What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?
What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?
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DOI：
10.1038/jp.2011.102
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发表时间：
2012-05-01
影响因子：
2.9
通讯作者：
Grunkemeier, G.
中科院分区：
文献类型：
--
作者：
Kaempf, J. W.;Wu, Y. X.;Grunkemeier, G.
目的：目前尚不清楚是否需要吲哚美辛（INDO）和/或手术结扎（LIGATE）来改善早产儿动脉导管未闭（PDA）的预后。我们采用保守的方法来管理PDA，强调等待自发关闭，除非满足某些心肺窘迫标准。研究设计：这是一项在两个不同时期出生的501至1500克婴儿的前后观察性研究。第1期（2005年1月至2007年12月）采用传统的管理方法，早期使用INDO和LIGATE关闭所有接受任何呼吸支持的婴儿的中大型pda。第2时代（2008年1月至2009年6月）强调适度的液体限制，观察等待和限制INDO和LIGATE，只有那些大pda符合某些心肺窘迫标准的婴儿。结果：Era 1纳入139例PDA患儿，平均（s.d）胎龄27.5(2)周；年龄：72例，平均胎龄27.5(2)周。在第二阶段，INDO的使用显著下降(79%的婴儿降至26%，P
Objective: It remains unclear whether indomethacin (INDO) and/or surgical ligation (LIGATE) are necessary to improve outcomes in premature infants with a patent ductus arteriosus (PDA). We have adopted a conservative approach to PDA management that emphasizes waiting for spontaneous closure unless certain cardiorespiratory distress criteria are met.Study Design: This was a before-after observational study in infants born 501 to 1500 g in two distinct epochs. Era 1 (January 2005 to December 2007) featured traditional management with INDO and LIGATE used early to close all moderate and large PDAs in infants receiving any respiratory support. Era 2 (January 2008 to June 2009) emphasized modest fluid restriction, watchful waiting and limited INDO and LIGATE to only those infants with large PDAs who met certain cardiorespiratory distress criteria.Result: Era 1 included 139 infants with a PDA, mean (s.d.) gestational age 27.5 (2) weeks; Era 2 72 infants, mean (s.d.) gestational age 27.5 (2) weeks. In Era 2, INDO use significantly decreased (79% of infants to 26%, P