An Observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for patent ductus arteriosus
| Autor: | Okulu, E., Erdeve, O., Arslan, Z., Demirel, N., Kaya, H., Gokce, I.K., Ertugrul, S., Cetinkaya, M., Buyukkale, G., Ozlu, F., Simsek, H., Celik, Y., Ozkan, H., Köksal, N., Akcan, B., Turkmen, M., Celik, K., Armangil, D., Bulbul, A., Tekgunduz, K.S., Oncel, M.Y., Tuzun, F., Ergenekon, E., Ergin, Hacer, Arsan, S., Turkish Neonatal Society INTERPDA Study Group |
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| Přispěvatelé: | Dicle Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Ertuğrul, Sabahattin |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pediatrics
paracetamol Patent ductus arteriosus morbidity Ibuprofen 030204 cardiovascular system & hematology lung dysplasia assisted ventilation 0302 clinical medicine newborn sepsis Ductus arteriosus odds ratio Conservative gestational age risk reduction ibuprofen steroid lcsh:RJ1-570 Retinopathy of prematurity cohort analysis Clinical Trial infant mortality Management medicine.anatomical_structure Intraventricular hemorrhage female multivariate analysis Paracetamol risk factor Necrotizing enterocolitis brain hemorrhage retrolental fibroplasia Gestation disease registry pregnancy newborn morbidity artery ligation management Cohort study prospective study survival rate medicine.medical_specialty conservative treatment surgical technique Article Sepsis 03 medical and health sciences patent ductus arteriosus male Preterm 030225 pediatrics Intensive care medicine controlled study human Mortality outcome assessment perinatal period necrotizing enterocolitis business.industry prematurity lcsh:Pediatrics medicine.disease mortality infant major clinical study neonatal intensive care unit clinical feature hospital discharge multicenter study confidence interval neonatal respiratory distress syndrome Pediatrics Perinatology and Child Health conservative observational study Morbidity business preterm artificial lung surfactant |
| Zdroj: | Frontiers in Pediatrics Frontiers in Pediatrics, Vol 8 (2020) |
| DOI: | 10.3389/fped.2020.00434/full |
| Popis: | No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 240/7 and 286/7 weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 ± 1.4 weeks and 926 ± 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (?Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p > 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01–2.80, p = 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37–0.92, p = 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p = 0.009 and 0.007, respectively). In preterm infants born at |
| Databáze: | OpenAIRE |
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