Effects of Prophylactic Indomethacin on Vasopressor-Dependent Hypotension in Extremely Preterm Infants.
Effects of Prophylactic Indomethacin on Vasopressor-Dependent Hypotension in Extremely Preterm Infants.
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DOI：
10.1016/j.jpeds.2016.11.008
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Clyman RI
中科院分区：
文献类型：
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作者：
Liebowitz M;Koo J;Wickremasinghe A;Allen IE;Clyman RI
To determine if a moderate-to-large PDA is responsible for vasopressor-dependent hypotension, occurring at the end of the first postnatal week. We performed a retrospective double cohort controlled study of infants delivered at ≤27+6 weeks gestation (n=313). From January 2004 through April 2011, all infants were treated with prophylactic indomethacin (PINDO epoch). From May 2011 through December 2015 no infant was treated with indomethacin until at least 8 postnatal days (Conservative epoch). Echocardiograms were performed on postnatal days 6 or 7. Hypotension was managed by a predefined protocol. The primary outcome was the incidence of dopamine-dependent hypotension, defined as having received at least 6 µg/kg/min dopamine for at least 24 hours during postnatal days 4–7. As expected, the incidence of moderate-to-large PDA at the end of the first week differed significantly between epochs (PINDO=8%; Conservative=64%). In multivariate analyses, PINDO infants had a significantly lower incidence of vasopressor-dependent hypotension (11%) than Conservative infants (21%)(OR=0.40, 95% CI: 0.20–0.82). PINDO infants also required less Mean Airway Pressure, had a lower Respiratory Severity Score and lower Mode of Ventilation Score than Conservative infants during postnatal days 4–7. The effects of PINDO on both the incidence of vasopressor-dependent hypotension and the need for respiratory support were no longer significant when analyses were adjusted for “presence or absence of a moderate-to-large PDA”. PINDO decreases vasopressor-dependent hypotension and the need for respiratory support at the end of the first postnatal week. These effects are mediated by closure of the PDA.
