Hemodynamically Significant Patent Ductus Arteriosus In Preterm Infants:the Risk Factors And The Therapy

Objective: To investigate the risk factors affecting the hemodynamic significant patent ductus arteriosus closure and efficacy of oral ibuprofen in the treatment of hemodynamic patent ductus arteriosus in premature infants,and to provide reference for the early diagnosis and treatment of hemodynamic patent ductus arteriosus in premature infans.Methods: The clinical data of 198 preterm infants who were confirmed to have patent ductus arteriosus by B-ultrasound in our department from January 2016 to October 2018 were retrospectively analyzed.The preterm infants divided into hemodynamically significant patent ductus arteriosus group(hsPDA)and non hemodynamically significant patent ductus arteriosus group(nhsPDA).The hsPDA group was divided into the ductal closure group and the patent ductus arteriosus group according to the situation of ductus arteriosus closure after oral ibuprofen.Risk factors were identified.Data were analyzed using logistic regression model.Results:A total of 67 patients in the hsPDA group and 131 patients in the nhsPDA group were included.Single factor analysis showed that hsPDA in preterm infants was significantly associated with gender(male),gestational age(weeks),low birth weight,amniotic fluid pollution,pregnancy induced hypertension,IVF,birth asphyxia.Logistic regression analysis showed that gender(male)(OR=0.169,95%CI 0.393-0.726),gestational age(OR=0.851,95%CI0.747-0.970)were independent protective factors for hsPDA,and amniotic fluid pollution(OR=4.81,95%CI 1.084-21.327)were independent risk factors for hsPDA.Single factor analysis showed that effect of oral ibuprofen on hsPDA in premature infants was significantly associated with gender(male),platelet distribution width,platelet count,respiratory support,pneumonia.Logistic regression analysis showed that platelet distribution width(OR=4.018,95%CI 1.739-9.003)and platelet count(OR=1.009,95%CI1.001-1.018)were independent risk factors affecting the effect of oral ibuprofen on hsPDA in premature infants.The sensitivity and specificity of predicting the effect of oral ibuprofen on hsPDA in preterm infants were 78.1% and 77.1%,when the platelet distribution width was 12.35 fl.Conclusions In this study,hsPDA in preterm infants was closely related to gestational age,gender,and amniotic fluid pollution.The effect of oral ibuprofen on hsPDA in premature infants is related to the platelet distribution width and platelet count,especially the platelet distribution width which can predict the effect of oral ibuprofen on hsPD in premature infants.