Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?
Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?
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DOI：
10.1038/jp.2010.3
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发表时间：
2010-04-01
影响因子：
2.9
通讯作者：
Benitz, W. E.
中科院分区：
文献类型：
--
作者：
Benitz, W. E.
医疗和手术干预广泛用于闭合早产儿持续未闭的动脉导管。缺乏支持这些做法的客观证据，导致一些人质疑它们的使用。新出现的证据表明，封闭导管未闭的治疗可能是有害的。这篇综述探讨了这些治疗的历史和证据。无论是单独的试验、随机对照试验组的汇总数据，还是对治疗直接后果的严格检查，都没有提供证据表明导管导管的药物或手术闭合对早产儿是有益的。这些结论是有充分证据支持的。继续常规使用这些治疗方法或使用类似设计的额外临床试验似乎都不合理。可能需要进行一项明确的试验，将当前的标准管理与主要并非旨在实现导管闭合的新策略进行比较，以解决对先前研究的质量或进行的疑问。围产期杂志 (2010) 30, 241-252; doi：10.1038/jp.2010.3； 2010 年 2 月 25 日在线发布
Medical and surgical interventions are widely used to close a persistently patent ductus arteriosus in preterm infants. Objective evidence to support these practices is lacking, causing some to question their usage. Emerging evidence suggests that treatments that close the patent ductus may be detrimental. This review examines the history of and evidence underlying these treatments. Neither individual trials, pooled data from groups of randomized-controlled trials, nor critical examination of the immediate consequences of treatment provide evidence that medical or surgical closure of the ductus is beneficial in preterm infants. These conclusions are supported by sufficient evidence. Neither continued routine use of these treatments nor additional clinical trials using similar designs seems to be justified. A definitive trial, comparing current standard management with novel strategies not primarily intended to achieve ductal closure, may be necessary to resolve doubts regarding the quality or conduct of prior studies. Journal of Perinatology (2010) 30, 241-252; doi: 10.1038/jp.2010.3; published online 25 February 2010