Failure of a repeat course of cyclooxygenase inhibitor to close a PDA is a risk factor for developing chronic lung disease in ELBW infants
Failure of a repeat course of cyclooxygenase inhibitor to close a PDA is a risk factor for developing chronic lung disease in ELBW infants
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DOI：
10.1186/1471-2431-12-10
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发表时间：
2012-01-27
期刊：
影响因子：
2.4
通讯作者：
Lin, Jing
中科院分区：
文献类型：
--
作者：
Adrouche-Amrani, Lynda;Green, Robert S.;Lin, Jing
背景资料：对于极低出生体重儿（ELBW）持续性动脉导管未闭（PDA）的最佳治疗方案或方案尚未完全确定。本研究旨在评价环氧合酶（考克斯）抑制剂（COI）封堵PDA的失败率，并确定需要结扎的ELBW婴儿PDA的发生率。我们研究的临床特点和危险因素，可能预测PDA关闭失败的临床后果COI.Methods：医疗信息138名婴儿出生体重（BW）< 1000 gm who survived for >48小时检索。结果：138例PDA患者中，112例存活出院。80例（71.4%）存活患者接受了1-3个疗程的COI治疗症状性PDA。共32例（40%）COI治疗失败，并接受PDA结扎。多变量Logistic回归分析表明，观察到的差异，在婴儿的结果与或没有症状的PDA可以解释为症状PDA的婴儿更不成熟和病情加重。PDA经药物治疗的婴儿与经药物治疗失败后再行结扎的婴儿的慢性肺病（CLD）发生率无显著差异。然而，在调整了疾病严重程度和其他已知的危险因素后，患有持续性PDA的存活婴儿发展CLD的比值比与那些通过1-2个疗程的COI成功关闭PDA的婴儿相比为3.24（1.07-9.81; p = 0.038）。当成功治疗时，ELBW婴儿的PDA对不良结局（如CLD、早产儿视网膜病变（ROP）和出院年龄）没有显著影响。这表明闭合血流动力学显著的PDA是有益的。COI重复治疗未能闭合PDA是ELBW婴儿发生CLD的主要危险因素。
Background: The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. This study was aimed at evaluating the failure rate of a cyclooxygenase (COX) inhibitor (COI) for PDA closure and to determine the incidence of a PDA requiring ligation in ELBW infants. We examined the clinical characteristics and risk factors that may predict the clinical consequences of failure of PDA closure by COI.Methods: Medical information on 138 infants with birth weight (BW) < 1000 gm who survived for > 48 hours was retrieved. Clinical characteristics and outcomes of patients whose PDAs closed with COI were compared with those who did not close.Results: Of the 138 patients, 112 survived to discharge. Eighty (71.4%) of those who survived received 1-3 courses of COI treatment for a symptomatic PDA. A total of 32 (40%) failed COI treatment and underwent PDA ligation. Multivariable logistic regression analysis suggests that the observed differences in the outcomes in infants with or without symptomatic PDA can be explained by the babies with symptomatic PDA being more immature and sicker. No significant difference was seen in the incidence of chronic lung disease (CLD) in infants whose PDA was treated medically versus those who failed medical treatment and then underwent ligation. However, after adjusting for disease severity and other known risk factors, the odds ratio of developing CLD for surviving babies with a persistent PDA compared to those whose PDA was successfully closed with 1-2 courses of COI is 3.24 (1.07-9.81; p = 0.038).Conclusions: When successfully treated, PDA in ELBW infants did not contribute significantly to the adverse outcomes such as CLD, retinopathy of prematurity (ROP) and age at discharge. This suggests that it is beneficial for a hemodynamically significant PDA to be closed. The failure of a repeat course of COI to close a PDA is a major risk factor for developing CLD in ELBW infants.