Mara K Weigner, Sherry L Kausch, Karen D Fairchild, Brynne A Sullivan
{"title":"药物治疗动脉导管未闭对极低出生体重儿急性呼吸和氧合指标的影响。","authors":"Mara K Weigner, Sherry L Kausch, Karen D Fairchild, Brynne A Sullivan","doi":"10.1055/a-2441-6639","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong> Hypoxemia and respiratory compromise occur in very low birth weight (VLBW, <1,500 g) infants and may be associated with shunting across patent ductus arteriosus (PDA). The impact of pharmacologic PDA treatment on acute hypoxemia and respiratory metrics is unclear. This study aimed to determine whether pharmacologic PDA treatment is associated with acute improvement in hypoxemia and respiratory metrics in VLBW infants.</p><p><strong>Study design: </strong> At a single center (2012-2022), all VLBW infants with echocardiographic evidence of PDA and without exclusions were classified as having received or not received pharmacologic PDA treatment (PDA-T and PDA-NT). Mean daily fraction of inspired oxygen (FIO<sub>2</sub>) and Respiratory Acuity Score (RAS, PMID 30374050) were compared at baseline (day 0) and 3 days after the start of treatment. For PDA-T infants with archived 0.5 Hz (every 2-second) oxygen saturation (SpO<sub>2</sub>) data, mean daily SpO<sub>2</sub> and the percentage of time with severe hypoxemia (SpO<sub>2</sub> <80%) were compared before and after treatment. Severe hypoxemia was further analyzed after stratification by clinical variables (sex, medication, gestational age, and postnatal age).</p><p><strong>Results: </strong> We analyzed 125 VLBW infants with PDA, of whom 66 received pharmacologic PDA treatment. We analyzed a subgroup of 43 PDA-T infants with every 2-second SpO<sub>2</sub> data available. PDA-T infants had higher baseline FiO<sub>2</sub> and RAS and lower SpO<sub>2</sub> than PDA-NT infants (<i>p</i> < 0.05). Compared to baseline, RAS decreased from a median of 258 (interquartile range [IQR]: 171, 348) to 254 (IQR: 174, 419), 3 days after the start of treatment (<i>p</i> = 0.012), but median FiO<sub>2</sub> increased from 37% (IQR: 28, 46) to 40% (IQR: 29, 52; <i>p</i> = 0.008). SpO<sub>2</sub> and the percent time with severe hypoxemia were unchanged.</p><p><strong>Conclusion: </strong> In this 10-year, retrospective, single-center analysis, pharmacologic PDA treatment in VLBW infants was not associated with a major improvement in acute measures of oxygenation or level of respiratory support.</p><p><strong>Key points: </strong>· Infants with pharmacologically treated PDA had worse baseline respiratory and oxygenation metrics.. · RAS decreased but FiO2 increased 3 days after pharmacologic PDA treatment.. · Pharmacologic PDA treatment did not acutely improve SpO2 or severe hypoxemia..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Pharmacologic Patent Ductus Arteriosus Treatment on Acute Respiratory and Oxygenation Metrics in Very Low Birth Weight Infants.\",\"authors\":\"Mara K Weigner, Sherry L Kausch, Karen D Fairchild, Brynne A Sullivan\",\"doi\":\"10.1055/a-2441-6639\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong> Hypoxemia and respiratory compromise occur in very low birth weight (VLBW, <1,500 g) infants and may be associated with shunting across patent ductus arteriosus (PDA). The impact of pharmacologic PDA treatment on acute hypoxemia and respiratory metrics is unclear. This study aimed to determine whether pharmacologic PDA treatment is associated with acute improvement in hypoxemia and respiratory metrics in VLBW infants.</p><p><strong>Study design: </strong> At a single center (2012-2022), all VLBW infants with echocardiographic evidence of PDA and without exclusions were classified as having received or not received pharmacologic PDA treatment (PDA-T and PDA-NT). Mean daily fraction of inspired oxygen (FIO<sub>2</sub>) and Respiratory Acuity Score (RAS, PMID 30374050) were compared at baseline (day 0) and 3 days after the start of treatment. For PDA-T infants with archived 0.5 Hz (every 2-second) oxygen saturation (SpO<sub>2</sub>) data, mean daily SpO<sub>2</sub> and the percentage of time with severe hypoxemia (SpO<sub>2</sub> <80%) were compared before and after treatment. Severe hypoxemia was further analyzed after stratification by clinical variables (sex, medication, gestational age, and postnatal age).</p><p><strong>Results: </strong> We analyzed 125 VLBW infants with PDA, of whom 66 received pharmacologic PDA treatment. We analyzed a subgroup of 43 PDA-T infants with every 2-second SpO<sub>2</sub> data available. PDA-T infants had higher baseline FiO<sub>2</sub> and RAS and lower SpO<sub>2</sub> than PDA-NT infants (<i>p</i> < 0.05). Compared to baseline, RAS decreased from a median of 258 (interquartile range [IQR]: 171, 348) to 254 (IQR: 174, 419), 3 days after the start of treatment (<i>p</i> = 0.012), but median FiO<sub>2</sub> increased from 37% (IQR: 28, 46) to 40% (IQR: 29, 52; <i>p</i> = 0.008). SpO<sub>2</sub> and the percent time with severe hypoxemia were unchanged.</p><p><strong>Conclusion: </strong> In this 10-year, retrospective, single-center analysis, pharmacologic PDA treatment in VLBW infants was not associated with a major improvement in acute measures of oxygenation or level of respiratory support.</p><p><strong>Key points: </strong>· Infants with pharmacologically treated PDA had worse baseline respiratory and oxygenation metrics.. · RAS decreased but FiO2 increased 3 days after pharmacologic PDA treatment.. · Pharmacologic PDA treatment did not acutely improve SpO2 or severe hypoxemia..</p>\",\"PeriodicalId\":7584,\"journal\":{\"name\":\"American journal of perinatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-11-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of perinatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2441-6639\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2441-6639","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Impact of Pharmacologic Patent Ductus Arteriosus Treatment on Acute Respiratory and Oxygenation Metrics in Very Low Birth Weight Infants.
Objective: Hypoxemia and respiratory compromise occur in very low birth weight (VLBW, <1,500 g) infants and may be associated with shunting across patent ductus arteriosus (PDA). The impact of pharmacologic PDA treatment on acute hypoxemia and respiratory metrics is unclear. This study aimed to determine whether pharmacologic PDA treatment is associated with acute improvement in hypoxemia and respiratory metrics in VLBW infants.
Study design: At a single center (2012-2022), all VLBW infants with echocardiographic evidence of PDA and without exclusions were classified as having received or not received pharmacologic PDA treatment (PDA-T and PDA-NT). Mean daily fraction of inspired oxygen (FIO2) and Respiratory Acuity Score (RAS, PMID 30374050) were compared at baseline (day 0) and 3 days after the start of treatment. For PDA-T infants with archived 0.5 Hz (every 2-second) oxygen saturation (SpO2) data, mean daily SpO2 and the percentage of time with severe hypoxemia (SpO2 <80%) were compared before and after treatment. Severe hypoxemia was further analyzed after stratification by clinical variables (sex, medication, gestational age, and postnatal age).
Results: We analyzed 125 VLBW infants with PDA, of whom 66 received pharmacologic PDA treatment. We analyzed a subgroup of 43 PDA-T infants with every 2-second SpO2 data available. PDA-T infants had higher baseline FiO2 and RAS and lower SpO2 than PDA-NT infants (p < 0.05). Compared to baseline, RAS decreased from a median of 258 (interquartile range [IQR]: 171, 348) to 254 (IQR: 174, 419), 3 days after the start of treatment (p = 0.012), but median FiO2 increased from 37% (IQR: 28, 46) to 40% (IQR: 29, 52; p = 0.008). SpO2 and the percent time with severe hypoxemia were unchanged.
Conclusion: In this 10-year, retrospective, single-center analysis, pharmacologic PDA treatment in VLBW infants was not associated with a major improvement in acute measures of oxygenation or level of respiratory support.
Key points: · Infants with pharmacologically treated PDA had worse baseline respiratory and oxygenation metrics.. · RAS decreased but FiO2 increased 3 days after pharmacologic PDA treatment.. · Pharmacologic PDA treatment did not acutely improve SpO2 or severe hypoxemia..
期刊介绍：
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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