未经批准:多年来,静脉消炎痛已在婴儿中用作动脉导管的药物闭合,但是发病率,风险,吲哚美辛治疗婴儿急性肾损伤(AKI)的危险因素,仍然稀缺。
未经评估:要确定发病率,风险,与匹配的未暴露婴儿相比,吲哚美辛(暴露组)治疗动脉导管未闭(PDA)的婴儿发生AKI的危险因素。
UNASSIGNED:对2003年1月至2018年12月在宋卡兰加林德医院新生儿重症监护病房住院的婴儿进行了一项匹配的回顾性队列研究。所有数据均从计算机病历中收集。未暴露的婴儿通过胎龄和出生体重与每个暴露的婴儿相匹配(1:1)。AKI,兴趣的结果,根据新生儿AKI定义诊断。估计各组的AKI发生率(95%CI)。使用条件逻辑回归来估计接受消炎痛的人与未接受消炎痛的人发生AKI的比值比(OR)。调整潜在的混杂因素(伴随使用的肾毒性潜在药物,包括氨基糖苷类,两性霉素B,万古霉素,呋塞米,全身性皮质类固醇,和全身性血管加压药和肌动蛋白)。进行Kaplan-Meier估计以检查AKI事件后从AKI恢复的概率。
UNASSIGNED:匹配导致193对暴露和非暴露婴儿。暴露组和非暴露组的AKI发生率[95%CI],分别为33.7%[27.0%:40.4%]和15.5%[10.4%:20.7%],分别。吲哚美辛在统计学上增加发生AKI的风险,原油OR2.94[95CI1.77:4.90],McNemar的卡方p<0.001,调整后OR为2.73[95CI1.55:4.80],p=0.001。与潜在肾毒性药物相关的AKI风险尚无定论。从AKI恢复的时间相对较快,两组的中位恢复时间均为3天,所有发生AKI的婴儿均在6天内恢复.
UNASSIGNED:使用吲哚美辛封堵PDA的婴儿中AKI的发生率是未暴露于吲哚美辛的婴儿的两倍。吲哚美辛显著增加AKI的风险,而与其他伴随的肾毒性药物相关的风险尚无定论。与吲哚美辛相关的短暂肾毒性应与延迟PDA关闭相关的风险相平衡。所有接受吲哚美辛的婴儿应常规监测血清肌酐和/或尿量,在整个治疗过程中以及治疗停止后一到两周。在AKI风险较高的人群中,应考虑肾脏安全性较好的替代方案。
UNASSIGNED: Intravenous indomethacin has been used in infants for many years as the pharmacological closure of ductus arteriosus, but the incidence, risk, and risk factors of acute kidney injury (AKI) among infants treated with indomethacin, were still scarce.
UNASSIGNED: To determine the incidence, risk, and risk factors of AKI among infants treated with indomethacin (exposed group) for
patent ductus arteriosus (PDA) closure compared with the matched non-exposed infants.
UNASSIGNED: A matched retrospective cohort
study of infants admitted to the neonatal intensive care unit of Songklanagarind Hospital from January 2003 to December 2018 was performed. All data were collected from computerized medical records. A non-exposed infant was matched (1:1) by gestational age and birth weight to each exposed infant. AKI, the outcome of interest, was diagnosed according to neonatal AKI definitions. The incidence (95% CI) of AKI was estimated for each group. Conditional logistic regression was used to estimate the odds ratio (OR) of developing AKI among those who received indomethacin compared with those who did not, adjusted for potential confounders (concomitantly used nephrotoxic potential medications including aminoglycosides, amphotericin B, vancomycin, furosemide, systemic corticosteroids, and systemic vasopressors and inotropes). Kaplan-Meier estimate was performed to examine probability of recovery from AKI after AKI events.
UNASSIGNED: The matching resulted in 193 pairs of exposed and non-exposed infants. The incidences [95% CI] of AKI in the exposed and the non-exposed group, were 33.7% [27.0%:40.4%] and 15.5% [10.4%:20.7%], respectively. Indomethacin statistically increased the risk for developing AKI, crude OR 2.94[95%CI 1.77:4.90], McNemar\'s chi square p<0.001, and adjusted OR 2.73 [95%CI 1.55:4.80], p=0.001. The risk of AKI associated with potentially nephrotoxic medications were inconclusive. Time to recovery from AKI was relatively rapid, median recovery time was 3 days in both groups and all infants who developed AKI recovered within 6 days.
UNASSIGNED: The incidence of AKI among infants treated with indomethacin for PDA closure were doubled that in the indomethacin-nonexposed infants. Indomethacin significantly increased the risk of AKI, while the risk associated with other concomitant nephrotoxic medications were inconclusive. Transient nephrotoxicity associated with indomethacin should be balanced with the risk associated with delayed PDA closure. All infants receiving indomethacin should be routinely monitored for serum creatinine and/or urine output, throughout the treatment and one to two weeks after treatment cessation. Alternatives with better renal safety profiles should be considered in the population with higher risk of AKI.