Брой 1/2025, Статии

Персистиращ артериален канал при недоносени новородени – терапевтично поведение

Публикувана на от admin

Т. Александрова1, П. Радулова1, Д. Печилков2, Л. Вакрилова1. Б. Слънчева1

1Клиника по неонатология, СБАЛАГ „Майчин дом“, София
2Клиника по детска кардиология, НКБ, София

Резюме

В клиничната практика се наблюдава неяснота относно терапевтичния подход при персистиращ артериален канал (ПАК) у недоносените. Съществуват много разнопосочни мнения за това дали, кога и как трябва да се затвори ПАК. Вероятно липсата на единен диагностичен подход води и до липсата на консенсус за поведение. В световен мащаб се наблюдават различни видове терапевтичен подход: изчаквателно поведение; изчаквателно поведение, придружено от рестрикция на течности и диуретици; консервативно лечение с медикаменти (профилактично, ранно таргетирано лечение и лечение на симптоматичните новородени); транскатетърно затваряне; хирургично затваряне. Настоящата статия представя различните терапевтични подходи, техните предимства и недостатъци, както и евентуалните краткосрочни и дългосрочни последствия при конкретно поведение.  

Ключови думи: персистиращ артериален канал (ПАК), терапевтично поведение, недоносено новородено

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Библиография

  1. Chan B, Singh Y. Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants. J Cardiovasc Dev Dis. 2023 Dec.
  2. Bischoff, Adrianne Rahde et al, Going Home with a Patent Ductus Arteriosus: Is it Benign? The Journal of Pediatrics, Volume 240, 10-13.
  3. Clyman R Liebowitz M, Kaempf J et al. PDA-TOLERATE Trial: An Exploratory Randomized Controlled Trial of Treatment of Moderate-to-Large Patent Ductus Arteriosus at 1 Week of Age. J Pediatr. 2019 Feb.
  4. Bell JL, Gupta S, Juszczak E et al. Baby-OSCAR: Outcome after Selective early treatment for Closure of patent ductus ARteriosus in preterm babies-a statistical analysis plan for short-term outcomes. Trials. 2021.
  5. de Waal K, Prasad R, Kluckow M. Patent ductus arteriosus management and the drift towards therapeutic nihilism – What is the evidence? Semin Fetal Neonatal Med. 2021.
  6. Dudley, S., Sen, S., Hanson, A. et al. The role of furosemide and fluid management for a hemodynamically significant patent ductus arteriosus in premature infants. J Perinatol 42.
  7. Thompson EJ, Greenberg RG, Kumar K et al. Association between Furosemide Exposure and Patent Ductus Arteriosus in Hospitalized Infants of Very Low Birth Weight. J Pediatr. 2018 Aug.
  8. MacLarenA, HeuchanAM. Patient Ductus Arteriosus: medical treatment and indications for surgical closure, NHSGGC Pediatrics for Health Professionals. 2017 May.
  9. Mitra S, de Boode WP, Weisz DE et al. Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews. Cochrane Database of Systematic Reviews 2023.
  10. Clyman RI, Saha S, Jobe A et al. Indomethacin prophylaxis for preterm infants: the impact of 2 multicentered randomized controlled trials on clinical practice. J Pediatr. 2007 Jan; 150(1):46-50 e2.
  11. Ohlsson A, Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2019 Jun 21; 6(6):CD004213.
  12. Jasani B, Mitra S, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2022.
  13. Bell JL, Gupta S, Juszczak E et al. Baby-OSCAR: Outcome after Selective early treatment for Closure of patent ductus ARteriosus in preterm babies-a statistical analysis plan for short-term outcomes. Trials. 2021 May.
  14. Kluckow  M, Jeffery M,  Gill A. A randomized placebо controlled trail of early treatment of the patient ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 2014 Mar.
  15. Altit G, Saeed S, Beltempo M et al. Outcomes of Extremely Premature Infants Comparing Patent Ductus Arteriosus Management Approaches. J Pediatr. 2021 Aug; 235:49-57.
  16. Baruteau AE, Fraisse Al, Butera et al. Transcatheter PDA closure in extremely premature infants. J Cardiovasc Dev Dis. 2023 Dec; 10(12): 476.
  17. Sathanandam S, Balduf K, Chilakala S et al. Role of transcatheter patent ductus arteriosus closure in extremely low birth weight infants. Catheterization and Cardiovascular Interventions. 2019 Jan 1;93(1):89-96.
  18. The Sydney Children’s Hospitals Network (SCHN) Patient Ductus Arteriosus (PDA) Surgical Management of Neonates, Practice Guideline No: 2022-076 v1). 2022.
  19. Whiting S, Sathanandam S. PDA Closure in ELBW Infants: If, When, and How to Do It. IntechOpen. 2020 doi: 10.5772/intechopen.88857.       
  20. Sathanandam S, Whiting S, Cunningham J et al Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Surveyresults among cardiologists and neonatologists. Congenit Heart Dis 2019 Jan;14(1):6-14.

Адрес за кореспонденция:

Клиника по неонатология,

СБАЛАГ “Майчин дом” – София

ул. “Здраве” 2 

1463, София