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Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns
  1. J Wells Logan1,
  2. T Michael O'Shea2,
  3. Elizabeth N Allred3,4,5,
  4. Matthew M Laughon6,
  5. Carl L Bose6,
  6. Olaf Dammann7,
  7. Daniel G Batton8,
  8. Stephen C Engelke9,
  9. Alan Leviton4,5,
  10. for the ELGAN Study Investigators
  1. 1New Hanover Regional Medical Center, Wilmington, North Carolina, USA
  2. 2Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Children's Hospital Boston, Boston, Massachusetts, USA
  6. 6The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  7. 7Floating Hospital, Tufts Medical Center, Boston, Massachusetts, USA
  8. 8Southern Illinois University School of Medicine, Springfield, Illinois, USA
  9. 9East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA
  1. Correspondence to Dr J W Logan, Division of Neonatal-Perinatal Medicine, Betty H Cameron Women's and Children's Hospital, 2131 South 17th Street, Wilmington, NC 28402, USA; wells.logan{at}ccneo.net

Abstract

Objectives To evaluate in extremely low gestational age newborns, relationships between indicators of hypotension during the first 24 postnatal hours and developmental delay at 24 months of age.

Methods The 945 infants in this prospective study were born at <28 weeks, were assessed for three indicators of hypotension in the first 24 postnatal hours, and were evaluated with the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 24 months corrected age. Indicators of hypotension included: (1) mean arterial pressure in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile for the difference between the lowest and highest mean arterial pressure. Logistic regression was used to evaluate relationships between hypotension and developmental outcomes, adjusting for potential confounders.

Results 78% of infants in this cohort received volume expansion or vasopressor; all who received a vasopressor were treated with volume expansion. 26% had an MDI <70 and 32% had a PDI <70. Low MDI and PDI were associated with low gestational age, which in turn, was associated with receipt of vasopressor treatment. Blood pressure in the lowest quartile for gestational age was associated with vasopressor treatment and labile blood pressure. After adjusting for potential confounders, none of the indicators of hypotension were associated with MDI <70 or PDI <70.

Conclusions In this large cohort of extremely low gestational age newborns, we found little evidence that early postnatal hypotension indicators are associated with developmental delay at 24 months corrected gestational age.

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Footnotes

  • Participating institutions (site principal investigators and neuro-developmental examiners) Baystate Medical Center, Springfield, MA (Bhavesh Shah, Solveg Pflueger, Herbert Gilmore, Susan McQuiston).

    Beth Israel Deaconess Medical Center, Boston, MA (Camilia R Martin).

    Brigham & Women's Hospital, Boston, MA (Linda J Van Marter).

    Children's Hospital Boston, Boston, MA (Alan Leviton, Samantha Butler, Haim Bassan, Adré Duplessis, Cecil Hahn, Omar Khwaha, AK Morgan, Janet S Soul).

    DeVos Children's Hospital, Grand Rapids, MI (Mariel Portenga, Barbara Doss, Wendy Burdo-Hartman, Lynn Fagerman, Kim Lohr, Steve Pastynrnak, Dinah Sutton).

    Floating Hospital for Children at Tufts Medical Center, Boston, MA (Cynthia Cole/John Fiascone, Ina Bhan, Paige T Church, Cecelia Keller, Karen Miller).

    Massachusetts General Hospital, Boston, MA (Robert Insoft, Drucilla Roberts, Kalpathy Krishnamoorthy).

    Michigan State University, Lansing, MI (Nigel Paneth).

    North Carolina Children's Hospital, Chapel Hill, NC (Carl Bose, Chad Livasy, Lisa Bostic, Janice Wereszczak, Diane Marshall, Kristi Milowic, Carol Hubbard).

    Sparrow Hospital, Lansing, MI (Padmani Karna, Gabriel Chamyan, Victoria J Caine, Padmani Karna, Nicholas Olomu, Joan Price).

    University of Chicago Hospital, Chicago, IL (Michael D Schreiber, Aliya Husain, Leslie Caldarelli, Sunila E O'Conno, Michael Msall, Susan Plesha-Troyke).

    University Health Systems of Eastern Carolina, Greenville, NC (Stephen Engelke, Sharon Buckwald, Rebecca Helms, Kathyrn Kerkering, Scott S MacGilvray, Peter Resnik).

    U Mass Memorial Health Center, Worcester, MA (Francis Bednarek, Karen Strehloh, Robin Adair, Richard Bream, Alice Miller, Albert Scheiner, Christy Stine).

    Wake Forest University Baptist Medical Center and Forsyth Medical Center, Winston-Salem, NC (T. Michael O'Shea, Deborah Allred, Don Goldstein, Gail Hounshell, Robert Dillard, Cherrie Heller, Debbie Hiatt, Lisa Washburn).

    William Beaumont Hospital, Royal Oak, MI (Daniel Batton, Chung-ho Chang, Karen Brooklier, Melisa Oca).

    Yale University School of Medicine, New Haven, CT (Richard Ehrenkranz, Vinita Parkas, Nancy Close, Elaine Romano, Joanne Williams).

  • Funding This study was supported by a cooperative agreement with the National Institute of Neurological Disorders and Stroke (5U01NS040069-05) and a programme project grant form the National Institute of Child Health and Human Development (NIH-P30-HD-18655).

  • Competing interests None.

  • Ethics approval The study protocol was approved by the institutional review boards of the 14 participating institutions. An external Operations Advisory Group, appointed by the principal investigator and approved by the sponsor, was charged with assuring patient safety.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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