Studies on the Correlation of Prematures with RDS and PDA Requiring Indomethacin

有呼吸窘迫症的早產兒與開放性動脈導管使用indomethacin相關性探討

李榮明(Zon-Min Lee) ； 張學文(Hsueh-Wen Chang) ； 江吉文(Chi-Wen Chiang) ； 陳立材(Li-Chai Chen)

《臺灣臨床藥學雜誌》 20卷1期 (2012/03) Pp. 1-9

摘要

目的：開放性動脈導管是非常早產新生兒常見的問題，也是有呼吸窘迫症且正使用呼吸器新生兒之常見併發症。本研究目的為探討華人出生時有無呼吸窘迫症與之後發生開放性動脈導管需用indomethacin治療的相關性。方法：於2008年1月1日至2009年12月31日止，兩年間共有658名新生兒住進我們的新生兒加護病房而納入此研究。他們的母親懷孕週數是23至42週（34.0±3.9週）。出生體重，母親懷孕週數，有無呼吸窘迫症及有無使用indomethacin 均有被記載。結果：此658名納入研究的新生兒有33個（5.02%）接受indomethacin治療。其中，88名有呼吸窘迫症新生兒中有9名（10.23%）之後接受indomethacin 治療，570名沒有呼吸窘迫症新生兒中有24名（4.21%）之後接受indomethacin治療。新生兒出生時有呼吸窘迫症似乎之後有較高機率會發展出開放性動脈導管而使用indomethacin。然而，就母親懷孕週數小於（等於）34週的這組350名早產兒當中，83名有呼吸窘迫症新生兒中有8名（9.64%）之後接受indomethacin治療，267名沒有呼吸窘迫症新生兒中有24名（8.99%）之後接受indomethacin治療，並沒有統計上有意義的差異性（p=0.858）。結論：在母親懷孕週數小於（等於）34週的這些早產兒，出生時有無呼吸窘迫症與之後發展出開放性動脈導管而使用indomethacin治療並無相關性，意指預防性indomethacin來避免開放性動脈導管於有呼吸窘迫症的早產兒在其出生後24小時內使用應該是不需要的。

關鍵字

早產兒 ； 呼吸窘迫症 ； 開放性動脈導管 ； indomethacin

並列摘要

Object:Patent ductus arteriosus (PDA) is a common problem in very premature neonates, and also is a common complication in neonates ventilated for respiratory distress syndrome (RDS). The goal of this study was to explore the association between Chinese neonates born with or without RDS and PDA with indomethacin therapy thereafter.Methods:In total 658 neonates admitted to our neonatal intensive care unit (NICU) from Jan. 1, 2008 through Dec. 31, 2009 had been enrolled in this study. The gestational age (GA) ranged from 23 to 42 weeks (34.0±3.9 weeks). Birth weight, gestational age, RDS or not, and indomethacin use or not were all recorded.Results:Thirty-three (5.02%) of 658 included neonates received indomethacin. Nine (10.23%) of the 88 neonates with RDS received indomethacin, and 24 (4.21%) of the 570 neonates without RDS received indomethacin thereafter. Neonates born with RDS seemed to have higher probability of developing PDA, which prompts the use of indomethacin. However, in the group of 350 prematures with GA≦34 weeks, 8 (9.64%) of the 83 neonates with RDS received indomethacin, and 24 (8.99%) of the 267 neonates without RDS received indomethacin thereafter. The difference ( p=0.858 ) was not significant.Conclusion:There was no association between RDS and PDA with indomethacin therapy thereafter in the prematurity with GA ≦ 34 weeks, meaning that prophylactic indomethacin therapy in the first twenty-four hours of life for the prevention of PDA in preterm infants with RDS is probably not necessary.

並列關鍵字

premature ； respiratory distress syndrome ； patent ductus arteriosus ； indomethacin