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Early blood pressure, antihypotensive therapy and outcomes at 18–22 months’ corrected age in extremely preterm infants
  1. Beau Batton1,2,
  2. Lei Li3,
  3. Nancy S Newman1,
  4. Abhik Das4,
  5. Kristi L Watterberg5,
  6. Bradley A Yoder6,
  7. Roger G Faix6,
  8. Matthew M Laughon7,
  9. Barbara J Stoll8,
  10. Rosemary D Higgins9,
  11. Michele C Walsh1
  12. for the Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network
  1. 1Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
  2. 2Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  3. 3Statistics & Epidemiology Unit, RTI International, Research Triangle Park, Raleigh, North Carolina, USA
  4. 4Statistics & Epidemiology Unit, RTI International, Rockville, Maryland, USA
  5. 5Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  6. 6Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
  7. 7Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  8. 8Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  9. 9Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Beau Batton, Division of Neonatology, Department of Pediatrics, Southern Illinois University School of Medicine, PO Box 19676, Springfield IL 62794, USA; bbatton{at}siumed.edu

Abstract

Objective To investigate the relationships between early blood pressure (BP) changes, receipt of antihypotensive therapy and 18–22 months’ corrected age (CA) outcomes for extremely preterm infants.

Design Prospective observational study of infants 230/7–266/7 weeks’ gestational age (GA). Hourly BP values and antihypotensive therapy exposure in the first 24 h were recorded. Four groups were defined: infants who did or did not receive antihypotensive therapy in whom BP did or did not rise at the expected rate (defined as an increase in the mean arterial BP of ≥5 mm Hg/day). Random-intercept logistic modelling controlling for centre clustering, GA and illness severity was used to investigate the relationship between BP, antihypotensive therapies and infant outcomes.

Setting Sixteen academic centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Main outcome measures Death or neurodevelopmental impairment/developmental delay (NIDD) at 18–22 months’ CA.

Results Of 367 infants, 203 (55%) received an antihypotensive therapy, 272 (74%) survived to discharge and 331 (90%) had a known outcome at 18–22 months’ CA. With logistic regression, there was an increased risk of death/NIDD with antihypotensive therapy versus no treatment (OR 1.836, 95% CI 1.092 to 3.086), but not NIDD alone (OR 1.53, 95% CI 0.708 to 3.307).

Conclusions Independent of early BP changes, antihypotensive therapy exposure was associated with an increased risk of death/NIDD at 18–22 months’ CA when controlling for risk factors known to affect survival and neurodevelopment.

Clinical trial registration number clinicaltrials.gov #NCT00874393.

  • Neonatology
  • Neurodevelopment
  • Cardiology

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