Kaluarachchi Dinushan C, Rysavy Matthew A, Do Barbara T, Chock Valerie Y, Laughon Matthew M, Backes Carl H, Colaizy Tarah T, Bell Edward F, McNamara Patrick J
Department of Pediatrics, University of Wisconsin-Madison, Madison, WI.
Department of Pediatrics, McGovern Medical School, UTHealth Houston, Houston, TX.
J Pediatr. 2025 Apr;279:114456. doi: 10.1016/j.jpeds.2024.114456. Epub 2024 Dec 26.
To investigate the association between the secular decrease in treatment of patent ductus arteriosus (PDA) and trends in neonatal mortality and morbidity in infants born at 26 0/7-28 6/7 weeks' gestation.
A retrospective cohort study including infants born between 2012 and 2021 in continually participating hospitals in the National Institute of Child Health and Human Development Neonatal Research Network. The primary composite outcome was defined as surgical necrotizing enterocolitis, grade 2-3 bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, or death. Relationships of temporal trends in PDA treatment with the primary composite outcome and its components were analyzed using a multilevel model accounting for patient-level factors. A separate analysis assessed these relationships stratified by hospital changes in PDA treatment.
The study included 7864 infants. There was a decrease in any PDA treatment from 21% to 16% (P < .01) and an increase in the primary composite outcome from 24% to 36% (P < .01). Change in the primary outcome was driven by increased grade 2-3 BPD (13%-26%, P < .01), with grade 2 BPD accounting for most of this increase (10%-22%, P < .01). Temporal decreases in PDA treatment were associated with increases in the primary outcome and grade 2-3 BPD after adjusting for patient-level factors (P < .01). However, stratified analyses showed that grade 2-3 BPD increased in all hospital groups, regardless of changes in PDA management.
From 2012 to 2021, temporal decreases in PDA treatment for infants 26-28 weeks were associated with an increase in grade 2-3 BPD. However, caution is warranted in determining causality. Reasons for increased grade 2-3 BPD during the past decade warrant investigation.
Generic Database: NCT00063063.
探讨动脉导管未闭（PDA）治疗的长期减少与妊娠26⁰/₇-28⁶/₇周出生婴儿的新生儿死亡率和发病率趋势之间的关联。
一项回顾性队列研究，纳入2012年至2021年期间在美国国立儿童健康与人类发展研究所新生儿研究网络中持续参与研究的医院出生的婴儿。主要复合结局定义为外科坏死性小肠结肠炎、2-3级支气管肺发育不良（BPD）、重度脑室内出血或死亡。使用考虑患者水平因素的多水平模型分析PDA治疗的时间趋势与主要复合结局及其组成部分之间的关系。另一项分析按医院PDA治疗的变化进行分层，评估了这些关系。
该研究纳入了7864名婴儿。任何PDA治疗从21%降至16%（P<.01），主要复合结局从24%增至36%（P<.01）。主要结局的变化是由2-3级BPD增加所致（从13%增至26%，P<.01），其中2级BPD占了大部分增加（从10%增至22%，P<.01）。在调整患者水平因素后，PDA治疗的时间减少与主要结局及2-3级BPD的增加相关（P<.01）。然而，分层分析显示，无论PDA管理如何变化，所有医院组的2-至3级BPD均增加。
2012年至2021年期间，26至28周婴儿PDA治疗的时间减少与2-3级BPD增加相关。然而，在确定因果关系时需谨慎。过去十年中2-3级BPD增加的原因值得研究。
通用数据库：NCT00063063
