日本常规超声心动图对早产儿动脉导管未闭的主动诊断和定制治疗:PLASE 研究的事后分析。

Neonatology Pub Date : 2024-04-09 DOI:10.1159/000538363
Seiichi Tomotaki, Tetsuya Isayama, Tohru Kobayashi, Satoshi Masutani, Hidenori Kawasaki, Atsushi Nakayama, Toshifumi Ikeda, K. Toyoshima
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引用次数: 0

摘要

简介在日本,极早产儿管理的一个特点是由新生儿科医生使用早期常规超声心动图进行积极的循环管理。方法本研究是对早产儿动脉导管未闭和左心房大小评估(PLASE)研究的一项事后分析,该研究是一项前瞻性队列研究,包括 2015 年 10 月至 2016 年 12 月期间在日本 34 家三级新生儿重症监护病房收治的早产儿。我们描述了基于早期常规超声心动图的动脉导管未闭(PDA)治疗策略的细节。结果共有613名早产儿纳入分析。20%使用预防性吲哚美辛的早产儿在完成整个预防性吲哚美辛疗程前改用治疗性环氧化酶抑制剂(COX-I)。治疗性 COX-I 大多是在 PDA 出现症状或血流动力学显著变化之前根据超声心动图结果使用的。在完成整个疗程(三剂)之前,治疗性 COX-I 经常在服用一到两剂后停止。与完成 3 个疗程的婴儿相比,停用 COX-I 疗程(<3 个疗程)后需要额外治疗(额外的 COX-I 疗程或手术关闭 PDA)的婴儿比例明显降低(第一个 COX-I 疗程后 46% 对 68%,P < 0.结论日本 PDA 临床治疗的特点是:(1) 在出现症状或血流动力学显著的 PDA 之前,根据超声心动图结果服用 COX-I;(2) 在完成标准的 3 个剂量疗程之前,频繁停用治疗性 COX-I。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proactive Diagnosis and Tailor-Made Treatment of Patent Ductus Arteriosus in Very Preterm Infants with Routine Echocardiography in Japan: A post hoc Analysis of the PLASE Study.
INTRODUCTION A feature of the management of extremely preterm infants in Japan is proactive circulatory management using early routine echocardiography performed by neonatologists. METHODS This study was a post hoc analysis of the Patent ductus arteriosus and Left Atrial Size Evaluation in preterm infants (PLASE) study, which is a prospective cohort study including preterm infants admitted to 34 tertiary neonatal intensive care units in Japan between October 2015 and December 2016. We described the details of the treatment strategy of patent ductus arteriosus (PDA) based on early routine echocardiography. RESULTS In total, 613 preterm infants were included into the analysis. Twenty percent of infants with prophylactic indomethacin were switched to therapeutic cyclooxygenase inhibitor (COX-I) before the completion of the full prophylactic indomethacin course. Therapeutic COX-I was mostly administered based on echocardiographic findings before PDA became symptomatic or hemodynamically significant. Therapeutic COX-I was frequently discontinued after one or two doses before the full course (three doses) was completed. The proportion of infants requiring additional treatment (additional therapeutic COX-I course or surgical PDA closure) after discontinued COX-I courses (<3 doses) compared to infants after completed 3 doses course was significantly lower (after the first therapeutic COX-I course 46% vs. 68%, p < 0.001) or without a significant difference (after the second or third course). CONCLUSIONS The clinical management of PDA in Japan featured (1) COX-I administration based on echocardiographic findings before symptomatic or hemodynamically significant PDA appeared and (2) frequent discontinuation of therapeutic COX-I before completing the standard three doses course.
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