Patent ductus arteriosus in preterm infants born at 23-24 weeks' gestation: Should we pay more attention?

被引：24

作者：

Dani, Carlo ^{[1
,2
]}

Mosca, Fabio ^{[3
,4
]}

Cresi, Francesco ^{[5
]}

Lago, Paola ^{[6
]}

Lista, Gianluca ^{[7
]}

Laforgia, Nicola ^{[8
]}

Del Vecchio, Antonello ^{[9
]}

Corvaglia, Luigi ^{[10
]}

Paolillo, Piermichele ^{[11
]}

Trevisanuto, Daniele ^{[12
]}

Capasso, Letizia ^{[13
]}

Fanos, Vassilios ^{[14
,15
]}

Maffei, Gianfranco ^{[16
]}

Boni, Luca ^{[17
]}

机构：

[1] Careggi Univ Hosp Florence, Div Neonatol, Largo Brambilla 3, I-50141 Florence, Italy

[2] Careggi Univ Hosp Florence, Dept Neurosci Psychol Drug Res & Child Hlth, Florence, Italy

[3] NICU Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy

[4] Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy

[5] Univ Turin, Dept Publ Hlth & Pediat, Neonatal Intens Care Unit, Turin, Italy

[6] Ca Foncello Hosp, NICU, Treviso, Italy

[7] V Buzzi Childrens Hosp ASST FBF Sacco, Div Neonatol, Milan, Italy

[8] Univ Aldo Moro Bari, Neonatal Intens Care Unit, Bari, Italy

[9] Di Venere Hosp Bari, Dept Womens & Childrens Hlth, Neonatal Intens Care Unit, Bari, Italy

[10] Univ Bologna, Dept Med & Surg Sci, Neonatal Intens Care Unit, Bologna, Italy

[11] ASL RM B, Casilino Gen Hosp, Dept Maternal & Child Hlth, Div Neonatol & Neonatal Intens Care, Rome, Italy

[12] Univ Padua, Azienda Osped Padova, Dept Womans & Childs Hlth, Padua, Italy

[13] Univ Naples Federico II, Dept Translat Med Sci, Sect Pediat, Div Neonatol, Naples, Italy

[14] Univ Cagliari, Neonatal Intens Care Unit, Inst Puericulture, Cagliari, Italy

[15] Univ Cagliari, Dept Surg, Neonatal Sect, Cagliari, Italy

[16] Univ Hosp Foggia, Neonatal Intens Care Unit, Foggia, Italy

[17] Careggi Univ Hosp Florence, Clin Trials Coordinating Ctr, Florence, Italy

来源：

EARLY HUMAN DEVELOPMENT | 2019年 / 135卷

关键词：

Patent ductus arteriosus; Ibuprofen; Paracetamol; Surgical closure; Preterm infant; REPEATED COURSES; INDOMETHACIN; ASSOCIATION; IBUPROFEN; CLOSURE; MANAGEMENT; EVOLUTION; LIGATION;

D O I：

10.1016/j.earlhumdev.2019.06.002

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Background: Infants born at 23-24 weeks' gestation have the highest risk of developing a hemodynamically significant patent ductus arteriosus (hsPDA), that is refractory to pharmacological closure requiring surgical ligation. Thus, these patients might have the greatest benefits from hsPDA closure, although previous studies on PDA closure were not focused on this population. Aim: To compare the occurrence of hsPDA, failure rate of the first course of ibuprofen in closing hsPDA, and need of surgical closure in infants born at 23(+0)-24(+6) weeks' gestation to those in infants born at 25(+0)-28(+6) weeks' gestation. Study design: This is a retrospective multicenter study including infants born at 23(+0)-28(+6) weeks of gestation admitted to the neonatal care units from January 2013 to December 2017. All infants underwent echocardiographical assessment for hsPDA diagnosis and eventually pharmacological treatment, and surgical closure. Results: We studied a total of 842 infants of which 562 (67%) developed a PDA. Among those with PDA, 511 (91%) received a pharmacological treatment for a hsPDA. We found that a hsPDA occurred in 70% (106/151) of infants born at 23-24 weeks and in 59% (405/691) of infants born at 25-28 weeks of gestation (P < 0.001). Failure of closure with the first-treatment cycle (69 vs. 40%; P < 0.001) and need of surgical closure (19 vs 10%) were more frequent (P < 0.011) in infants born at 23-24 than 25-28 gestational weeks. Paracetamol vs. ibuprofen treatment and gestational age of 23-24 versus 25-28 weeks increased closure failure, while less severe RDS and maternal clinical chorioamnionitis decreased it. Conclusions: Among extremely preterm infants, infants born at 23-24 weeks of gestation have the highest risk of developing a hsPDA refractory to pharmacological treatment requiring surgical closure. Our findings support the need of individualized more careful strategies for hsPDA management in this special population.

引用

页码：16 / 22

页数：7

共 29 条

[1] Chorioamnionitis appears not to be a Risk Factor for Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis [J].