Grosfeld J L, Chaet M, Molinari F, Engle W, Engum S A, West K W, Rescorla F J, Scherer L R
Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, USA.
Ann Surg. 1996 Sep;224(3):350-5; discussion 355-7. doi: 10.1097/00000658-199609000-00011.
The authors evaluated the risk of necrotizing enterocolitis (NEC) in very low birth weight infants receiving indomethacin (INDO) to close patent ductus arteriosus (PDA).
Controversy exists regarding the best method of managing very low birth weight infants with PDA and whether to employ medical management using INDO or surgical ligation of the ductus.
Two hundred fifty-two premature infants with symptomatic PDA were given intravenously INDO 0.2 mg/kg every 12 hours x 3 in an attempt to close the ductus. Patients were evaluated for sex, birth weight, gestational age, ductus closure, occurrence of NEC, bowel perforation, and mortality.
There were 135 boys and 117 girls. The PDA closed or became asymptomatic in 224 cases (89%), whereas 28 (11%) required surgical ligation. Ninety infants (35%) developed evidence of NEC after INDO therapy. Fifty-six were managed medically; surgical intervention was required in 34 of 90 cases (37.8%) or 13% of the entire PDA/INDO study group. Bowel perforation was noted in 27 cases (30%). Factors associated with the onset of NEC included gestational age < 28 weeks, birth weight < 1 kg, and prolonged ventilator support. The overall mortality rate was 25.5%, but was higher in infants with NEC versus those without. The highest mortality was noted in perforated NEC cases. The PDA/INDO patients were compared with a control group of 764 infants with similar sex distribution, birth weights, and gestational ages without PDA who did not receive INDO. Necrotizing enterocolitis occurred in 105 of 764 control patients (13.7%), including 13 (12.3%) with perforation. The overall mortality rate of controls was 25%, which was similar to the overall 25.5% mortality rate in the PDA/INDO study group.
These data indicate that there is increased risk of NEC and bowel perforation in premature infants with PDA receiving INDO. Mortality was higher in the PDA/INDO group with NEC than those PDA/INDO infants without NEC.
作者评估了接受吲哚美辛（INDO）以关闭动脉导管未闭（PDA）的极低出生体重儿发生坏死性小肠结肠炎（NEC）的风险。
对于管理患有PDA的极低出生体重儿的最佳方法以及是否采用INDO进行药物治疗或手术结扎动脉导管存在争议。
252例有症状性PDA的早产儿每12小时静脉注射INDO 0.2mg/kg，共3次，试图关闭动脉导管。对患者的性别、出生体重、胎龄、动脉导管关闭情况、NEC的发生、肠穿孔和死亡率进行评估。
有135名男孩和117名女孩。224例（89%）的PDA关闭或无症状，而28例（11%）需要手术结扎。90例（35%）婴儿在INDO治疗后出现NEC迹象。56例接受药物治疗；90例中的34例（37.8%）或整个PDA/INDO研究组的13%需要手术干预。27例（30%）发现肠穿孔。与NEC发生相关的因素包括胎龄<28周、出生体重<1kg和机械通气支持时间延长。总体死亡率为25.5%，但NEC婴儿的死亡率高于无NEC的婴儿。穿孔性NEC病例的死亡率最高。将PDA/INDO患者与764例性别分布、出生体重和胎龄相似但无PDA且未接受INDO的婴儿组成的对照组进行比较。764例对照患者中有105例（13.7%）发生坏死性小肠结肠炎，其中13例（12.3%）发生穿孔。对照组的总体死亡率为25%，与PDA/INDO研究组的总体死亡率25.5%相似。
这些数据表明，接受INDO的患有PDA的早产儿发生NEC和肠穿孔的风险增加。有NEC的PDA/INDO组的死亡率高于无NEC的PDA/INDO婴儿。
