Can Treatment of Patent Ductus Arteriosus with Ibuprofen Compared to Supportive Management Affect Regional Brain Volume in Very Low Birth Weight Infants? A Pilot Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to compare cerebral hemispheric volumes between pharmacologic treatment and supportive management of patent ductus arteriosus (PDA). Methods: The study was conducted retrospectively. The subjects of period 1 group were very low birth weight infants whose PDA were treated with pharmacologic closure. Period 2 group were treated with supportive management. Regional brain volumes measured using magnetic resonance imaging were compared between the two groups. Results: A total of 12 infants were included. Their median gestational age was 27+6 (range: 24+1–31+1) weeks and birth weight was 1,065 g (range: 690–1,380). Between the two groups, there was no difference in Apgar score, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, and culture proven sepsis. The regional brain volumes such as gray matter (Period 1 group, 76,833 mm3 [55,759–100,388] vs. Period 2 group, 79,870 mm3 [59,957–113,018], P=0.59), white matter (82,993 mm3 [63,130–121,311] vs. 92,576 mm3 [77,200–104,506], P=0.18), cerebrospinal fluid (17,167 mm3 [9,279–22,760] vs. 14,348 mm3 [7,018–27,604], P=0.94), basal ganglia (2,065 mm3 [1,697 –2,482] vs. 2,306 mm3 [2,065–3,009], P=0.18), and cerebellum (18,374 mm3 [14,843–24,657] vs. 18,096 mm3 [16,134–23,627], P=0.94) were not different between the two groups. Conclusion: Regional brain volumes were not different between pharmacological and conservative treatment in infants with PDA. Further wellcontrolled studies are required to evaluate the advantages or disadvantages of supportive management without pharmacologic treatment of PDA.
Abstract
Purpose: This study aimed to compare cerebral hemispheric volumes between pharmacologic treatment and supportive management of patent ductus arteriosus (PDA). Methods: The study was conducted retrospectively. The subjects of period 1 group were very low birth weight infants whose PDA were treated with pharmacologic closure. Period 2 group were treated with supportive management. Regional brain volumes measured using magnetic resonance imaging were compared between the two groups. Results: A total of 12 infants were included. Their median gestational age was 27+6 (range: 24+1–31+1) weeks and birth weight was 1,065 g (range: 690–1,380). Between the two groups, there was no difference in Apgar score, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, and culture proven sepsis. The regional brain volumes such as gray matter (Period 1 group, 76,833 mm3 [55,759–100,388] vs. Period 2 group, 79,870 mm3 [59,957–113,018], P=0.59), white matter (82,993 mm3 [63,130–121,311] vs. 92,576 mm3 [77,200–104,506], P=0.18), cerebrospinal fluid (17,167 mm3 [9,279–22,760] vs. 14,348 mm3 [7,018–27,604], P=0.94), basal ganglia (2,065 mm3 [1,697 –2,482] vs. 2,306 mm3 [2,065–3,009], P=0.18), and cerebellum (18,374 mm3 [14,843–24,657] vs. 18,096 mm3 [16,134–23,627], P=0.94) were not different between the two groups. Conclusion: Regional brain volumes were not different between pharmacological and conservative treatment in infants with PDA. Further wellcontrolled studies are required to evaluate the advantages or disadvantages of supportive management without pharmacologic treatment of PDA.
참고문헌 (21)
- Northway WH Jr., "Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia", N Engl J Med, 276, pp.357~368 (1967)
- Clyman RI, "The role of patent ductus arteriosus and its treatments in the development of bronchopulmonary dysplasia", Semin Perinatol, 37, pp.102~107 (2013)
- 김수정, "Risk Factors for Postoperative Cardiopulmonary Instability Following Ligation of Patent Ductus Arteriosus in Very Low Birth Weight Infants", Neonatal medicine, 22(4), pp.198~204 (2015), 대한신생아학회
- Siassi B, "Patent ductus arteriosus complicating prolonged assisted ventilation in respiratory distress syndrome", J Pediatr, 74, pp.11~19 (1969)
- Gregory GA, "Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure", N Engl J Med, 284, pp.1333~1340 (1971)
- Noori S, "Failure of ductus arteriosus closure is associated with increased mortality in preterm infants", Pediatrics, 123, pp.e138~e144 (2009)
- Benitz WE, "Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?", J Perinatol, 30, pp.241~252 (2010)
- Gersony WM, "Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study", J Pediatr, 102, pp.895~906 (1983)
- Benitz WE, "Learning to live with patency of the ductus arteriosus in preterm infants", J Perinatol, 31(Suppl 1), pp.S42~S48 (2011)
- Nemerofsky SL, "The ductus arteriosus rarely requires treatment in infants > 1000 grams", Am J Perinatol, 25, pp.661~666 (2008)
- Clyman RI, "Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?", Semin Perinatol, 36, pp.123~129 (2012)
- Lemmers PM, "Patent Ductus Arteriosus and Brain Volume", Pediatrics, pp.137~ (2016)[DOI]
- Kaempf JW, "What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?", J Perinatol, 32, pp.344~348 (2012)
- Inder TE, "Abnormal cerebral structure is present at term in premature infants", Pediatrics, 115, pp.286~294 (2005)
- Boardman JP, "Abnormal deep grey matter development following preterm birth detected using deformation-based morphometry", Neuroimage, 32, pp.70~78 (2006)
- Keunen K, "Brain volumes at term-equivalent age in preterm infants: imaging biomarkers for neurodevelopmental outcome through early school age", J Pediatr, 172, pp.88~95 (2016)
- Pickard JD, "Inhibition of prostaglandin synthesis and the response of baboon cerebral circulation to carbon dioxide", Nat New Biol, 245, pp.187~188 (1973)
- Wennmalm Å, "Effect of indomethacin on basal and carbon dioxide stimulated cerebral blood flow in man", Clin Physiol, 1, pp.227~234 (1981)
- Evans DH, "The effect of indomethacin on cerebral blood-flow velocity in premature infants", Dev Med Child Neurol, 29, pp.776~782 (1987)
- Romagnoli C, "Effects of prophylactic ibuprofen on cerebral and renal hemodynamics in very preterm neonates", Clin Pharmacol Ther, 67, pp.676~683 (2000)
- Bhatt M, "Does treatment of patent ductus arteriosus with cyclooxygenase inhibitors affect neonatal regional tissue oxygenation?", Pediatr Cardiol, 33, pp.1307~1314 (2012)