Cristina Borràs‐Novell , Ana Riverola , Victoria Aldecoa‐Bilbao , Montserrat Izquierdo , Monica Domingo , Martín Iriondo
{"title":"早产儿动脉导管未闭保守治疗后的临床结果","authors":"Cristina Borràs‐Novell , Ana Riverola , Victoria Aldecoa‐Bilbao , Montserrat Izquierdo , Monica Domingo , Martín Iriondo","doi":"10.1016/j.jpedp.2018.10.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation.</p></div><div><h3>Method</h3><p>Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009–2011), patients who failed medical treatment underwent surgical closure; in second period (2012–2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival‐without‐morbidity were compared.</p></div><div><h3>Results</h3><p>This study included 188 patients (27<!--> <!-->±<!--> <!-->2 weeks, 973<!--> <!-->±<!--> <!-->272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 <em>versus</em> 56% P2, <em>p</em> <!--><<!--> <!-->0.001) and surgical closure (34.5% P1 <em>versus</em> 16.1% P2, <em>p</em> <!--><<!--> <!-->0.001) were observed. No differences were found in chronic lung disease (28.8% <em>versus</em> 13.9%, <em>p</em> <!-->=<!--> <!-->0.056), severe retinopathy of prematurity (7.5% <em>versus</em> 11.8%, <em>p</em> <!-->=<!--> <!-->0.403), necrotizing enterocolitis (15.5% <em>versus</em> 6.9%, <em>p</em> <!-->=<!--> <!-->0.071), severe intraventricular hemorrhage (25.4% <em>versus</em> 18.4%, <em>p</em> <!-->=<!--> <!-->0.264), mortality (17.5% <em>versus</em> 15.2%, <em>p</em> <!-->=<!--> <!-->0.690) or survival‐without‐morbidity adjusted OR<!--> <!-->=<!--> <!-->1.10 (95% CI: 0.55–2.22); <em>p</em> <!-->=<!--> <!-->0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (<em>n</em> <!-->=<!--> <!-->82) showed significant differences: lower incidence of chronic lung disease (50% <em>versus</em> 19.6%, <em>p</em> <!-->=<!--> <!-->0.019) and more survival‐without‐morbidity (20% <em>versus</em> 45.6%, <em>p</em> <!-->=<!--> <!-->0.028) were found.</p></div><div><h3>Conclusion</h3><p>A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival‐without‐morbidity. However, two‐thirds of preterm infants under 26 weeks are still treated.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 2","pages":"Pages 177-183"},"PeriodicalIF":0.0000,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2018.10.007","citationCount":"0","resultStr":"{\"title\":\"Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants\",\"authors\":\"Cristina Borràs‐Novell , Ana Riverola , Victoria Aldecoa‐Bilbao , Montserrat Izquierdo , Monica Domingo , Martín Iriondo\",\"doi\":\"10.1016/j.jpedp.2018.10.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation.</p></div><div><h3>Method</h3><p>Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009–2011), patients who failed medical treatment underwent surgical closure; in second period (2012–2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival‐without‐morbidity were compared.</p></div><div><h3>Results</h3><p>This study included 188 patients (27<!--> <!-->±<!--> <!-->2 weeks, 973<!--> <!-->±<!--> <!-->272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 <em>versus</em> 56% P2, <em>p</em> <!--><<!--> <!-->0.001) and surgical closure (34.5% P1 <em>versus</em> 16.1% P2, <em>p</em> <!--><<!--> <!-->0.001) were observed. No differences were found in chronic lung disease (28.8% <em>versus</em> 13.9%, <em>p</em> <!-->=<!--> <!-->0.056), severe retinopathy of prematurity (7.5% <em>versus</em> 11.8%, <em>p</em> <!-->=<!--> <!-->0.403), necrotizing enterocolitis (15.5% <em>versus</em> 6.9%, <em>p</em> <!-->=<!--> <!-->0.071), severe intraventricular hemorrhage (25.4% <em>versus</em> 18.4%, <em>p</em> <!-->=<!--> <!-->0.264), mortality (17.5% <em>versus</em> 15.2%, <em>p</em> <!-->=<!--> <!-->0.690) or survival‐without‐morbidity adjusted OR<!--> <!-->=<!--> <!-->1.10 (95% CI: 0.55–2.22); <em>p</em> <!-->=<!--> <!-->0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (<em>n</em> <!-->=<!--> <!-->82) showed significant differences: lower incidence of chronic lung disease (50% <em>versus</em> 19.6%, <em>p</em> <!-->=<!--> <!-->0.019) and more survival‐without‐morbidity (20% <em>versus</em> 45.6%, <em>p</em> <!-->=<!--> <!-->0.028) were found.</p></div><div><h3>Conclusion</h3><p>A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival‐without‐morbidity. However, two‐thirds of preterm infants under 26 weeks are still treated.</p></div>\",\"PeriodicalId\":100742,\"journal\":{\"name\":\"Jornal de Pediatria (Vers?o em Português)\",\"volume\":\"96 2\",\"pages\":\"Pages 177-183\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.jpedp.2018.10.007\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Jornal de Pediatria (Vers?o em Português)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2255553619300709\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jornal de Pediatria (Vers?o em Português)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2255553619300709","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants
Objective
Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation.
Method
Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009–2011), patients who failed medical treatment underwent surgical closure; in second period (2012–2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival‐without‐morbidity were compared.
Results
This study included 188 patients (27 ± 2 weeks, 973 ± 272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p < 0.001) and surgical closure (34.5% P1 versus 16.1% P2, p < 0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p = 0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p = 0.403), necrotizing enterocolitis (15.5% versus 6.9%, p = 0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p = 0.264), mortality (17.5% versus 15.2%, p = 0.690) or survival‐without‐morbidity adjusted OR = 1.10 (95% CI: 0.55–2.22); p = 0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n = 82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p = 0.019) and more survival‐without‐morbidity (20% versus 45.6%, p = 0.028) were found.
Conclusion
A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival‐without‐morbidity. However, two‐thirds of preterm infants under 26 weeks are still treated.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
