| Objective To evaluate the effect of patent ductus arteriosus on the myocardium by measuring levels of cTnT and CK-MB,markers of ischemic myocardial damage.Study design Between May 2010 and January 2011,110 preterm infants with a gestation range of 28 to 36 weeks underwent cTnT , CK-MB and echocardiographic assessments on the third day of life.According to echocardiogram,they were devided into two groups,44 preterm infants with PDA,and 66 preterm infants with spontaneous closure. The infants with PDA were treated with ibuprofen,and follow-up echocardiography was performed after treatment.If the ductus was closed ,serum assay was re-measured.Results Before treatment,median cTnT and CK-MB in the PDA group were significantly higher than in the control group, (0.259±0.134)vs(0.083±0.054)ug/L,p<0.01;(7.31±2.69)vs(5.71±1.88)ug/L,p<0.05,respectively.Following successful treatment,cTnT and CK-MB levels decreased significantly, to(0.062±0.039)ug/L and (5.34±1.50)ug/L,respectively,but both lower than in the control group,p<0.05. cTnT was correlated positively with the duration of ventilatory support ,respiratory distress syndrome and ductal diameter,and was unaffected by sex,gestation and birth weight. On the contrary,CK-MB levels was correlated significantly with sex,gestation,birth weight and the duration of ventilatory support,not with respiratory distress syndrome and ductal diameter. The receiver operating characteristics curve for detection of PDA through cTnT values had an area under the curve of 0.760(95% confidence interval 0.641 to 0.895),through CK-MB values had an area under the curve of 0.715(95% confidence interval 0.609 to 0.863). Conclusions A haemodynamically significant PDA could cause myocardial injury in preterm infant.The changes of cTnT and CK-MB in serum are consistent with the course,and have guilding significance for therapy and prognosis. Objective This study aimed to examine and compare the efficacy and safety of oral ibuprofen and oral indomethacin for the early closure of PDA in preterm infants,and identify affectingfactors for PDA after therapy with indomethacin.Study design Retrospectively select 160 preterm infants with a haemodynamically significant PDA who received oral indomethacin treatment as a control group,and enrolled 44 infants with hsPDA to receive oral ibuprofen.Ibuprofen group received an initial dose of 10 mg/kg,followed by two doses of 5 mg/kg at 24h intervals. Indomethacin group received three doses of 0.2mg/kg,at 12h and 24h intervals,if the birth weight greater than 1.25kg;otherwise with an initial dose of 0.2 mg/kg, followed by two doses of 0.1mg/kg each,after 12 and 36 hours. Assessed the clinical symptoms and echocardiographic parameters,especially the closure rate of PDA and side effects of NSAID.Based on the clinical efficacy in indomethacin group, infants with closed ductus were classified as responders,and infants with patent ductus were classified as nonresponders.Multiple logistic regression analysis was used to determine which perinatal/neonatal variables were most closely associated with the persistent PDA during the indomethacin therapy.Results The PDA closure rates and the surgical ligation requiring were similar in both groups:34/44(77.3%)and 3/44(6.8%)in ibuprofen; 113/160(70.6%)and 17/160(10.6%)in indomethacin. More patients [34/160(21.8%)] treated with indomethacin tended to develop oliguria than those with ibuprofen [3/44(6.8%)].Moreover,patients treated with idomethacin showed a significant increase in serum creatinine[43/160(26.9%)versus 4/44(9.1%)].There were no significant differences in other side effects or complicantions between the groups. 113 infants were responders,and 47 infants were nonresponders. No differences were noted in ductal size ,sex,mode of delivery,SGA,and main morbidities such as intraventricular hemorrhage≥Ⅱ°,necrotizing enterocolitis,or chronic lung disease. Nonresponders was characterized by lower gestational age and birth weight, low rate of antenatal dexamethasone exposure, high rates of respiratory distress syndrome,infection and mechanical ventilation,longer time of mechanical ventilation and hospital stay,and higher mortality. By multiple logistic regression analysis,immature gestational age (OR= 7.095), infection (OR=2.324), respiratory distress syndrome (OR=4.754) and antenatal dexamethasone exposure(OR=0.224) were significantly associated with persistent PDA during the indomethacin therapy.Conclusions oral ibuprofen is as effective as indometacin for the early-targeted PDA treatment in preterm infants,without increasing the incidence of complications,and has fewer effects on renal function in terms of urine output and serum creatinine lever.Gestational age, infection, and respiratory distress syndrome are independent affectingfactors that appear to affect ductus closure when indomethacin has been used to inhibit prostaglandin production,and antenatal dexamethasone exposure is conductive to the closure of ductus. |
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