Lee C S, Hwang B, Lu J H, Soong W J, Chen S J
Department of Pediatrics, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Feb;61(2):93-8.
Premature neonatal survival rates have increased significantly. The diagnosis of patent ductus arteriosus (PDA) has also increased. In this paper, we present our experience of incidence, clinical features and outcome of the treatment of symptomatic PDA in very low birth weight infants.
From January 1990 to December 1995, 181 premature infants with birth weight less than 1,500 g were admitted to the Neonatal Intensive Care Unit (NICU) of Veterans General Hospital-Taipei. Thirty-seven were diagnosed to have symptomatic PDA. By reviewing hospital records, the clinical features and outcome of treatment of these infants were analyzed retrospectively.
The incidence of symptomatic PDA was 20.9% and 21.4% in infants with birth weight less than or equal to 1,000 g, 1,001-1,500 g, respectively. The mean age at diagnosis of infants with symptomatic PDA was significantly less than those without symptoms (3.6 +/- 2.9 days vs 9.6 +/- 17.2 days, p = 0.044, 95% CI = 0.2-11.8). With fluid restriction and diuretic therapy, asymptomatic patients had a higher spontaneous ductal closure rate than symptomatic patients (58.3% vs 10.8%, p < 0.001, 95% CI = 17.9-77.1%). Thirty-two (97.0%) infants with symptomatic PDA responded to indomethacin therapy. However, four infants (12.1%) had recurrence. These four infants and a nonresponder received surgical ligation of the PDA and survived. There were four deaths. The reasons for death were respiratory failure in two, sepsis in one and necrotizing enterocolitis with intestinal perforation in one.
Conservative medical management such as fluid restriction and diuretics are often adequate for asymptomatic PDA. However, since symptomatic PDA tends not to close spontaneously, patients should be treated with indomethacin if ductal shunting compromises cardiopulmonary function.
早产新生儿存活率显著提高。动脉导管未闭（PDA）的诊断率也有所上升。本文介绍了我们在极低出生体重儿有症状PDA的发病率、临床特征及治疗结果方面的经验。
1990年1月至1995年12月，181例出生体重小于1500g的早产儿入住台北荣民总医院新生儿重症监护病房（NICU）。37例被诊断为有症状PDA。通过查阅医院记录，对这些婴儿的临床特征及治疗结果进行回顾性分析。
出生体重小于或等于1000g、1001 - 1500g的婴儿中，有症状PDA的发病率分别为20.9%和21.4%。有症状PDA婴儿的诊断平均年龄显著低于无症状婴儿（3.6±2.9天 vs 9.6±17.2天，p = 0.044，95%可信区间 = 0.2 - 11.8）。通过限制液体摄入和利尿治疗，无症状患者的动脉导管自然闭合率高于有症状患者（58.3% vs 10.8%，p < 0.001，95%可信区间 = 17.9 - 77.1%）。32例（97.0%）有症状PDA婴儿对吲哚美辛治疗有反应。然而，4例婴儿（12.1%）复发。这4例婴儿和1例无反应者接受了PDA手术结扎并存活。有4例死亡。死亡原因分别为2例呼吸衰竭、1例败血症和1例坏死性小肠结肠炎伴肠穿孔。
对于无症状PDA，限制液体摄入和使用利尿剂等保守药物治疗通常就足够了。然而，由于有症状PDA往往不会自然闭合，如果动脉导管分流影响心肺功能，患者应接受吲哚美辛治疗。
