Neonatal Medicine

  • 제27권3호
  • /
  • Pages.111-117
  • /
  • 2020
  • /
  • 2287-9412(pISSN)
  • /
  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
권호 표지
DOI QR코드

DOI QR Code

Differences in Outcomes According to the Time of Patent Ductus Arteriosus Closure in Preterm Infants

  • Han, Changhun (Department of Pediatrics, Inje University Busan Paik Hospital) ;
  • Jeon, Ga Won (Department of Pediatrics, Inje University Busan Paik Hospital)
  • 투고 : 2020.04.24
  • 심사 : 2020.07.21
  • 발행 : 2020.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Patent ductus arteriosus (PDA) is associated with increased mortality and morbidities such as intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, and neurodevelopmental impairment. The objective of this study was to evaluate mortality and morbidities according to the time of PDA closure. Methods: For this study, 117 preterm infants with gestational age (GA) of <30 weeks who had PDA were enrolled and allocated to two groups according to the time of PDA closure as follows: early closed group (n=40, PDA closure in <14 days after birth) and delayed closed group (n=77, PDA closure in ≥14 days after birth). Results: GA was higher in the early closed group than in the delayed closed group (27.2±1.6 weeks vs. 26.3±1.7 weeks, P=0.005). Other demographic factors, such as birth weight, Apgar score, and maternal status were not significantly different between the two groups. The incidence rates of surfactant redosing, retinopathy of prematurity (stage ≥II), necrotizing enterocolitis (stage ≥II), moderate to severe bronchopulmonary dysplasia, and mortality were similar between the two groups. The total durations of mechanical ventilation, invasive ventilation, and hospital stay were longer in the delayed closed group than in the early closed group. However, these became similar after adjustment for GA. The incidence rate of intraventricular hemorrhage (grade ≥III) was significantly higher in the early closed group than in the delayed closed group after adjustment for GA (25.0% vs. 13.0%, adjusted P for GA=0.021). Conclusion: In this study, delayed PDA closure was safe, as it did not increase mortality and morbidity rates.

키워드

참고문헌

  1. Wyllie JP, Gupta S. Prophylactic and early targeted treatment of patent ductus arteriosus. Semin Fetal Neonatal Med 2018;23:250-4. https://doi.org/10.1016/j.siny.2018.03.005
  2. Liu H, Manganiello V, Waleh N, Clyman RI. Expression, activity, and function of phosphodiesterases in the mature and immature ductus arteriosus. Pediatr Res 2008;64:477-81. https://doi.org/10.1203/PDR.0b013e3181827c2c
  3. Vettukattil JJ. Pathophysiology of patent ductus arteriosus in the preterm infant. Curr Pediatr Rev 2016;12:120-2. https://doi.org/10.2174/157339631202160506002215
  4. Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol 2018;42:235-42. https://doi.org/10.1053/j.semperi.2018.05.006
  5. Finlay ER, Subhedar NV. Pulmonary haemorrhage in preterm infants. Eur J Pediatr 2000;159:870-1. https://doi.org/10.1007/s004310000578
  6. Havranek T, Rahimi M, Hall H, Armbrecht E. Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes. J Matern Fetal Neonatal Med 2015;28:526-30. https://doi.org/10.3109/14767058.2014.923395
  7. Mirza H, Laptook AR, Oh W, Vohr BR, Stoll BJ, Kandefer S, et al. Effects of indomethacin prophylaxis timing on intraventricular haemorrhage and patent ductus arteriosus in extremely low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2016;101: F418-22. https://doi.org/10.1136/archdischild-2015-309112
  8. Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009;123:e138-44. https://doi.org/10.1542/peds.2008-2418
  9. Sinha R, Negi V, Dalal SS. An interesting observation of PDA closure with oral paracetamol in preterm neonates. J Clin Neonatol 2013;2:30-2. https://doi.org/10.4103/2249-4847.109245
  10. Foster M, Mallett LH, Govande V, Vora N, Castro A, Raju M, et al. Short-term complications associated with surgical ligation of patent ductus arteriosus in ELBW infants: a 25-year cohort study. Am J Perinatol 2019 Nov 4 [Epub]. https://doi.org/10.1055/s-0039-1698459.
  11. Kaempf JW, Wu YX, Kaempf AJ, Kaempf AM, Wang L, Grunkemeier G. What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants? J Perinatol 2012;32:344-8. https://doi.org/10.1038/jp.2011.102
  12. Sung SI, Chang YS, Kim J, Choi JH, Ahn SY, Park WS. Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23-28 weeks of gestation. PLoS One 2019;14:e0212256. https://doi.org/10.1371/journal.pone.0212256
  13. Sung SI, Choi SY, Park JH, Lee MS, Yoo HS, Ahn SY, et al. The timing of surgical ligation for patent ductus arteriosus is associated with neonatal morbidity in extremely preterm infants born at 23-25 weeks of gestation. J Korean Med Sci 2014;29:581-6. https://doi.org/10.3346/jkms.2014.29.4.581
  14. Jobe A. Respiratory distress syndrome: new therapeutic approaches to a complex pathophysiology. Adv Pediatr 1983;30: 93-130.
  15. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet 2006;367:1421-31. https://doi.org/10.1016/S0140-6736(06)68615-7
  16. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34. https://doi.org/10.1016/S0022-3476(78)80282-0
  17. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986;33:179-201. https://doi.org/10.1016/s0031-3955(16)34975-6
  18. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005;123:991-9. https://doi.org/10.1001/archopht.123.7.991
  19. Ibrahim MH, Azab A, Kamal NM, Salama MA, Elshorbagy HH, Abdallah EA, et al. Outcomes of early ligation of patent ductus arteriosus in preterms, multicenter experience. Medicine (Baltimore) 2015;94:e915. https://doi.org/10.1097/MD.0000000000000915
  20. Liebowitz M, Koo J, Wickremasinghe A, Allen IE, Clyman RI. Effects of prophylactic indomethacin on vasopressor-dependent hypotension in extremely preterm infants. J Pediatr 2017; 182:21-7. https://doi.org/10.1016/j.jpeds.2016.11.008
  21. Liebowitz M, Clyman RI. Prophylactic indomethacin compared with delayed conservative management of the patent ductus arteriosus in extremely preterm infants: effects on neonatal outcomes. J Pediatr 2017;187:119-26. https://doi.org/10.1016/j.jpeds.2017.03.021
  22. Schena F, Francescato G, Cappelleri A, Picciolli I, Mayer A, Mosca F, et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr 2015;166:1488-92. https://doi.org/10.1016/j.jpeds.2015.03.012
  23. Sellmer A, Bjerre JV, Schmidt MR, McNamara PJ, Hjortdal VE, Host B, et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed 2013;98:F505-10. https://doi.org/10.1136/archdischild-2013-303816
  24. Fonseca E, Georgiev SG, Gorenflo M, Loukanov TS. Patent ductus arteriosus in preterm infants: benefits of early surgical closure. Asian Cardiovasc Thorac Ann 2014;22:391-6. https://doi.org/10.1177/0218492313480051
  25. Bourgoin L, Cipierre C, Hauet Q, Basset H, Gournay V, Roze JC, et al. Neurodevelopmental outcome at 2 years of age according to patent ductus arteriosus management in very preterm infants. Neonatology 2016;109:139-46. https://doi.org/10.1159/000442278
  26. Benitz WE; Committee on Fetus and Newborn, American Academy of Pediatrics. Patent ductus arteriosus in preterm infants. Pediatrics 2016;137:e20153730. https://doi.org/10.1542/peds.2015-3730
  27. Slaughter JL, Reagan PB, Newman TB, Klebanoff MA. Comparative effectiveness of nonsteroidal anti-inflammatory drug treatment vs no treatment for patent ductus arteriosus in preterm infants. JAMA Pediatr 2017;171:e164354. https://doi.org/10.1001/jamapediatrics.2016.4354
  28. Weisz DE, Mirea L, Resende MHF, Ly L, Church PT, Kelly E, et al. Outcomes of surgical ligation after unsuccessful pharmacotherapy for patent ductus arteriosus in neonates born extremely preterm. J Pediatr 2018;195:292-6. https://doi.org/10.1016/j.jpeds.2017.11.029
  29. Sung SI, Chang YS, Chun JY, Yoon SA, Yoo HS, Ahn SY, et al. Mandatory closure versus nonintervention for patent ductus arteriosus in very preterm infants. J Pediatr 2016;177:66-71. https://doi.org/10.1016/j.jpeds.2016.06.046
  30. Jhaveri N, Moon-Grady A, Clyman RI. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment. J Pediatr 2010;157:381-7. https://doi.org/10.1016/j.jpeds.2010.02.062

피인용 문헌

  1. Risk Factors and Neonatal Outcomes of Patent Ductus Arteriosus Ligation in Preterm Infants in a Single Center over 6 Years vol.31, pp.4, 2020, https://doi.org/10.14734/pn.2020.31.4.191