Comparative Effectiveness of Nonsteroidal Anti-inflammatory Drug Treatment vs No Treatment for Patent Ductus Arteriosus in Preterm Infants.
Comparative Effectiveness of Nonsteroidal Anti-inflammatory Drug Treatment vs No Treatment for Patent Ductus Arteriosus in Preterm Infants.
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非甾体类抗炎药物治疗的比较有效性与在早产儿中没有专利导管的治疗。
DOI：
10.1001/jamapediatrics.2016.4354
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发表时间：
2017-03-06
期刊：
影响因子：
26.1
通讯作者：
Klebanoff MA
中科院分区：
文献类型：
--
作者：
Slaughter JL;Reagan PB;Newman TB;Klebanoff MA
动脉导管未闭（PDA）与早产儿死亡率增加和呼吸结果恶化有关，包括支气管肺发育不良（BPD）。非甾体抗炎药（NSAIDs）对关闭PDA有效，但nsaid介导的关闭PDA在改善死亡率和预防BPD方面的有效性尚不清楚。确定非甾体抗炎药治疗PDA在降低经后36周死亡率和中/重度BPD方面的有效性。在2006年1月至2013年12月期间出院的婴儿回顾性队列中，我们进行了工具变量分析，纳入了基于提供者偏好的非甾体抗炎药治疗频率的制度差异，以确定非甾体抗炎药治疗PDA对死亡率和BPD的影响。纳入儿科健康信息系统的25家美国儿童医院的新生儿重症监护病房（NICUs）。12,018名出生≤28周的婴儿在出生日期入住NICU，住院至少3天。每个婴儿机构在婴儿出生后±6个月内接受非甾体抗炎药治疗的婴儿的比例。主要综合结局为36周月经后死亡、中度或重度BPD。该工具，即在婴儿出生后±6个月内在每个婴儿医院接受非甾体抗炎药治疗的婴儿比例，与非甾体抗炎药治疗显著相关，而与妊娠、种族或性别无显著相关。在给定的医院，每增加1个百分点的年度非甾体抗炎药治疗百分比，单个婴儿接受非甾体抗炎药治疗的机会增加0.84个百分点（95% CI: 0.8-0.9; p<0.001）。工具变量分析显示，非甾体抗炎药治疗与幸存者的死亡率或BPD （or 0.94 [95% CI: 0.70, 1.25]）、死亡率（0.73[0.43,1.13]）或BPD（1.01[0.73, 1.45]）之间无显著关联。当我们将基于提供者偏好的实践变化作为最小化未测量混杂影响的工具时，我们发现在出生后2-28天开始使用非甾体抗炎药治疗PDA的相似≤28周的早产儿中，死亡率或中度/重度BPD的几率没有变化。我们的研究结果与现有的随机试验证据一致，支持采用保守方法治疗PDA。
Patent Ductus Arteriosus (PDA) is associated with increased mortality and worsened respiratory outcomes including bronchopulmonary dysplasia (BPD) in preterm infants. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are efficacious in closing PDA, but the effectiveness of NSAID-mediated PDA closure in improving mortality and preventing BPD is unclear. To determine the effectiveness of NSAID treatment for PDA in reducing mortality and moderate/severe BPD at 36-weeks postmenstrual age. Within a retrospective cohort of infants discharged between January 2006–December 2013, we performed an instrumental variable analysis that incorporated provider preference-based, institutional variation in NSAID treatment frequency to determine the effect of NSAID treatment for PDA on mortality and BPD. Neonatal Intensive Care Units (NICUs) within 25 United States’ Children’s Hospitals included in the Pediatric Health Information System. 12,018 infants born at ≤28-weeks-gestation who were admitted to the NICU on their birth date and hospitalized at least 3 days. Proportion of NSAID treated infants born at each infant’s institution within ±6-months of that infant’s birth. The primary composite outcome was death, moderate, or severe BPD at 36-weeks’ postmenstrual age. The instrument, the proportion of NSAID treated infants at each unique infant’s hospital within ±6-months of that infant’s birth, was significantly associated with NSAID treatment and not significantly associated with gestation, race, or gender. An individual infant’s chances of receiving NSAID treatment increased by 0.84 percentage points (95% CI: 0.8–0.9; p<0.001) for every 1 percentage point increase in the annual NSAID treatment percentage at a given hospital. Instrumental variable analysis demonstrated no significant association between NSAID treatment and the odds of mortality or BPD (OR 0.94 [95% CI: 0.70, 1.25]), mortality (0.73 [0.43, 1.13]), or BPD in survivors (1.01 [0.73, 1.45]). When we incorporated provider preference-based practice variation as an instrument to minimize the effect of unmeasured confounding, we detected no changes in the odds of mortality or moderate/severe BPD among similar ≤28-week gestation preterm infants following NSAID treatment for PDA initiated 2–28 days postnatally. Our findings are in agreement with available randomized trial evidence and support a conservative approach to PDA management.
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影响因子：
2.9
作者：
Benitz, W. E.
通讯作者：
Benitz, W. E.
影响因子：
2.9
作者：
Hermes-DeSantis, E. R.;Clyman, R. I.
通讯作者：
Clyman, R. I.
影响因子：
2
作者：
Lainwala, Shabnam;Hussain, Naveed
通讯作者：
Hussain, Naveed
DOI：
10.1164/rccm.201101-0055oc
发表时间：
2011-06-15
影响因子：
24.7
作者：
Laughon, Matthew M.;Langer, John C.;Walsh, Michele C.
通讯作者：
Walsh, Michele C.
DOI：
10.1177/0272989x11416512
发表时间：
2012-01
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
--
作者：
Newman TB;Vittinghoff E;McCulloch CE
通讯作者：
McCulloch CE