• Hypotension
• preterm
• intraventricular haemorrhage

The decision to intervene in preterm infants with low blood pressure remains unresolved and as a result significant variability in practice persists.1 However, there are two consistent findings: first, in the majority (90%) of circumstances, intervention commences on the first day of life and second, intervention is driven by blood pressure values.1 ,2 A recent survey confirmed that the gestational age-based rule remains the most common criterion used by neonatologists, with over 75% of respondents using this value to direct intervention.2 It is not surprising that neonatologists continue to rely on blood pressure values, as there are relatively few other options readily available at the bedside. Echocardiography, and perhaps non-invasive cardiac output monitoring, may change the way we approach this all too familiar problem in the future, but currently these assessment tools provide many of their own challenges.3

So should we worry when the blood pressure is low? Göpel and colleagues present very compelling data from the German Neonatal Network exploring the association between short-term outcome and hypotension in very preterm infants.4 This study examined the lowest mean blood pressure on day 1 in over 4900 preterm infants <32 weeks born in 47 centres throughout Germany. The study has many strengths: the very large number of infants included, the large number of predefined variables entered, the consistency in data entry, the consistency in the outcome definitions and robust analysis of the data. The lowest mean arterial pressure (MAP) defined …