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Hypotension in Preterm Infants (HIP) randomised trial
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  • Published on:
    Blood pressure trials in preterm infants
    • Sujith S. Pereira, Consultant Neonatologist Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK
    • Other Contributors:
      • Ajay K. Sinha, Consultant Neonatologist
      • David F. Wertheim, Professor
      • Divyen K. Shah, Consultant Neonatologist
      • Stephen T. Kempley, Consultant Neonatologist

    We read with interest results from the Hypotension in Preterm Infants (HIP) trial by Dempsey et al.1 Unfortunately this multicentre randomised controlled trial (RCT) could not provide robust conclusions. Enrolment was limited to 58 of the planned 830 infants, 7% of those screened, attributed to strict inclusion criteria and recruitment challenges. This along with high inotropic usage in the restrictive group limits study power and generalisation.
    Some clarification would be useful. The CONSORT diagram should label the two study arms, where imbalance in numbers not receiving the allocated intervention (6/29 vs 1/29) may warrant further analysis. The proportion with invasive lines seems low, exact reasons for exclusion/non-inclusion could be detailed, and maximum age at enrolment given.
    In our published RCT 2, three blood pressure (BP) intervention protocols were compared (BP below gestational age as in HIP, more active, or less active). This single centre pilot study randomised 60 infants <29 weeks, 45% of those screened and 100% of target recruitment, with invasive BP acquired every 10 seconds for a week. The HIP trial suggests their hypotension rate of 25% is low but without BP acquisition details, comparison is difficult. Their figure showing BP following dopamine or placebo requires data variability measures.
    In our study, we found higher BP was associated with lower EEG discontinuity.3 The HIP study4 did not stipulate commonly used end-organ p...

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    Conflict of Interest:
    None declared.