Risk factors of hemodynamically significant patent ductus arteriosus in extremely preterm infants
10.3760/cma.j.issn.2096-2932.2021.06.004
- VernacularTitle:超早产儿有血流动力学意义的动脉导管未闭危险因素分析
- Author:
Aimin QIAN
1
;
Wen ZHU
;
Yang YANG
;
Youyan ZHAO
;
Jun CHEN
;
Hui RONG
;
Qing KAN
;
Yan GUO
;
Keyu LU
;
Rui CHENG
Author Information
1. 南京医科大学附属儿童医院新生儿医疗中心 210008
- Keywords:
Patent ductus arteriosus;
Hemodynamically significant;
Fluid overload;
Extremely preterm infants
- From:Chinese Journal of Neonatology
2021;36(6):18-22
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the risk factors of hemodynamically significant patent ductus arteriosus (hsPDA) in extremely preterm infants (EPI).Method:From July 2017 to April 2020, EPI (gestational age <28 weeks) admitted to the Department of Neonatology of our hospital were included and analyzed retrospectively. According to whether hsPDA existed or not, the infants were assigned into non-hsPDA group and hsPDA group. Demographic findings and possible risk factors of hsPDA were collected.The cumulative fluid overload (FO) within 3 days after birth was calculated. Univariate and multivariate analysis were used to determine the risk factors of hsPDA.Result:A total of 79 infants with gestational age of (27.0±0.9) weeks and birth weight of (987±173)g were enrolled, including 23 cases in non-hsPDA group and 56 cases in hsPDA group. Univariate analysis showed that thrombocytopenia ( P=0.044), respiratory distress syndrome (RDS) treated with pulmonary surfactant (PS) ( P=0.006) and high FO level ( P=0.002) were associated with hsPDA. Multivariate analysis showed that RDS treated with PS ( OR=5.933, 95% CI 1.360~25.883, P=0.018) and high FO level ( OR=1.261, 95% CI 1.063~1.496, P=0.008) were independent risk factors for hsPDA in EPIs. ROC curve analysis showed that the cut-off value of FO was -0.2%, with 85.7% sensitivity and 56.5% specificity distinguishing the presence of hsPDA (AUC=0.712, Youden index=0.422). Conclusion:High level of FO within the first 3 days of life and RDS treated with PS are independent risk factors for hsPDA in EPI. After PS treatment, hemodynamic changes of infants with RDS should be monitored closely. During early fluid management of EPI, FO should be strictly monitored to avoid high FO level.
