| Objective:To investigate the relationship between patent ductus arteriosus(PDA)and intrauterine inflammation in preterm infants with gestational age less than 32 weeks and the effect of ibuprofen on the occurrence and prognosis of PDA in preterm infants with gestational age less than 32 weeks.Methods:In this retrospective case-control study,216 premature infants with gestational age less than 32 weeks who were born in the obstetrics department of the Affiliated Hospital of Qingdao University and hospitalized in NICU from September 2018 to September 2020 were selected as the research objects.The infants were divided into intrauterine inflammation group(n=69)and control group(n=147)according to maternal clinical and placental pathology.216 cases of premature infants were examined by echocardiography on the 3rd day after birth.116 cases of premature infants diagnosed with PDA were observed symptomatically.Cardiac ultrasound was reexamined 6-7 days after birth.Combined with the clinical manifestations,there were still hs PDA(10 cases in the intrauterine inflammation group and 11 cases in the control group).Oral ibuprofen(the first dose of 10 mg/kg,5 mg/kg at 24 h and 48 h)was given to close the arterial catheter.3-7days after the completion of the first course of treatment,cardiac ultrasound was reexamined,and hs PDA was still present for the second and third courses of ibuprofen treatment.The clinical data of perinatal and neonatal period were collected and analyzed statistically.Results:(1)Analysis of perinatal and neonatal general conditions between intrauterine inflammation group and control group: the incidence of premature rupture of membranes in intrauterine inflammation group was significantly higher than that in control group(72.46% vs 47.62%),the difference was statistically significant(P<0.05);There were no significant differences between the two groups in maternal times of pregnancy,age,antibiotic use,prenatal magnesium sulfate,hormone use,gestational diabetes mellitus and gestational hypertension,gestational age and birth weight of premature infants(P>0.05).The vaginal delivery rate in the intrauterine inflammation group was higher than that in the control group(60.87% vs 20.41%).The incidence of Apgar ≤ 3 points in 1 minute and ≤ 7points in 5 minutes in the intrauterine inflammation group(27.54% vs 14.97;P<0.05);24hours after birth CRP was also higher than the control group,the differences were statistically significant(P<0.05).(2)The incidence of PDA in intrauterine inflammation group was 59.42%(41/69),and the incidence of hs PDA was 17.39%(12/69);In the control group,the incidence of PDA was 51.02%(75/147),and the incidence of hs PDA was 10.88%(16/147).At 6-7 days after birth,the natural closure rate of PDA in 116 premature infants was 33.62%(39/116);The natural closure rate of PDA and HSPDA in intrauterine inflammation group was 26.82%(11/41)and 16.67%(2/12),respectively;In the control group,the natural closure rate of PDA was 37.33%(28/75),and that of hs PDA was 31.25%(5/16).The incidence of PDA,hs PDA and the natural closure rate of 6-7 days after birth in the intrauterine inflammation group were lower than those in the control group,and the difference was statistically significant(P<0.05).After one course of oral ibuprofen treatment,the closure rate of ductus arteriosus was50.00%(5/10)in intrauterine inflammation group and 63.63%(7/11)in control group,with significant difference between the two groups(P<0.05).After the second course of ibuprofen treatment,the closure rates of intrauterine inflammation group and control group were 80%(8/10)and 90.9%(10/11),respectively,with significant difference between the two groups(P<0.05).After 3 courses of ibuprofen treatment,PDA was ligated in 2 cases(20%)of intrauterine inflammation group and 1 case(9%)of control group.There was significant difference between the two groups(P<0.05).(3)The complications of two groups of premature infants: intrauterine inflammation group intrauterine intubation rate was higher than the control group(28.99% vs 17.01%);The incidence of early-onset sepsis(17.39% vs 4.76%),intraventricular hemorrhage(16.34%vs 7.48%),necrotizing enterocolitis(18.84% vs 7.48%),bronchopulmonary dysplasia(33.33% vs 12.24%)in intrauterine inflammation group were higher than those in the control group(P<0.05);There was no significant difference in the incidence of neonatal respiratory distress syndrome,pulmonary surfactant use,hospitalization time,invasive ventilation time,noninvasive ventilation time and oxygen inhalation time between the two groups(P>0.05).Conclusion:(1)The PDA of some premature infants can be tumed of naturally within a week,and intrauterine inflammation has a strong correlation with PDA and hs PDA.Intrauterine inflammation can increase the incidence of PDA and hs PDA in very preterm infants,reduce the natural closure rate of ductus arteriosus,and affect the therapeutic effect of ibuprofen.(2)Intrauterine inflammation also increased the incidence of bronchopulmonary dysplasia,neonatal necrotizing enterocolitis,early sepsis and intraventricular hemorrhage. |
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