早产儿动脉导管未闭的保守治疗：随机对照试验的系统回顾和荟萃分析

IF 0.8 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY Pub Date : 2024-12-04 DOI:10.1016/j.ppedcard.2024.101774

Rajanikant Kumar , Efeoghene Praise Epia , Mark W. Abdelnour , Joo Young Belen Kim Kim , Anne Boakyewaa Anokye-Kumatia , Rimmo Loyi Lego , Vrunda Kulkarni , Syed Ali Farhan Abbas Rizvi , Maryam Asif , Huzaifa Ahmad Cheema , Adeel Ahmad , Wajeeh Ur Rehman , Raheel Ahmed , Sourbha S. Dani

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引用次数: 0

摘要

近年来，采用保守方法治疗早产儿动脉导管未闭（PDA）的情况有所增加。对支持该方法的临床证据进行系统评估对于指导指南的建议至关重要。本系统综述和荟萃分析旨在探讨保守治疗与积极治疗对PDA早产儿的影响。综述的关键科学概念：从成立到2024年4月，我们对MEDLINE、Embase、Cochrane图书馆和ClinicalTrials.gov进行了全面检索，以确定评估早产儿PDA保守管理与积极治疗的相关随机对照试验（RCTs）。我们使用RevMan 5.4汇总风险比（rr）。我们的综述包括6项随机对照试验。两组死亡风险无差异(RR 0.83；95% CI: 0.64-1.08)和BPD (RR 0.89；95% CI: 0.76-1.03)。坏死性小肠结肠炎、脑室内出血、早产儿视网膜病变、败血症、肺出血、手术结扎或经导管闭塞的发生率在两组之间相似。总之，我们的分析显示，与积极治疗相比，保守治疗策略在全因死亡率、BPD或其他临床结果的风险方面没有差异。此外，需要针对PDA并发症风险最高的婴儿进行靶向治疗的大规模随机对照试验。

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Conservative management of patent ductus arteriosus in preterm infants: A systematic review and meta-analysis of randomized controlled trials

Background

In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding guideline recommendations.

Aim of review

This systematic review and meta-analysis aims to investigate a strategy of conservative management in comparison to active treatment in preterm infants with PDA.

Key scientific concepts of review

From inception to April 2024, we conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs) that evaluated conservative management versus active treatment of PDA in preterm infants. We used RevMan 5.4 to pool risk ratios (RRs).

Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95 % CI: 0.64–1.08) and BPD (RR 0.89; 95 % CI: 0.76–1.03) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups. In conclusion, our analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. Further, large-scale RCTs focusing on targeted therapy for infants at the highest risk of complications from PDA are required.

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来源期刊

PROGRESS IN PEDIATRIC CARDIOLOGY PEDIATRICS-

CiteScore

0.90

自引率

11.10%

发文量

审稿时长

75 days

期刊介绍： Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest.