| Objective:By observing the case-control study of oral ibuprofen in infants less than 32 weeks of gestational age and preterm infants with significant hemodynamic changes in patent ductus arteriosus,to investigate the outcome of ibuprofen in the treatment of hsPDA,and analyze the related factors that affect the efficacy of ibuprofen and the impact of failure of drug closure on the respiratory system and other systems.Methods:In this study,a total of 636 preterm infants who were hospitalized in the NICU of Qingdao University Affiliated Hospital with a gestational age of less than 32 weeks from January 1,2017 to December 31,2019 were selected.All preterm infants underwent echocardiography at 3 days after birth.159 cases were diagnosed with PDA,and they were given fluid restriction and watched and waited for treatment.The echocardiogram was re-examined at 6 days after birth,48 cases with arterial duct closed spontaneously,111 cases with hsPDA still had hemodynamic changes.111 premature infants with hsPDA were given oral ibuprofen after excluding drug contraindications.The first dose of ibuprofen was 10mg/kg,and 5mg/kg was given at 24 h and 48 h respectively.Check echocardiography again 3-7 days after the end of treatment,and according to whether the PDA was closed or not,it is divided into the DA closed group(n=72)and the DA unclosed group(n=39).Perinatal data of two groups of preterm infants was collected: such as premature rupture of membranes,placental abruption,gestational diabetes mellitus,gestational hypertension,delivery mode,pregnancy and delivery times,abortion history,parents’ age,prenatal use of hormones and magnesium sulfate,etc.The general situation and complications of premature infants was collected: such as gestational age,weight,sex,postnatal asphyxia history,Apgar scores at 1 minute and 5 minutes after birth,neonatal respiratory distress syndrome(RDS),bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),intraventricular hemorrhage(IVH),necrotizing enterocolitis(NEC)and other complications,mechanical ventilation time,non-invasive ventilation time,oxygen inhalation time,pulmonary surfactant(PS)application.Clinical data such as blood routine within 24 hours and 4-7 days after birth was collected.These clinical data were statistically analyzed.Results:1.Among the 636 very premature infants,159 cases were diagnosed with PDA at 3days after birth,and the incidence of PDA in very premature infants was 25%.159 premature infants with PDA were given fluid restriction,observed and waited for treatment.48 infants were naturally closed and the natural closure rate of PDA in very premature infants was 30% at 6 days after birth.The drug closure rates of preterm infants under 28 weeks of gestational age,28-29+6 weeks,and 30-31+6 weeks were 48%,60%,and 79%,respectively.The three groups of preterm infants with different gestational ages had statistically significant differences in drug efficacy.The greater the gestational age,the higher the shut-off rate of ibuprofen(P<0.05).2.Among 111 very premature infants with hsPDA,72 cases of arterial ducts were completely closed after the first course of ibuprofen treatment,39 cases of arterial ducts were not closed,and the closure rate of the first course of ibuprofen treatment was 65%.Among the 39 cases with unclosed arterial ducts,16 cases had reduced arterial duct diameters without hemodynamic fluctuations;20 cases were treated with a second course of ibuprofen,of which 17 cases had arterial ducts narrowed or completely closed,3 cases of arterial ducts were reopened;After 3courses of ibuprofen treatment,3 children were still not closed and had hemodynamic changes that could not be withdraw the ventilator,they were surgically ligated.3.Univariate analysis showed that prenatal use of magnesium sulfate,small gestational age,low birth weight,history of postnatal asphyxia,low 1-minute Apgar score,low 5-minute Apgar score,large catheter diameter,high LA/AO ratio,acidosis,RDS,the use of PS,sepsis,and large mean platelet volume(MPV)within 4-7 days after birth were risk factors that caused the failure of ibuprofen to treat hsPDA(P<0.05).4.Multivariate logistic regression analysis showed that large gestational age and high birth weight were independent protective factors for the treatment effect of ibuprofen;large catheter diameter and the use of prenatal magnesium sulfate were independent risk factors for the treatment effect of ibuprofen.5.The invasive ventilation time,non-invasive ventilation time,and oxygen inhalation time of the DA patent group were higher than those of the DA closed group;the incidence of BPD and hospital stay in the DA patent group were also higher than those of the DA closed group.These differences were statistically significant(P<0.05).While the incidence of IVH,abnormal blood coagulation,ROP,and NEC were not significantly different between the two groups(P>0.05).Conclusions:1.The incidence of PDA in premature infants under 32 weeks of gestational age is 25%.The natural closure rate of PDA in very premature infants is 30%.The PDA closure rate of the first course of ibuprofen treatment was 65%,and its efficacy was positively correlated with gestational age.2.Small gestational age,low birth weight,prenatal use of magnesium sulfate,and wide catheter diameter are independent high-risk factors for the failure of ibuprofen in the treatment of PDA in very preterm infants;PS use and combined RDS can affect the efficacy of ibuprofen.The failure of ibuprofen to close PDA prolongs respiratory support and hospitalization time of premature infants,and increases the occurrence of BPD. |
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