Abstract:Objective To investigate the risk factors for the occurrence of patent ductus arteriosus (PDA) and to provide a clinical basis for reducing the occurrence of PDA in early preterm infants. Methods A total of 136 early preterm infants (gestational age ≤32 weeks) who were hospitalized between January 2013 and December 2014 and diagnosed with hemodynamicalhy significant PDA (hs-PDA) were enrolled as the case group. Based on the matched case-control principle, 136 early preterm infants without hs-PDA were selected among those who were hospitalized within the same period at a ratio of 1:1 and enrolled as the control group. The two groups were matched for sex and gestational age. The basic information of neonates and maternal conditions during the pregnancy and perinatal periods were collected. Logistic regression analysis was performed to identify the risk factors for the development of PDA. Results Univariate analysis showed that neonatal infectious diseases, neonatal respiratory distress syndrome, decreased platelet count within 24 hours after birth, and low birth weight were associated with the development of hs-PDA (POR=2.368) and decreased platelet count within 24 hours after birth (OR=0.996) were independent risk factors for hs-PDA. Conclusions Neonatal infectious diseases and decreased platelet count within 24 hours after birth increase the risk of hs-PDA in early preterm infants.
DU Jin-Feng,LIU Tian-Tian,WU Hui. Risk factors for patent ductus arteriosus in early preterm infants: a case-control study[J]. CJCP, 2016, 18(1): 15-19.
Koch J, Hensley G, Roy L, et al. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less[J]. Pediatrics, 2006, 117(4): 1113-1121.
[2]
Rolland A, Shankar-Aguilera S, Diomandé D, et al. Natural evolution of patent ductus arteriosus in the extremely preterm infant[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(1): F55-F58.
[3]
AlFaleh K, Alluwaimi E, AlOsaimi A, et al. A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants[J]. 2015, 15: 47.
[4]
Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant[J]. Pediatrics, 2010, 125(5): 1020-1030.
[5]
Chock VY, P u n n R , O z a A , e t a l . P r e d i c t o r s o f bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus[J]. Pediatr Res, 2014, 75(4): 570-575.
[6]
Sellmer A, Bjerre JV, Schmidt MR, et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3[J]. Arch Dis Child Fetal Neonatal Ed, 2013, 98(6): F505-F510.
[7]
Chen YY, Wang HP, Chang JT, et al; Taiwan Premature Infant Development Collaborative Study Group. Perinatal factors in patent ductus arteriosus in very low-birth-weight infants[J]. Pediatr Int, 2014, 56(1): 72-76.
[8]
Echtler K, Stark K, Lorenz M, et al. Platelets contribute to postnatal occlusion of the ductus arteriosus[J]. Nat Med, 2010, 16(1): 75-82.
Gonzalez A, Sosenko IR, Chandar J, et al. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less[J]. J Pediatr, 1996, 128(4): 470-478.
[11]
Kim ES, Kim EK, Choi CW, et al. Intrauterine inflammation as a risk factor for persistent ductus arteriosus patency after cyclooxygenase inhibition in extremely low birth weight infants[J]. J Pediatr, 2010, 157(5): 745-750.
[12]
Rakza T, Magnenant E, Klosowski S, et al. Early hemodynamic conseque nces of patent ductus arteriosus in preterm infants with intrauterine growth restriction[J]. J Pediatr, 2007, 151(6): 624-628.
Vucovich MM, Cotton RB, Shelton EL, et al. Aminoglycosidemediated relaxation of the ductus arteriosus in sepsis-associated PDA[J]. Am J Physiol Heart Circ Physiol, 2014, 307(5): H732-H740.
[15]
Kesiak M, Nowiczewski M, Gulczyńska E, et al. Can we expect decreasing the incidence of patent ductus arteriosus (PDA) in the population of premature neonates who had received antenatal steroid therapy? [J]. Ginekol Pol, 2005, 76(10): 812-818.
[16]
Bhandari V, Zhou G, Bizzarro MJ, et al. Genetic contribution to patent ductus arteriosus in the premature newborn[J]. Pediatrics, 2009, 123(2): 669-673.
[17]
Elimian A, Verma R, Ogburn P, et al. Magnesium sulfate and neonatal outcomes of preterm neonates[J]. J Matern Fetal Neonatal Med, 2002, 2(2): 118-122.
[18]
Fujioka K, Morioka I, Miwa A, et al. Does thrombocytopenia contribute to patent ductus arteriosus?[J]. Nat Med, 2011, 17(1): 29-30.
[19]
Bas-Suárez MP, González-Luis GE, Saavedra P, et al. Platelet counts in the first seven days of life and patent ductus arteriosus in preterm very low-birth-weight infants[J]. Neonatology, 2014, 106(3): 188-194.
[20]
Bokodi G, Derzbach L, Bányász I, et al. Association of interferon gamma T+874A and interleukin 12 p40 promoter CTCTAA/GC polymorphism with the need for respiratory support and perinatal complications in low birthweight neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2007, 92(1): F25-F29.
[21]
McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging[J]. Arch Dis Child Fetal Neonatal Ed, 2007, 92(6): F424-F427.
Kajimoto H, Hashimoto K, Bonnet SN, et al. Oxygen activates the Rho/ Rho-kinase pathway and induces RhoB and ROCK-1 expression in human and rabbit ductus arteriosus by increasing mitochondria-derived reactive oxygen species: a newly recognized mechanism for sustaining ductal constriction[J]. Circulation, 2007, 115(13): 1777-1788.
Lee MJ, Conner EL, Charafeddine L, et al. A critical birth weight and other determinants of survival for infants with severe intrauterine growth restriction[J]. Ann N Y Acad Sci, 2001, 943: 326-339.
[32]
Itabashi K, Ohno T, Nishida H. Indomethacin responsiveness of patent ductus arteriosus and renal abnormalities in preterm infants treated with indomethacin[J]. J Pediatr, 2003, 143(2): 203-207.
[33]
del Moral T, Gonzalez-Quintero VH, Claure N, et al. Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants[J]. J Perinatol, 2007, 27(3): 154-157.