Hamzah Mansoura, Chelsea Drennan, Vikas Gupta, Matthew Harting, Neil Patel, Ashley Ebanks, Shobhan Vachhrajani, Daniel Robie
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We excluded patients with missing prenatal data, postnatal diagnosis > 28 days, CDH never repaired, death < 30 days, and PDA ligated on day of or before CDH repair. Patients were matched 4:1 on propensity scores for PDA ligation. The primary outcome was mortality. The secondary outcome was any use of extracorporeal life support (ECLS).</p><p><strong>Results: </strong>3953 cases were identified for analysis (3899 in no PDA ligation (-PDAL) group, 54 in PDA ligation (+ PDAL) group). After 4:1 matching, there were 196 in the -PDAL group and 49 in the + PDAL group. There was no significant difference in mortality (OR 1.1, (0.5-2.4), p = 0.811) or in use of ECLS (OR 1.5 (0.8-2.8), p = 0.218) between the two groups.</p><p><strong>Conclusions: </strong>PDA ligation can be considered as a therapeutic option for CDH patients with persistent ductus arteriosus. 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引用次数: 0
摘要
目的：新生儿先天性膈疝（CDH）有不同程度的肺动脉高压（PH），肺动脉高压是由肺血管发育和结构异常引起的，并因缺氧引起的血管收缩而加重。出生后动脉导管关闭失败会间歇性地将血液从肺部输送或输送出去。我们假设可以进行动脉导管未闭结扎。方法：我们查询先天性膈疝研究组注册表，以确定2007年至2020年接受PDA结扎的患者。我们排除了产前资料缺失、产后诊断0 ~ 28天、CDH未修复、死亡的患者。结果：共发现3953例进行分析（未结扎（-PDAL）组3899例，结扎（+ PDAL）组54例）。4:1配对后-PDAL组196例，+ PDAL组49例。两组患者的死亡率（OR 1.1, (0.5-2.4), p = 0.811）和ECLS的使用（OR 1.5 (0.8-2.8), p = 0.218）差异无统计学意义。结论：对于伴有持续性动脉导管的CDH患者，PDA结扎可作为一种治疗选择。它可能在已经用尽其他治疗方法的高度选定的病例中发挥作用。证据等级：三级证据。
Outcomes of CDH patients receiving PDA ligation: a propensity score matched analysis.
Purpose: Neonates with congenital diaphragmatic hernia (CDH) have varying severity of pulmonary hypertension (PH) caused by developmental and structural abnormalities of the pulmonary vasculature and exacerbated by hypoxia induced vasoconstriction. Failure of the ductus arteriosus to close postnatally can intermittently shunt blood either to or away from the lungs. We hypothesize patent ductus arteriosus (PDA) ligation can be performed.
Methods: We queried the Congenital Diaphragmatic Hernia Study Group registry to identify patients from 2007 to 2020 who underwent PDA ligation. We excluded patients with missing prenatal data, postnatal diagnosis > 28 days, CDH never repaired, death < 30 days, and PDA ligated on day of or before CDH repair. Patients were matched 4:1 on propensity scores for PDA ligation. The primary outcome was mortality. The secondary outcome was any use of extracorporeal life support (ECLS).
Results: 3953 cases were identified for analysis (3899 in no PDA ligation (-PDAL) group, 54 in PDA ligation (+ PDAL) group). After 4:1 matching, there were 196 in the -PDAL group and 49 in the + PDAL group. There was no significant difference in mortality (OR 1.1, (0.5-2.4), p = 0.811) or in use of ECLS (OR 1.5 (0.8-2.8), p = 0.218) between the two groups.
Conclusions: PDA ligation can be considered as a therapeutic option for CDH patients with persistent ductus arteriosus. It may have a role in highly selected cases that have exhausted other therapeutic options.
期刊介绍：
Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children.
The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include:
-Review articles-
Original articles-
Technical innovations-
Letters to the editor
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