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Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life
  1. Kirstin Faust1,
  2. Christoph Härtel1,
  3. Michael Preuß2,
  4. Heike Rabe3,
  5. Claudia Roll4,
  6. Michael Emeis5,
  7. Christian Wieg6,
  8. Miklos Szabo7,
  9. Egbert Herting1,
  10. Wolfgang Göpel1
  11. for the Neocirculation project and the German Neonatal Network (GNN)
  1. 1Department of Paediatrics, University of Lübeck, Lübeck, Germany
  2. 2Institute of Medical Biometrics and Statistics, University of Lübeck, Lübeck, Germany
  3. 3Academic Department of Paediatrics, Brighton & Sussex Medical School, Brighton, UK
  4. 4Department of Neonatology, Vest Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany
  5. 5Department of Neonatology, Vivantes Hospital, Berlin-Neukölln, Berlin, Germany
  6. 6Department of Neonatology, Children's Hospital Aschaffenburg, Aschaffenburg, Germany
  7. 7Department of Neonatology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
  1. Correspondence to Professor Wolfgang Göpel, Department of Paediatrics, University of Lübeck Children's Hospital, Ratzeburger Allee 160, Lübeck 23538, Germany; wolfgang.goepel{at}uksh.de

Abstract

Objective To evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP24) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome.

Design Retrospective cohort analysis of the minMAP24 of 4907 VLBW infants with a gestational age <32 weeks in correlation with clinical data. Hypotension was defined as minMAP24 being lower than the median value of all patients of the same gestational age.

Results MinMAP24 values correlated with gestational age. Median minMAP24 values of VLBW infants ≤29 weeks’ gestation were 1–2 mm Hg lower than gestational age in completed weeks. Hypotensive infants had a higher rate of intraventricular haemorrhage (IVH, 20.3% vs 15.9%, p<0.001), bronchopulmonary dysplasia (BPD, 19.2% vs 15.1%, p<0.001) and death (5.2% vs 3.0%, p<0.001). Multivariate logistic regression analyses, including potential confounders, confirmed these data. MinMAP24 was an independent risk factor for IVH (OR 0.97/mm Hg, 95% CI 0.96 to 0.99, p=0.003), BPD (OR 0.96/mm Hg, 95% CI 0.94 to 0.98, p<0.001) and mortality (OR 0.94/mm Hg, 95% CI 0.90 to 0.98, p=0.003).

Conclusions Hypotension during the first 24 h of life is associated with adverse outcomes in VLBW infants. This underlines the need for randomised controlled trials on the use of vasoactive drugs in this vulnerable patient cohort.

  • Neonatology
  • preterm infant
  • hypotension
  • blood pressure

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