Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants
Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants
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DOI：
10.1016/j.jpeds.2017.02.003
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发表时间：
2017-07-01
影响因子：
5.1
通讯作者：
Schmidt, Barbara
中科院分区：
文献类型：
--
作者：
Jensen, Erik A.;Dysart, Kevin C.;Schmidt, Barbara
目的在最近的一个大型极早产儿队列中评估预防性吲哚美辛与支气管肺发育不良（BPD）之间的关系。研究设计回顾性队列研究，前瞻性收集2008年至2012年在国家儿童健康与人类发展研究所新生儿研究网络参与医院出生的胎龄< 29周或出生体重401- 1000g的婴儿数据。在出生后24小时内接受吲哚美辛治疗的婴儿与未接受吲哚美辛治疗的婴儿进行比较。研究结果包括BPD，定义为存活者在经后36周时使用补充氧，死亡，以及死亡或BPD的复合。进行预先指定的亚组分析。结果不同医院预防性使用吲哚美辛的情况不同。在2587名接受预防性吲哚美辛治疗的婴儿中，出生第一天后动脉导管未闭的治疗较少，而未接受预防性吲哚美辛治疗的婴儿为5244名（21.0% vs 36.1%, P < 0.001）。在对潜在混杂因素进行校正后，预防性使用吲哚美辛与BPD （or 0.89, 95% CI 0.72-1.10）、死亡（or 0.80, 95% CI 0.64-1.01）、死亡或BPD （or 0.87, 95% CI 0.71-1.05）的发生率升高或降低无关。与预防性吲哚美辛相关的亚组效应的唯一证据是，出生体重超过10%的婴儿和出生后第一天未接受动脉导管未闭治疗的婴儿的死亡几率较低。结论：预防性使用吲哚美辛与BPD或死亡风险的降低或增加无关。
Objective To assess the association between prophylactic indomethacin and bronchopulmonary dysplasia (BPD) in a recent, large cohort of extremely preterm infants.Study design Retrospective cohort study using prospectively collected data for infants with gestational ages < 29 weeks or birth weights of 401-1000 g born between 2008 and 2012 at participating hospitals of the National Institute of Child Health and Human Development Neonatal Research Network. Infants treated with indomethacin in the first 24 hours of life were compared with those who were not. Study outcomes were BPD, defined as use of supplemental oxygen at 36 weeks postmenstrual age among survivors to that time point, death, and the composite of death or BPD. Prespecified subgroup analyses were performed.Results Prophylactic indomethacin use varied by hospital. Treatment of a patent ductus arteriosus after the first day of life was less common among 2587 infants who received prophylactic indomethacin compared with 5244 who did not (21.0% vs 36.1%, P < .001). After adjustment for potential confounders, use of prophylactic indomethacin was not associated with higher or lower odds of BPD (OR 0.89, 95% CI 0.72-1.10), death (OR 0.80, 95% CI 0.64-1.01), or death or BPD (OR 0.87, 95% CI 0.71-1.05). The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life.Conclusions Prophylactic indomethacin was not associated with either reduced or increased risk for BPD or death.