Therapeutic Effect Of Different Drugs On Symptomatic Patent Ductus Arteriosus In Preterm Infants And The Clinical Value Of NT-proBNP

Background and objectiveWith the development of medical technology,the survival rate of preterm infants has increased significantly.It has been reported that the gestational age of the world's smallest successful treatment of premature infant was 21⁺⁶ week,and the birth weight was about 280g.The minimum preterm infant in China was 23⁺⁴ weeks,and the weight was 530g.Maintaining normal cardiac function is vital to the body.Patent ductus arteriosus?PDA?as a common congenital heart disease,seriously affects the survival and prognosis of premature infants.The ductus arteriosus of normal full-term newborns usually constricted in the postnatal 72h,causing anoxia and reconstruction of the intima of the ductus arteriosus,which would be permanently closed.But the ductus arteriosus of premature infant is immature,so the incidence of PDA is high.Once the heart has a large left-to-right shunting,it is prone to heart failure.There will be symptomatic patent ductus arteriosus?sPDA?,also known as haemodynamically significant patent ductus arteriosus?hsPDA?.At present,there are still many controversies in the current diagnosis and treatment of patent ductus arteriosus in the management of premature children,and there is no theory of unification in many aspects.Since 1976,the previous treatment of premature infants with PDA was oral indomethacin,but its side effects were too much,and there were large differences in pharmacokinetics in preterm infants.So the doctors currently use ibuprofen to treat premature infants with PDA.In recent years,there were also reports on the use of paracetamol in the treatment of PDA in preterm infants,but there is still controversy in comparison with the efficacy of ibuprofen,and there were still few reports in this field in China.Another study showed that N-terminal pro brain natriuretic peptide?NT-proBNP?as a biomarker,could quickly and accurately reflect the hemodynamic changes,also could be a sensitive and specific quantitative reaction in heart function,and it had some significance in guiding PDA diagnosis and treatment of preterm infants.Now through retrospective observation and analysis,based on the detection of plasma NT-proBNP levels and other indicators in preterm infants,we explored the clinical application value of acetaminophen and ibuprofen treatment of premature infants with symptomatic patent ductus arteriosus and the clinical value of NT-proBNP in evaluating the condition of PDA in premature infants.This may provide more basis for clinical diagnosis and treatment.Materials and methods86 premature infants,diagnosed as PDA,were set up as PDA group in the neonatal ward of our hospital from October 2015 to February 2018,28 weeks<gestational age<34 weeks,birth weight>1000g.90 cases of premature infants without PDA,28 weeks<gestational age<34 weeks and birth weight>1000g in the same period were selected as control group.PDA group was divided into symptomatic PDA group?hs PDA group?41 cases and asymptomatic PDA group?nhsPDA group?45 cases according to ultrasound results and clinical manifestations,and according to the drug selection,hsPDA group was divided into ibuprofen group22 cases and acetaminophen group 19 cases.The children in each group were given routine nursing care.Ibuprofen group was given the first dose of oral ibuprofen10mg/kg,the second and the third dose were 5mg/kg,and each interval was 24h.Paracetamol group given oral acetaminophen each 15mg/kg,once every 6 hours,for 3days,a total of 12 times.Record the urine volume and feeding situation during the period of treatment.All children were examined by echocardiography on third days after birth,and the peripheral venous blood was taken to the laboratory to determine the level of NT-proBNP.In group PDA,echocardiography and the level of NT-proBNP were reviewed after 3 days of treatment.Detected and recorded the children's level of platelet,creatinine,urea nitrogen,alanine aminotransferase and aspartate aminotransferase in hsPDA group before and after treatment.Record the changes of NT-proBNP level in each group and analyse the occlusion rates of arterial catheters,incidences of adverse reactions?such as the incidence of oliguria,feeding intolerance?and complication in ibuprofen group and acetaminophen group.SPSS 21.0 software was used to analyze the data.The T test was used to compare the normal distribution data.The rank sum test was used to compare the data which did not match the normal distribution among the groups.The chi square test was used to compare the counting data.P<0.05 was considered statistically significant.Results1.There were no statistically significant differences in gender?F/M?,gestational age?W?,birth weight?g?,delivery mode?cesarean section/spontaneous labor?,gestational age,gestational infection,premature rupture of membranes,asphyxia,respiratory distress syndrome and positive pressure ventilation in all groups?P>0.05?.2.The closure rate of paracetamol group?73.7%?was lower than that of ibuprofen group?77.3%?,with no significant difference between two groups?P>0.05?.The incidence of oliguria in the paracetamol group?5.3%?was lower than that of the ibuprofen group?9.1%?,and the difference was not statistically significant?P>0.05?.There was 1 cases of feeding intolerance?manifested as vomiting?in the ibuprofen group and there was also 1 cases of feeding intolerance?manifested as vomiting?in the acetaminophen group,and the difference was not statistically significant?P>0.05?.There was no significant difference in platelet,creatinine,urea nitrogen,alanine aminotransferase and aspartate aminotransferase between the two groups before and after treatment?P>0.05?.3.On the third day after birth,the level of NT-proBNP in PDA group was higher than that in control group,and NT-proBNP level in hsPDA group was higher than that in nhsPDA group?P<0.05?.The levels of NT-proBNP after treatment in group nhsPDA and group hsPDA were lower than those before treatment,and the levels of NT-proBNP in the ibuprofen and acetaminophen groups were significantly lower than those before treatment?P<0.05?.The reduction of NT-proBNP level in the acetaminophen group before and after treatment was similar to that in the ibuprofen group,and there was no statistical significance in the difference?P>0.05?.4.We drawn the receiver operator characteristic?ROC?curve of NT-proBNP on the third day after birth,and the area under curve?AUC?was 0.961.When the NT-proBNP level was 13158pg/mL,the sensitivity of diagnosing hsPDA was 87.8%,and the specificity was 86.7%.Conclusion1.The effect of oral acetaminophen and ibuprofen in the treatment of hsPDA in preterm infants is similar,and the adverse reaction is small.It is advisable.2.Plasma NT-proBNP on the third day after birth can be used as a biochemical indicator for predicting hsPDA in preterm infants.3.Dynamic monitoring of NT-proBNP can be used as a basis for assessing the condition of PDA in preterm infants.