ABSTRACT
OBJECTIVE: The study aims to assess the impact on neurodevelopmental outcomes of a prolonged hemodynamically significant patent ductus arteriosus (PDA) after a conservative treatment. STUDY DESIGN: This involves the study of two cohorts of preterm infants 23 to 29 weeks gestation, before (n = 29) and after (n = 54) a conservative approach of PDA. We compared survival, major outcomes, and neurodevelopmental impairment (NDI) at 2 years and analyzed NDI in the conservative cohort according to the duration of the PDA. RESULTS: Conservative cohort received less medical (31.5%) and surgical treatment (7.4%) and had more days of PDA (59 days in 24-26 weeks and 22 days in 27-29 weeks; p < 0.001) in comparison with control cohort (19 days in 24-26 weeks and 11 days in 27-29 weeks; p = 0.688). Mortality, survival-without-morbidity at discharge, and NDI at 2 years were similar between the two groups (p = 0.732). In the multivariate analysis PDA >28 days was not related to worse outcomes at discharge (p = 0.296) or less survival-without-NDI at 2 years (p = 0.498). CONCLUSION: Until randomized trials prove the benefit of attempting to close the PDA with ibuprofen in the first week of life, conservative management may be a reasonable option.
Subject(s)
Ductus Arteriosus, Patent/drug therapy , Ductus Arteriosus, Patent/surgery , Infant Mortality , Infant, Premature/growth & development , Neurodevelopmental Disorders/etiology , Child, Preschool , Conservative Treatment , Female , Gestational Age , Humans , Ibuprofen/therapeutic use , Infant , Infant, Newborn , Male , Multivariate Analysis , Neurodevelopmental Disorders/epidemiology , Prospective Studies , Regression Analysis , Spain , Treatment OutcomeABSTRACT
La CPAP (Presión Positiva Continua en Vía Aérea) es un método de ventilación no invasiva que proporciona una presión positiva continua en la vía aérea durante todo el ciclo respiratorio. Se aplica en pacientes con respiración espontánea. El sistema de CPAP Benveniste es un sistema de flujo variable en el que el nivel de presión se genera mediante cambios de flujo. Se necesita un flujo de 10-15 litros/min para conseguir una presión terapéutica. Este sistema es útil en prematuros y lactantes. La característica más relevante del sistema Benveniste es la adaptación y confort que proporciona por el hecho de ser un sistema de flujo variable, evitando así la necesidad de sedoanalgesia. Sus ventajas son la escasa complejidad tecnológica, la fácil fijación de la interfase, la escasez de fugas por boca, la buena tolerancia y que permite una buena manipulación y movilidad del niño. El buen manejo por parte de la enfermera de este sistema garantiza su éxito y para ello deben conocerse sus efectos fisiológicos así como su correcto funcionamiento (AU)
CPAP (Continuous Positive Airway Pressure) is a non-invasive ventilation method that provides continuous positive pressure in the airway during the entire respiratory cycle. It is applied in patients with spontaneous breathing. The Benviste CPAP system is a variable flow system in which the pressure level is generated by flow changes. A 10-15 litre/min flow is necessary to reach therapeutic pressure. This system is useful in premature and breastfeeding infants. The most relevant characteristic of the Benviste system is the adaptation and comfort that it provides by offering variable flow, thus avoiding the need for sedoanalgesia. Its advantages are its low technological complexity, the easy fastening of the interphase, the minimal leaks from the mouth, its good tolerance and that it enables good handling and mobility of the child. The nurses correct handling of this system ensures its success and to this end its physiological effects as well as its correct operation must be understood (AU)
