Zanardo V, Trevisanuto D, Dani C, Milanesi O, Secchieri S, Guglielmi A, Brentegani L, Cantarutti F
Department of Pediatrics, Padua University, Italy.
J Perinat Med. 1995;23(6):493-9. doi: 10.1515/jpme.1995.23.6.493.
We conducted a clinical study on the antecedents of bronchopulmonary dysplasia (BPD) in 290 premature RDS infants with < or = 1.75 kg birth weight (BW). They were enrolled in a prospective trial of indomethacin treatment for "silent" patent ductus arteriosus (PDA), screened by 2-D echocardiographic and pulsed Doppler evaluation on the third day of life. The trial took place at the NICU of the Pediatric Department of Padua University between January 1987 and December 1991. Out of 290 infants screened, 96 had evidence of "silent" PDA (33%) and 77 responded to indomethacin treatment (80%). Comprehensively 79 (27%) developed BPD, and from these the incidence of BPD was statistically increased in infants with "silent" PDA, 47 out of 96 (49 +/- 9%), with respect to 32 out of 194 (16 +/- 3%) preterm infants without PDA. Statistical analysis showed that in preterm infants with "silent" PDA the development of BPD was correlated at 99% C.L. to their low BWs (mean BW = 1.13 kg): in fact the mean and the mode of BW distributions were statistically lower in the presence of BPD, 1.03 kg versus 1.24 kg, and 0.88 kg versus 1.65 kg respectively. Moreover, the preterm infants with "silent" PDA unresponsive to the first course of indomethacin and/or submitted later to surgical closure, presented a statistically lower BW with respect to the early responders, 1.06 kg versus 1.18 kg, and at the same time a statistically higher incidence of BPD (63 +/- 20% versus 43 +/- 9%). From these data we conclude that, although "silent", PDA increase per se the incidence of BPD, even if benefits from an early induced closure. Furthermore, a lower BW of infants affected by "silent" PDA represents a contributing factor to the development of BPD.
我们对290例出生体重（BW）≤1.75kg的早产呼吸窘迫综合征（RDS）婴儿进行了一项关于支气管肺发育不良（BPD）病因的临床研究。他们参加了一项关于吲哚美辛治疗“无症状”动脉导管未闭（PDA）的前瞻性试验，在出生后第三天通过二维超声心动图和脉冲多普勒评估进行筛查。该试验于1987年1月至1991年12月在帕多瓦大学儿科新生儿重症监护病房（NICU）进行。在290例接受筛查的婴儿中,96例有“无症状”PDA的证据（33%），77例对吲哚美辛治疗有反应（80%）。总共有79例（27%）发生了BPD，其中“无症状”PDA婴儿中BPD的发生率在统计学上高于无PDA的早产婴儿，96例中有47例（49±9%），而194例中32例（16±3%）。统计分析表明，在有“无症状”PDA的早产婴儿中，BPD的发生在99%置信区间与低出生体重相关（平均出生体重=1.13kg）：事实上，存在BPD时出生体重分布的均值和众数在统计学上更低，分别为1.03kg对1.24kg，以及0.88kg对1.65kg。此外，对第一疗程吲哚美辛无反应和/或后来接受手术闭合的“无症状”PDA早产婴儿，其出生体重在统计学上低于早期有反应者，分别为1.06kg对1.18kg，同时BPD的发生率在统计学上更高（63±20%对43±9%）。从这些数据我们得出结论，尽管是“无症状”的，PDA本身会增加BPD的发生率，即使早期诱导闭合有益。此外，受“无症状”PDA影响的婴儿出生体重较低是BPD发生的一个促成因素。
