Wildes Dermot, Mullaly Rachel, Costigan Caoimhe, Awan Atif, El-Khuffash Afif, Boyle Michael A
Department of Paediatrics, RCSI University of Medicine & Health Sciences, Dublin 2, Ireland.
Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland.
Acta Paediatr. 2025 Jul;114(7):1609-1615. doi: 10.1111/apa.70001. Epub 2025 Jan 30.
This study hypothesised that infants with a haemodynamically significant patent ductus arteriosus (hsPDA) as defined by a validated score have a higher incidence of acute kidney injury (AKI).
A retrospective study was conducted including infants < 29 weeks' gestation, born at the Rotunda Hospital. The El-Khuffash patent ductus arteriosus (PDA) severity score was applied following an echocardiographic assessment. Mann Whitney-U and χ tests were utilised to assess for association with AKI.
We report a cohort of n = 86 infants with PDA of a mean (standard deviation) gestation of 27 (1) weeks and birth weight of 957 g (235 g). Ten (11.6%) of infants developed AKI. Birth weight, gestation, death-by-discharge, high-risk PDA score, PDA treatment, and ibuprofen receipt were associated with AKI. The presence of a high-risk PDA score was independently associated with the occurrence of AKI. Therapeutic intervention and ibuprofen use proved significant in their associations with AKI.
A high-risk El-Khuffash PDA score is predictive of AKI in our cohort. Ductal diameter in isolation is ineffective as a measure of haemodynamic significance in the context of AKI prediction. Both PDA treatment and ibuprofen-use are associated with an increased risk of AKI. Further work to validate the use of this score for AKI prediction is warranted.
本研究假设，根据有效评分定义的具有血流动力学显著意义的动脉导管未闭（hsPDA）婴儿发生急性肾损伤（AKI）的发生率更高。
进行了一项回顾性研究，纳入在罗通达医院出生的孕周<29周的婴儿。在超声心动图评估后应用El-Khuffash动脉导管未闭（PDA）严重程度评分。采用Mann Whitney-U检验和χ检验评估与AKI的相关性。
我们报告了一组n = 86例患有PDA的婴儿，其平均（标准差）孕周为27（1）周，出生体重为957 g（235 g）。10例（11.6%）婴儿发生了AKI。出生体重、孕周、出院时死亡、高危PDA评分、PDA治疗和布洛芬使用与AKI相关。高危PDA评分的存在与AKI的发生独立相关。治疗干预和布洛芬使用在与AKI的关联中被证明具有显著性。
在我们的队列中，高危El-Khuffash PDA评分可预测AKI。在预测AKI的背景下，单独的导管直径作为血流动力学意义的衡量指标无效。PDA治疗和布洛芬使用均与AKI风险增加相关。有必要进一步开展工作以验证该评分在AKI预测中的应用。
