Clinical And Hemodynamic Change Of Patent Ductus Arteriosus In Preterm Infants

Objective:Patent ductus arteriosus(PDA)refers to the ductus arteriosus(DA)which still remain open after 72 hours of birth.Patent ductus arteriosus makes the hemodynamic change,with mostly left to right shunt leading to the pulmonary artery and cardiac load increase,and the systemic decrease at the same time.It's easy to have a difficulty breathing,heart murmur,increased heart rate,increased pulse pressure difference and a series of clinical symptoms.Even in severe cases,patent ductus arteriosus cause pulmonary hemorrhage,bronchopulmonary dysplasia(BPD),intraventricular hemorrhage(IVH),necrotizing enterocolitis(NEC)and retinopathy of prematurity(ROP).Currently,opinions on PDA management remains controversial:How to determine hemodynamically significant PDA(hs-PDA)?Do all PDA need treatment?How to choose the treatment and timing of PDA?This experiment adopts the way of retrospective study,to explore the high risk factors of PDA,and evaluate echocardiography for hemodynamically significant PDA(hs-PDA)the judgment of value.Through summarizing the clinical characteristics of the babies with PDA,explore the relationship between hs-PDA and neonatal respiratory distress syndrome(NRDS),pulmonary hemorrhage,BPD,IVH or NEC.Also,through taking ibuprofen treat PDA to summary the the therapeutic effect and side effects of ibuprofen.Method:Choose the prematures 257 cases who were hospitalized in neonatal intensive care unit(NICU)of the Second Hospital of Hebei Medical University within 24 hours after birth with gestational age?34 while weight?2000 g at the same time during September 2015 to August 2016.Rule out the babies with serious congenital heart disease,asphyxia(Apgar 1min score?7)and the children who given up treatment or dead within 7 days.Results by echocardiography after birth for PDA,the research objects can bedivided into no-PDA group(148cases)and PDA group(109cases).According to the presence of clinical symptoms,PDA group was divided into the hs-PDA group(48cases)and without hemodynamic significance of PDA(nhsPDA)group(61cases).The no-PDA group and nhs-PDA group were not given special treatment,while hs-PDA group gave oral ibuprofen first dose of10mg/kg,second and third dose of 5 mg/kg,for once every 24 hours.Review echocardiography after the first round of medication.If the ductus arteriosus was still open and the clinical symptoms obvious may be given a second round of ibuprofen take orally.Statistical analysis was performed by using IBM SPSS Statistics version 21.Enumeration data use rate(%)to represent it's constituent ratio,and the difference between group compared with ?2 test.Normal distribution of measurement data are expressed by the mean±standard deviation(x±s),and difference is compared by t test or analysis of variance.Abnormal distribution of measurement data are expressed by the median(interquartile range)(M(IQR)),and difference is compared by nonparametric test.The value to the diagnosis of hs-PDA of echocardiographic index using ROC curve.?=0.05 is considered as test standard,and P<0.05 indicates statistically significant differences.Result:The incidence of PDA is 42.4%(109/257)in the preterm infants who's gestational age?34 weeks,birth weight?2000 g,while the hs-PDA accounted for 18.7%(48/257)of the total.The gestational age and birth weight are negatively correlated with PDA(R respectively 0.270,0.259,P <0.05).There is no statistical difference(P > 0.05)in the aspect of sex and childbirth way between three groups,while in terms of whether merging NRDS the difference was statistically significant(P < 0.05).In terms of echocardiographic indicators,the nhs-PDA group's DA diameter is less than the hs-PDA group(P < 0.05),and the difference is statistically significant.Between no-PDA group,nhs-PDA and hs-PDA group,the differences of LA/AO and LV/AO are statistically significant(P < 0.05),and LVEF and pulmonary artery flow velocity have no obvious statistical difference(P >0.05).When DA diameter = 2.25 mm,the sensitivity is 0.646,and the specificdegree is 0.869.When LA/AO = 1.27,the sensitivity is 0.896,and the specific degree is 0.713.When LV/AO= 2.17,the sensitivity is 0.729,and the specific degree is 0.703.Single factor analysis results show that,the difference of the IVH has no statistical significance(P > 0.05),while pulmonary hemorrhage,NEC,and BPD have statistical significance(P < 0.05).The difference is statistically significant(all P < 0.05)in mechanical ventilation and hospitalization time between three groups.There are 83.6%(51/61)of the nhsPDA group can be spontaneously closed.The effective rate of taking ibuprofen for first course is 68.8%(33/48),and two course is 77.1%(37/48).Two patients occurred gastrointestinal bleeding in oral ibuprofen,and there is no oliguria,kidney damage or thrombocytopenia occurred.Conclusion:1 PDA easily occurred in low birth weight babies who's gestational age?34 weeks.The smaller the gestational age,the lower the birth weight,the higher incidence of PDA.2 Premature birth,low birth weight and merging NRDS are high risk factors for PDA.3 When the clinical symptoms appears that the area before the heart beats,heart murmur,breathing situation worse,and echocardiographic prompt that DA diameter ? 2.25 mm,LA/AO ? 1.27,LV/AO ? 2.17,indicate the hs-PDA and the application of drug therapy.4 Mechanical ventilation and hospitalization time can be prolonged by hs-PDA.There is correlation between the occurrence of hs-PDA with pneumorrhagia,NEC,and BPD.5 The effect of taking ibuprofen for treating PDA is obvious,and the side effects is little.