Objective: To describe the current status and trends in the treatment of patent ductus arteriosus (PDA) among very preterm infants (VPI) admitted to the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) from 2019 to 2021, and to compare the differences in PDA treatment among these units. Methods: This was a cross-sectional study based on the CHNN VPI cohort, all of 22 525 VPI (gestational age<32 weeks) admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included. The overall PDA treatment rates were calculated, as well as the rates of infants with different gestational ages (≤26, 27-28, 29-31 weeks), and pharmacological and surgical treatments were described. PDA was defined as those diagnosed by echocardiography during hospitalization. The PDA treatment rate was defined as the number of VPI who had received medication treatment and (or) surgical ligation of PDA divided by the number of all VPI. Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups. A multivariate Logistic regression model was constructed to compute the standardized ratio (SR) of PDA treatment across different units, to compare the rates after adjusting for population characteristics. Results: A total of 22 525 VPI were included in the study, with a gestational age of 30.0 (28.6, 31.0) weeks and birth weight of 1 310 (1 100, 1 540) g; 56.0% (12 615) of them were male. PDA was diagnosed by echocardiography in 49.7% (11 186/22 525) of all VPI, and the overall PDA treatment rate was 16.8% (3 795/22 525). Of 3 762 VPI who received medication treatment, the main first-line medication used was ibuprofen (93.4% (3 515/3 762)) and the postnatal day of first medication treatment was 6 (4, 10) days of age; 59.3% (2 231/3 762) of the VPI had been weaned from invasive respiratory support during the first medication treatment, and 82.2% (3 092/3 762) of the infants received only one course of medication treatment. A total of 143 VPI underwent surgery, which was conducted on 32 (22, 46) days of age. Over the 3 years from 2019 to 2021, there was no significant change in the PDA treatment rate in these VPI (P=0.650). The PDA treatment rate decreased with increasing gestational age (P<0.001). The PDA treatment rates for VPI with gestational age ≤26, 27-28, and 29-31 weeks were 39.6% (688/1 737), 25.9% (1 319/5 098), and 11.4% (1 788/15 690), respectively. There were 61 units having a total number of VPI≥100 cases, and their rates of PDA treatment were 0 (0/116)-47.4% (376/793). After adjusting for population characteristics, the range of standardized ratios for PDA treatment in the 61 units was 0 (95%CI 0-0.3) to 3.4 (95%CI 3.1-3.8). Conclusions: From 2019 to 2021, compared to the peers in developed countries, VPI in CHNN NICU had a different PDA treatment rate; specifically, the VPI with small birth gestational age had a lower treatment rate, while the VPI with large birth gestational age had a higher rate. There are significant differences in PDA treatment rates among different units.
目的： 总结2019—2021年中国新生儿协作网（CHNN）各单位收治的极早产儿中动脉导管未闭（PDA）的治疗现状和变化趋势以及单位间治疗差异。 方法： 横断面研究基于CHNN极早产儿队列，纳入2019—2021年CHNN 79家三级新生儿重症监护病房（NICU）收治的所有入院≤3日龄的22 525例极早产儿（出生胎龄<32周）。描述所有极早产儿以及不同出生胎龄（≤26、27~28、29~31周）组的PDA治疗率以及药物和手术治疗情况。PDA定义为住院期间通过心脏超声诊断的PDA；PDA治疗率为接受过PDA药物和（或）手术治疗的极早产儿人数/所有极早产儿人数。使用Logistic回归检验分析研究3年间及不同出生胎龄组PDA治疗率的变化趋势。建立多元Logistic回归模型计算不同单位PDA治疗的标准化比率（SR），以比较调整人群特征后单位间PDA治疗率的差异。 结果： 22 525例极早产儿中男12 615例（56.0%），出生胎龄30.0（28.6，31.0）周，出生体重1 310（1 100，1 540）g，经超声心动图诊断的PDA 49.7%（11 186/22 525），所有极早产儿PDA治疗率为16.8%（3 795/22 525）。在3 762例接受了药物治疗的极早产儿中，首次药物治疗以布洛芬为主［93.4%（3 515例）］，首次药物治疗的年龄为6（4，10）日龄；59.3%（2 231例）的极早产儿在首次药物治疗时已经撤离了有创呼吸支持，82.2%（3 092例）的极早产儿仅接受1个疗程药物治疗。在143例接受了手术治疗的极早产儿中，手术治疗的年龄为32（22，46）日龄。2019—2021年3年间，极早产儿PDA治疗率差异无统计学意义（P=0.650）。PDA治疗率随着出生胎龄的增加而降低（P<0.001）。出生胎龄≤26、27~28、29~31周极早产儿PDA治疗率分别为39.6%（688/1 737）、25.9%（1 319/5 098）、11.4%（1 788/15 690）。极早产儿总数≥100例的单位共61家，这些单位的极早产儿PDA治疗率范围为0（0/116）~47.4%（376/793）。在调整患儿基本特征后，61家单位极早产儿PDA治疗的SR范围为0（95%CI 0~0.3）~3.4（95%CI 3.1~3.8）。 结论： 2019—2021年中国新生儿协作单位收治极早产儿中，小出生胎龄患儿PDA治疗率低于发达国家，大出生胎龄患儿治疗率则偏高，不同单位间PDA治疗率差异显著。.