Zanardo V, Trevisanuto D, Dani C, Milanesi O, Guglielmi A, Cantarutti F
Department of Pediatrics, Padua University, Italy.
Acta Genet Med Gemellol (Roma). 1993;42(3-4):253-6. doi: 10.1017/s0001566000003251.
During a screening protocol of early echocardiographic diagnosis (ATL MK 600) and treatment of "silent" PDA in RDS preterms with BW < or = 1.750 kg, clinical data on premature twins were collected, including diagnosis of both PDA and BPD, to investigate whether twin birth influences PDA incidence and BPD development. Out of the 290 RDS preterms evaluated, 96 (33%) showed evidence of PDA, and a total of 79 (27%) developed BPD, 47 (16%) with associated PDA and 32 (11%) without PDA. Out of 238 singletons, 74 (31%) presented "silent" PDA and a total of 75 (31%) developed BPD, 44 (18%) with associated PDA, and 31 (13%) without PDA. In 52 other twins (18% of the total number of babies studied), 22 (42% of this subgroup) presented evidence of "silent" PDA, and 4 (8% of the subgroup), developed BPD, 3 with associated PDA (6% of the subgroup), and 1 without PDA (2% of the subgroup). From these data, it is inferred that that low-birthweight twins are at high risk for PDA hemodynamic complications during RDS, and may benefit from early induced ductal closure. Instead, in RDS twins, BPD was statistically less frequent (at the 99% C.L.) probably because twinning enhances fetal lung maturity, influencing enzymatic and nonenzymatic protective systems of lung defence.
在一项针对出生体重≤1.750 kg的呼吸窘迫综合征（RDS）早产儿“沉默型”动脉导管未闭（PDA）的早期超声心动图诊断（ATL MK 600）及治疗的筛查方案中，收集了早产双胞胎的临床数据，包括PDA和支气管肺发育不良（BPD）的诊断情况，以研究双胎出生是否会影响PDA的发生率及BPD的发生发展。在评估的290例RDS早产儿中，96例（33%）有PDA证据，共有79例（27%）发生了BPD，其中47例（16%）合并PDA，32例（11%）无PDA。在238例单胎中，74例（31%）出现“沉默型”PDA，共有75例（31%）发生BPD，其中44例（18%）合并PDA，31例（13%）无PDA。在其他52对双胞胎（占所研究婴儿总数的18%）中，22例（该亚组的42%）有“沉默型”PDA证据，4例（该亚组的8%）发生了BPD，其中3例合并PDA（该亚组的6%），1例无PDA（该亚组的2%）。从这些数据可以推断，低出生体重双胞胎在RDS期间发生PDA血流动力学并发症的风险很高，可能会从早期导管闭合中获益。相反，在RDS双胞胎中，BPD在统计学上的发生率较低（在99%置信区间），可能是因为双胎妊娠可促进胎儿肺成熟，影响肺防御的酶性和非酶性保护系统。
