动脉导管未闭早产儿血清皮质醇水平变化及临床意义

目的 探讨血清皮质醇水平与早产儿动脉导管未闭(patent ductus arteriosus,PDA)的关系.方法 选择2009年1月1日至12月31日间出生后即在福建省妇幼保健院新生儿科治疗的432例早产儿为研究队列,预采集其桡动脉血,以出生3 d后诊断PDA的为PDA组,按照1∶1匹配巢式病例对照研究的方法,选择同期住院的胎龄相近(相差小于1周)、有相同的孕母产前地塞米松应用史,同一日龄行超声心动图排除PDA的早产儿为对照组进行匹配,共38对.收集两组早产儿临床资料,并在行超声心动图的当天第2次采集桡动脉血.用化学发光法检测两组两次血标本的血清皮质醇水平,并采用Logistic回归分析方法 分析PDA的危险因素.结果 PDA组及对照组的性别比例、胎龄、分娩方式、出生窒息史、是否合并呼吸衰竭、败血症以及血清球蛋白、白蛋白值的差异无统计学意义(P均＞0.05).PDA组出生时的血清皮质醇浓度为(261.9±229.6)nmol/L,低于对照组的(379.8±236.3)nmol/L,差异有统计学意义(t=2.20,P=0.03).条件 Logistic回归分析显示出生低血清皮质醇水平是早产儿发生PDA的危险因素(OR=0.916,95%CI:0.854～0.983,P=0.015).在控制了出生血清皮质醇基础值、缺氧、感染、危重症等影响因素后,PDA组和对照组的第2次血清皮质醇浓度的校正均值(95%CI)分别为300.0 nmol/L(232.4～367.4 nmol/L)和263.6 nmol/L(196.2～331.2 nmol/L),两组比较差异无统计学意义(t=0.537,P=0.466).结论 出生低血清皮质醇水平是早产儿PDA的危险因素,而早产儿发生PDA不影响血清皮质醇水平.

Abstract：

Objective To determine the relationship between the levels of serum cortisol and patent conducted.Thirty-eight pairs of preterm infants were selected from January 1 to December 31 in 2009.Thirty-eight preterm infants developed PDA.And we also selected 38 non-PDA preterm infants as the controls,who had the corresponding gestational age,same exposure to antenatal steroid and sameechocardiography examination time.The serum cortisol concentrations of these infants were measured twice by chemiluminesence immunoassay.All data were analyzed via SPSS 13.0.Results No significant difference was found between PDA and control groups in demographic characteristics and influence factors for serum cortisol.The first mean level of serum cortisol in PDA group was (261.9± 229.6) nmol/L,significantly lower than that in control group [(379.8 ± 236.3) nmol/L] (t = 2.20,P = 0.03).Logisticregression analysis showed low serum cortisol concentrations at birth was risk factor for PDA in preterm infants(OR = 0.916,95% CI:0.854-0.983,P = 0.015).The second adjusted mean levels (95 % CI) of serum cortisol in PDA and control groups were 300.0 nmol/L(232.4-367.4 nmol/L) and 263.6 nmol/L (196.2-331.2 nmol/L),respectively.There was no significant difference between the two groups (t=0.537,P=0.466).Conclusions Low serum cortisol concentrations at birth is a risk factor for PDA in preterm infants,while the serum cortisol value may be not affected by PDA.     

静脉预防性应用布洛芬对早产儿动脉导管未闭影响的meta分析

目的 评价早产儿静脉预防性应用布洛芬对动脉导管未闭(patent ductus arteriosus,PDA)的有效性及安全性.方法 计算机检索PubMed、ScienceDirect、EMBASE、OVID、Cochrane 图书馆、维普中文科技期刊数据库、中国学术期刊网全文数据库,并手工检索作为补充,收集静脉预防性应用布洛芬对早产儿PDA影响的随机对照试验(randomized controlled trial,RCT)并进行筛选和质量评价,采用RevMan 5.0.21软件进行meta分析,计量资料采用加权均数差(weighted mean difference,WMD)及其95%CI表示,计数资料采用相对危险度(risk ratio,RR)及其95%CI表示.结果 最终纳入文献4篇,其中3篇文献Jadad评分为4分,1篇文献为3分.Meta分析结果示:(1)静脉预防性应用布洛芬可以减少早产儿第3天动脉导管未关闭的风险(RR=0.40,95%CI:0.31～0.51,P＜0.01)、需环氧酶抑制剂再治疗以关闭动脉导管(RR=0.18,95%CI:0.07～0.45,P=0.0003)及需外科结扎以关闭动脉导管(RR=0.34,95%CI:0.14～0.81,P=0.02).(2)就目前数据而言,本meta分析未发现静脉预防性应用布洛芬对早产儿肺、脑、胃肠、肾等系统产生显著不良影响.结论 早产儿静脉预防性应用布洛芬可显著减少生后第3天动脉导管未关闭、需环氧酶抑制剂再治疗以关闭动脉导管和外科结扎关闭动脉导管,且短期内未见明显不良影响,但现有证据尚不足以推荐临床静脉预防性应用布洛芬防治早产儿PDA.     

极低出生体重早产儿动脉导管未闭的治疗

目的探讨极低出生体重早产儿有临床表现的动脉导管未闭的治疗方法方法 本研究为前瞻性队列研究.2008年1月1日至2010年12月31日间出生体重＜1500 g的确诊有临床表现的动脉导管未闭早产儿78例,其中42例采用口服吲哚美辛治疗者作为治疗组,36例未治疗者为对照组.观察吲哚美辛的疗效、副作用以及对早产儿的近远期预后.结果治疗组及对照组在性别比例、胎龄、动脉导管直径、合并心力衰竭、败血症、新生儿呼吸窘迫综合征、脑室内出血的差异均无统计学意义(P均＞0.05).治疗组治疗后动脉导管关闭33例,关闭率为78.6%,高于对照组,自发关闭9例,关闭率25.0%,差异有统计学意义(χ2=22.39,P=0.000).治疗组治疗前后的血肌酐、血小板差异无统计学意义(P均＞0.05).治疗组较对照组有较少的脑室内出血发生比例(z=1.167,P=0.030)、较短的总用氧时间[分别为(8.0±5.5) d和(13.3±9.3) d,t=2.225,P=0.032]及住院时间[(39.0±7.7) d和(43.6±10.6) d,t=2.229,P=0.029],且支气管肺发育不良、坏死性小肠结肠炎的发生情况组间差异无统计学意义(P均＞0.05).治疗组中有5例药物治疗失败后使用胸腔镜钳闭动脉导管,术后3例发生肺部感染,1例出现胸腔积液,无死亡及气胸发生.结论极低出生体重早产儿有临床表现的动脉导管未闭应积极干预,口服吲哚美辛可有效关闭动脉导管,胸腔镜钳闭动脉导管可作为药物治疗失败后的一种选择.

Abstract：

Objective To investigate the treatment of symptomatic patent ductus arteriosus (PDA) in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants (birth weight＜1500 g) were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin (0.2 mg/kg, every 12 hrs for three times) were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for ductus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups (P>0.05, respectively). The ductus arteriosus closed in 33 patients of treatment group (78.6%) and in nine patients of control group (25.0%)(χ2=22.39,P=0.000). There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group(P>0.05). Compared with control group, the treatment group had lower incidence of intraventricular hemorrhage (z=1.167, P=0.030), shorter duration of oxygen therapy [(8.0±5.5) d vs (13.3±9.3) d, t=2.225, P=0.032] and shorter hospital stay [(39.0±7.7) d vs (43.6±10.6) d, t=2.229, P=0.029]; while the incidence of bronchopulmonary dysplasia and necrotizing enterocolitis were similar (P>0.05). The five cases of PDA who received video-assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant death associated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight preterm infants should be treated actively. Oral indomethacin was an effective and safe method to cure the PDA in these infants. Surgical ligation under video-assisted thoracoscopic surgery after failure of indomethacin treatment might be a good option.     

心肌损伤标记物在动脉导管未闭早产儿的变化和临床意义

目的 探讨早产儿动脉导管未闭(patent ductus arteriosus,PDA)对早产儿心肌的影响.方法 选择2010年5月1日至2011年1月31日入院治疗的110例胎龄28～36周的早产儿,在生后72 h和7d取血,测定血清肌钙蛋白T(cardiac troponin T,cTnT)和肌酸激酶MB同工酶(creatine kinase MB isoenzyme,CK-MB)水平,并行心脏超声心动图检查.根据超声心动图结果分为PDA组(44例)和对照组(66例).PDA组患儿接受布洛芬治疗后,再次行超声心动图检查,同时2组复查相关的血清学指标.统计学方法采用t或近似t检验、x2检验、多元线性回归和Spearman秩相关检验.结果 治疗前,PDA组的血清cTnT和CK-MB均高于对照组[(0.259±0.134)μg/L与(0.083±0.054)μg/L,t=9.557,P＜0.01;(7.31±2.69)μg/L与(5.71±1.88)μg/L,t=2.588,P＜0.05].治疗成功的34例PDA患儿cTnT和CK-MB较治疗前显著降低,分别降至(0.062±0.039)μg/L和(5.34±1.50)μg/L(t分别为9.268和5.974,P＜0.05);但与对照组cTnT、CK-MB相比差异均无统计学意义(P＞0.05).治疗失败的10例PDA患儿cTnT、CK-MB水平较治疗前稍有降低[分别为(0.193±0.049)μg/L和(6.93±1.63)μg/L,t分别为1.525和0.766,P均＞0.05],但仍明显高于对照组(t分别为9.068和4.055,P＜0.05).cTnT水平与机械通气时间、PDA、肺透明膜病呈正相关,不受性别、胎龄、体重的影响;而CK-MB与性别、胎龄、体重、机械通气时间及PDA均显著相关.在PDA组,cTnT水平与动脉导管直径呈正相关;而CK-MB与各项超声心动图指标均不相关.结论 有临床表现的PDA可造成早产儿心肌损伤,cTnT和CK-MB的动态变化与PDA病情程度相平行,动态监测cTnT和CK-MB有助于PDA并发心肌损伤的早期诊断和及时干预.     

口服布洛芬和吲哚美辛治疗早产儿动脉导管未闭的效果及其影响因素

目的 比较口服布洛芬和吲哚美辛治疗早产儿动脉导管未闭(patent ductus arteriosus,PDA)的效果和安全性,并分析影响吲哚美辛治疗效果的因素. 方法 采用回顾性对照研究,2007年1月1日至2009年12月30日纳入的有临床症状的PDA早产儿160例为吲哚美辛组,2009年12月31日至2011年1月31日纳入的44例早产儿为布洛芬组.吲哚美辛组鼻饲吲哚美辛(25 mg/片),每次0.2 mg/kg,第2剂与第1剂间隔12h,第3剂与第2剂间隔24 h,3剂为1个疗程;布洛芬组口服布洛芬悬液(40 g/L),首剂10 mg/kg,第2、3剂均为5 mg/kg,每剂间隔24 h,3剂为1个疗程.采用卡方、两独立样本t检验和秩和检验比较2组导管的关闭情况及不良反应,用Logistic 回归模型分析影响吲哚美辛治疗效果的因素. 结果 (1)治疗效果比较:布洛芬组1个疗程动脉导管关闭率、2个疗程动脉导管关闭率和总关闭率分别为68.2％(30/44)、9.1％(4/44)和77.3％(34/44),与吲哚美辛组[63.8％(102/160)、6.9％(11/160)和70.6％ (113/160)]差异无统计学意义(x2分别为0.297、0.030和0.757,P均＞0.05).(2)不良反应:吲哚美辛组尿量＜1 ml/(kg?h)和血肌酐＞88μmol/L的发生率分别为21.3％(34/160)和26.9％(43/160),均高于布洛芬组[6.8％(3/44)和9.1％(4/44)],差异有统计学意义(x2分别为4.841和6.156,P均＜0.05).(3)影响吲哚美辛疗效的因素:胎龄小(OR=2.563,95％CI:1.099～5.976,P=0.029)、合并败血症(OR=4.575,95％CI:1.782～26.768,P=0.009)和新生儿呼吸窘迫综合征(OR=2.407,95％CI:1.023～5.664,P=0.044)是影响早产儿吲哚美辛治疗PDA疗效的危险因素,而母亲产前使用地塞米松(OR=0.530,95 ％CI:0.312～0.901,P=0.018)是保护因素. 结论 口服布洛芬与吲哚美辛治疗早产儿PDA疗效相当,但布洛芬对肾功能的影响较小,一些因素如败血症等影响吲哚美辛的疗效.     

口服布洛芬治疗早产儿动脉导管未闭的前瞻性随机对照研究

目的 研究口服布洛芬在早产儿动脉导管未闭(patent ductus arteriosus,PDA)治疗中的安全性、治疗效果和副作用,以评估其在早产儿PDA治疗中的应用价值.方法 采用前瞻性随机对照研究方法,根据PDA诊断的时间顺序,按随机数字顺序表,将74例PDA早产儿随机分为布洛芬治疗组(36例)与对照组(38例),布洛芬治疗方法为口服布洛芬混悬液每剂10 mg/kg,间隔24 h 1次,共3次;记录并比较2组PDA的关闭率、相关副作用及患儿住院期间的情况.结果 布洛芬治疗组PDA关闭率为52.8%(19/36),高于对照组(18.4%,7/38),差异有统计学意义(χ2=9.575,P=0.002).在口服布洛芬治疗期间,患儿未出现少尿、肾功能损害、出血倾向、胃肠道穿孔、Ⅲ或Ⅳ级脑室内出血或出血加重等严重副作用,布洛芬治疗组和对照组出现腹胀或胃潴留的发生率分别为33.3%(12/36)和26.3%(10/38),差异无统计学意义(χ2=0.436,P=0.509).布洛芬治疗组患儿平均住院(22.8±14.8) d,用氧(8.3±9.3) d,5.6%(2/36)需要机械通气,与对照组[分别为(24.1±17.1) d、(8.8±8.3) d和2.6%(1/38)]比较差异均无统计学意义(P均＞0.05).结论 口服布洛芬对早产儿PDA有较好的治疗效果,且无明显合并症或副作用发生,应用方便,安全性较高.

Abstract：

Objective To assess the safety, efficacy, temporary side effects and feasibility of oral ibuprofen suspension in the treatment of patent ductus arteriosus (PDA) with hemodynamic significance in premature infants. Method A randomized controlled trial including seventy-four premature infants with PDA was performed from February 2007 to May 2008. Infants were randomly assigned to two groups: testing group (36 patients) received three doses of oral ibuprofen suspension (10 mg/kg at 24-hour intervals) and control group (38 patients) did not receive such treatment. The cure rate of PDA, relative side effects of ibuprofen and complications during treatment were recorded.Results The closure rate of ductus arteriosus in the testing group was 52.8% (19/36), which was higher than that of control group (18.4%, 7/38) (χ2=9.575, P=0.002). The severe side effects did not occur in testing group, such as oliguria, renal impairment, prone of bleeding, gastrointestinal perforation and novel appearing or deteriorative of intraventricular hemorrhage (IVH). Compared with the infants in control group (26.3%, 10/38), the morbidity of abdominal distension or gastric retention in testing group (33.3%, 12/36) was higher, while there was no statistically significant difference (χ2=0.436, P=0.509). The hospital stay [(22.8±14.8) d vs (24.1±17.1) d], mechanical ventilation rate [5.6% (2/36) vs 2.6% (1/38)] and oxygen supplement time [(8.3±9.3) d vs (8.8±8.3) d] between the testing and control groups remained no significant difference (P>0.05). Conclusions Oral ibuprofen suspension could be effective in closing PDA of preterm infants; no significant complications and side-effects occurred during oral ibuprofen treatment. It is suggested that oral ibuprofen suspension treatment was safe, effective and well tolerated for preterm infants with PDA.     

口服布洛芬治疗早产儿动脉导管未闭疗效和安全性的meta分析

目的 评价口服布洛芬治疗早产儿动脉导管未闭(patent ductus arteriosus,PDA)的疗效和安全性. 方法 检索Cochrane图书馆临床对照试验数据库、PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库、万方数据库、维普数据库及中国生物医学文献光盘数据库从建库至2011年12月31日的所有文献.同时手工检索会议记录和专题论文集,资料来源于复旦大学附属儿科医院.同时满足以下条件的文献被纳入:(1)研究对象为出生胎龄＜37周和/或出生体重＜2500 g的早产儿;(2)随机或半随机对照研究;(3)研究组干预类型为经肠道给予布洛芬,对照组为经肠道给予安慰剂或静脉应用吲哚美辛或布洛芬;(4)主要研究结果为PDA关闭失败率;(5)超声证实存在血流动力学改变的PDA.采用Review Manager 4.22软件进行meta分析. 结果 共纳入11篇文献,均为随机临床对照研究,其中3篇文献质量较高.Meta分析表明,与安慰剂组相比,口服布洛芬早产儿PDA关闭失败率显著降低(RR=0.22,95％CI:0.14～0.35),且需要手术治疗PDA的患儿比例明显减少(RR=0.16,95％CI:0.03～0.86).口服布洛芬关闭早产儿PDA的疗效与静脉应用吲哚美辛相似(RR=0.93,95％CI:0.57～1.53),而优于静脉应用布洛芬(RR=0.42,95％ CI:0.26～～0.67).与静脉应用吲哚美辛或布洛芬相比,口服布洛芬并不能减少需要手术治疗的早产儿PDA比例(RR=0.58,95％CI:0.24～1.41).口服布洛芬与安慰剂比较,消化道出血的发生率显著增加(RR=1.99,95％CI:1.13～3.50).口服布洛芬组血清肌酐水平显著低于静脉应用吲哚美辛或静脉应用布洛芬组(加权平均差=-19.10,95％CI:-25.12～～12.31).与静脉应用吲哚美辛组比较,口服布洛芬组发生新生儿坏死性小肠结肠炎的比例较小,但2组的差异无统计学意义(RR=0.57,95％CI:0.30～1.09).所有文献均未报道远期预后. 结论 口服布洛芬具有较好的早产儿PDA关闭率,疗效与静脉应用吲哚美辛一致,且优于静脉应用布洛芬;早产儿口服布洛芬安全性较好.     

早产儿动脉导管未闭的床边外科治疗

目的:对早产儿动脉导管未闭行床边手术治疗的患儿进行回顾性分析,探索早期行床边外科治疗的可行性和优越性。方法:7例动脉导管未闭(PDA)早产儿,男4例,女3例,均合并呼吸窘迫综合征(RDS),在新生儿监护室(NICU)内行动脉导管未闭结扎术。并对手术注意点、术后呼吸机使用情况、术后并发症进行分析。结果:全组无手术死亡,均治愈出院。其中6例于术后3—5天撤离呼吸机,1例于术后30天撤离呼吸机。全组无气胸、喉返神经损伤、乳糜胸等术后并发症,无高血压、术后并发感染等情况。复查心脏B超均未见分流信号,心功能正常。结论:合并呼吸窘迫综合征的早产儿在药物治疗不能关闭PDA或无法使用消炎痛等药物及时关闭PDA时,早期行动脉导管未闭结扎术效果好,能缩短呼吸机使用时间及减少并发症的发生。重症早产儿的PDA宜采用床边外科治疗。     

早产儿动脉导管自然关闭时间及其影响因素

目的 观察早产儿生后1周内动脉导管功能性自然关闭的时间及其影响因素. 方法 177例动脉导管开放的早产儿根据胎龄分为28～31+6、32～34+6和35～36+6周组,各组分别为44、59和74例.所有研究对象按8个时间段以超声心动图监测动脉导管关闭情况及心功能变化,分别为≤12h、～24 h、～48 h、～72 h、～96 h、～120 h、～144 h、＞144但≤168 h.心功能测量指标包括左心室射血分数、每搏输出量、心搏出量、主动脉瓣口峰流速、肺动脉瓣口峰流速以及二尖瓣口、三尖瓣口的舒张早期峰流速和舒张晚期峰流速比值.对影响动脉导管自然关闭时间的因素进行Logistic多因素分析. 结果 28～31+6、32～34+6和35～36+6周3组生后1周动脉导管累积自然关闭率分别为95.5％、100.0％和100.0％,3组不同时间段动脉导管累积关闭率比较,差异有统计学意义(x2值分别为4.23、7.45、12.46、7.14、4.75、6.47、3.89、3.89,P均＜0.05).生后12～24 h动脉导管自然关闭者,动脉导管关闭后肺动脉瓣口峰流速较关闭前增快[(0.69±0.12) cm/s与(0.65±0.12) cm/s,t=2.37,P=0.02],主动脉瓣口峰流速较动脉导管关闭前减慢[(0.65±0.11) cm/s与(0.69±0.12) cm/s,t=2.51,P=0.02],左心室射血分数较关闭前降低[(63.00±8.50)％与(66.00±8.50)％,t=2.34,P=0.02].Logistic回归分析显示,影响早产儿动脉导管生后12～24 h未闭的独立危险因素为胎龄(OR=1.825,95％CI:1.239～2.689)、1 min Apgar评分0～3分(OR=1.946,95％CI:1.572～3.527)和早发型败血症(OR=3.215,95％CI:1.245～5.463);24～48 h未闭的独立危险因素为胎龄(OR=3.270,95％CI:1.852～5.774)、双胎(OR=3.634,95％CI:1.489～8.871)、1 min Apgar评分0～3分(OR=3.752,95％CI:2.156～5.436)、呼吸窘迫综合征Ⅲ～Ⅳ期(OR=2.897,95％CI:1.764～5.348)和早发型败血症(OR=3.172,95％CI:2.134～6.437);48～72 h未闭的独立危险因素为胎龄(OR=2.471,95％CI:1.087～5.613)、1 min Apgar评分0～3分(OR=2.985,95％CI:1.469～5.736)、呼吸窘迫综合征Ⅲ～Ⅳ期(OR=3.645,95％CI:1.879～6.282)、液体人量过多(OR=4.135,95％ CI:2.146～7.428)和早发型败血症(OR=3.246,95％CI:2.146～4.526),P均＜0.05. 结论 胎龄＞28周的早产儿出生1周内动脉导管自然关闭率超过90％,动脉导管自然关闭前后左心室泵功能无明显变化.避免早产、双胎、重度窒息、严重呼吸窘迫综合征、液体人量过多和早发型败血症的发生,有利于早产儿动脉导管的自然关闭.     

小儿动脉导管未闭封堵术患者的护理

目的：总结封堵器介入治疗动脉导管未闭（PDA）患者的护理及预防并发症的方法。方法：对11例接受介入治疗的PDA患者进行回顾行分析,并针对各自的并发症实施相应护理。结果：11例患者介入治疗技术成功率100%。术中5例室早,表现为出血短阵室速的患者有4例患者,给予患者停止应用,患者的情况得到恢复,患者手术之后没有出现其他并发症,患者的恢复情况很好。结论：准确的术前决策,充分的术前准备,积极的术中、术后监护处理,对保证患者手术顺利、预防或减少并发症发生有重要意义。     

Morbidities associated with patent ductus arteriosus in preterm infants. Nationwide cohort study

Purpose: To evaluate the predictive factors for the development of haemodynamically significant patent ductus arteriosus (PDA) in preterm infants and to study the morbidities associated with the treatment of PDA during the first hospitalization.

Materials and methods: Data were collected from the Finnish national register of preterm infants (<32 gestational weeks) born in 2005–2013. In total, 3668 infants were included. Morbidities during the first hospitalization were analysed and compared between infants who received treatments for the closure of PDA (n?=?1132) and infants who received no treatment for PDA (n?=?2536). The results were adjusted for the duration of pregnancy, intrauterine growth pattern, antenatal steroids, delivery hospital and respiratory distress syndrome (RDS).

Results: RDS and mechanical ventilation were independently associated with an increased risk of PDA requiring treatment. Medical and surgical treatments were associated with the risk of severe bronchopulmonary dysplasia (BPD). Primary surgical ligation was associated with an increased risk of severe intraventricular haemorrhage (IVH) and necrotizing enterocolitis (NEC). Medical treatment itself and also followed by surgical ligation was associated with lower mortality.

Conclusion: The severity of lung disease rather than prematurity per se was associated with the development of PDA requiring therapy. Both medical and surgical therapies for PDA were associated with severe BPD, and primary surgical ligation was associated with NEC and severe IVH.     

Catheter-based closure of the patent ductus arteriosus in lower weight infants

Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6 kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (<6 kg) infants is growing. Among these smaller infants, the goals of this review are to: (1) provide an overview of the procedure; (2) review the types of PDA closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants.