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Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus



شناسه مقاله
10.1016/j.jped.2014.04.010
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انگلیسی

Title: Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus

Authors: Lilian S.R. Sadeck and Cléa R. Leone and Renato S. Procianoy and Ruth Guinsburg and Sergio T.M. Marba and Francisco E. Martinez and Ligia M.S.S. Rugolo and M. Elisabeth L. Moreira and Renato M. Fiori and Ligia L. Ferrari and Jucille A. Menezes and Paulyne S. Venzon and Vânia Q.S. Abdallah and José Luiz M.B. Duarte and Marynea V. Nunes and Leni M. Anchieta and Navantino Alves Filho

Journal: Jornal de Pediatria

Year: 2014

Abstract:

AbstractObjective To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. Methods This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the {BNRN} from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: {G1} – conservative approach (without treatment), {G2} – pharmacologic (indomethacin or ibuprofen), {G3} – surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, {O2} dependence at 36 weeks (BPD36wks), {IVH} III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student’s t-test, chi-squared test, or Fisher’s exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. Results 1,097 newborns were selected and 494 newborns were included: {G1} – 187 (37.8%), {G2} – 205 (41.5%), and {G3} – 102 (20.6%). The highest mortality was observed in {G1} (51.3%) and the lowest in {G3} (14.7%). The highest frequencies of {BPD36wks} (70.6%) and {ROPsur} were observed in {G3} (23.5%). The lowest occurrence of death/BPD36wks occurred in {G2} (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. Conclusion The conservative approach of {PDA} was associated to high mortality, the surgical approach to the occurrence of {BPD36wks} and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.

Keywords: Preterm, Very low birth weight, Ligation, PDA management-chave, Prematuridade, Muito baixo peso, Ligadura cirúrgica, Canal arterial

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عنوان: اثر روش درمانی در تکامل نوزادان نوزاد با وزن بسیار کم با مجرای شریانی

نویسندگان: Lilian S.R. Sadeck and Cléa R. Leone and Renato S. Procianoy and Ruth Guinsburg and Sergio T.M. Marba and Francisco E. Martinez and Ligia M.S.S. Rugolo and M. Elisabeth L. Moreira and Renato M. Fiori and Ligia L. Ferrari and Jucille A. Menezes and Paulyne S. Venzon and Vânia Q.S. Abdallah and José Luiz M.B. Duarte and Marynea V. Nunes and Leni M. Anchieta and Navantino Alves Filho

ژورنال: Jornal de Pediatria

سال: ۲۰۱۴

چکیده:
۳٪) و در {G3} (147٪) پایین ترین بالاترین فرکانس {BPD36wks} (706٪) و {ROPsur} در {G3} (235٪) پایین ترین وقوع مرگ مشاهده شد / BPD36wks در {G2 رخ داده است } (۵۸۰٪) دارویی (OR 029 95٪ CI: 014-062) و محافظه کار (OR 034 95٪ CI: 014-079) درمان های حفاظتی برای مرگ نتیجه / BPD36wks نتیجه رویکرد محافظه کارانه از {} ​​PDA بود مربوط به مرگ و میر بالا، روش جراحی به وقوع {BPD36wks} و ROPsur و درمان دارویی برای حفاظت از مرگ نتیجه / BPD36wks بود
کلمات کلیدی:   زودرس، وزن کم هنگام تولد بسیار، بستن، PDA مدیریت chave، Prematuridade، Muito baixo پزو، Ligadura cirúrgica، شریانی کانال

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