FIT成功的一个预测因素[比值比（OR）：0.967；95%置信区间（CI）：0.935 - 0.999；P = 0.042]。出生后第一周内的液体平衡与FIT结局的关联更大（OR：0.967，95%CI：0.939 - 0.996，P = 0.027）。妊娠期糖尿病和较高的阿氏评分降低了FIT后PDA闭合的可能性。
FIT前较低的液体平衡，尤其是出生后第一周内的液体平衡似乎是早产儿FIT后hsPDA闭合的一个预测因素。
