Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3
Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3
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DOI：
10.1136/archdischild-2013-303816
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发表时间：
2013-11-01
影响因子：
4.4
通讯作者：
Henriksen, Tine Brink
中科院分区：
文献类型：
--
作者：
Sellmer, Anna;Bjerre, Jesper Vandborg;Henriksen, Tine Brink
目的探讨出生第3天动脉导管未闭（PDA）与重症发病率和死亡率的关系。设计队列研究。丹麦奥胡斯大学医院新生儿重症监护室。2010 ~ 2012年所有胎龄小于32周的新生儿入院。干预措施所有新生儿（183例）在出生后第3天例行超声心动图筛查PDA。通过结构化编码表和医疗记录收集基线特征和结果信息。评估PDA直径与肺出血、脑室内出血（IVH）、坏死性小肠结肠炎、支气管肺发育不良（BPD）、死亡以及死亡或严重发病率的复合结局之间的关系。在28孕周之前出生的新生儿中，与没有PDA的新生儿相比，出生第3天发生PDA与死亡或严重发病率增加3倍相关（or =3.4; CI 1.1 - 11）。在PDA较大（直径1.5mm）的新生儿中，发生率最高。与没有PDA的新生儿相比，PDA大的新生儿IVH （OR 4.2, CI 1.3 - 14）和BPD （OR 3.7, CI 1.0 - 14）的几率也增加。结论：胎龄小于28周的新生儿出生后第3天出现PDA与不良结局相关；这种联系在大型PDA上更为明显。因此，早期超声心动图可能有助于在未来的随机对照试验中识别适合采取有针对性干预措施的新生儿。
Objective To assess the association between a patent ductus arteriosus (PDA) on day 3 of life and severe morbidity and mortality.Design Cohort study.Setting Neonatal Intensive Care Unit, Aarhus University Hospital, Denmark.Patients All neonates with a gestational age less than 32weeks admitted from 2010 to 2012.Interventions All neonates (n=183) were routinely screened with echocardiography for PDA on day 3 of life. Information on baseline characteristics and outcome was collected by structured coding sheets and medical records.Main outcome measures The association among PDA diameter and pulmonary haemorrhage, intraventricular haemorrhage (IVH), necrotising enterocolitis, bronchopulmonary dysplasia (BPD), death, and the composite outcome of death or severe morbidity was assessed.Results In neonates, born prior to 28 gestational weeks, a PDA on day 3 of life was associated with a threefold increase in odds of death or severe morbidity compared with neonates without PDA (OR=3.4; CI 1.1 to 11). The odds were highest in neonates with a large PDA (diameter 1.5mm). Neonates with a large PDA were also found to have increased odds of IVH (OR 4.2; CI 1.3 to 14) and BPD (OR 3.7; CI 1.0 to 14) compared with neonates with no PDA.Conclusions In neonates born with a gestational age below 28weeks the presence of a PDA on day 3 of life was associated with adverse outcome; this association was even more pronounced with a large PDA. Thus, early echocardiography may facilitate the identification of neonates suitable for a targeted approach to intervention in future randomised controlled trials.