Erika Fernandez1, Kristi L Watterberg1, Roger G Faix2, Bradley A Yoder3, Michele C Walsh3, Conra Backstrom Lacy1, Karen A Osborne3, Abhik Das4, Douglas E Kendrick5, Barbara J Stoll6, Brenda B Poindexter7, Abbot R Laptook8, Kathleen A Kennedy9, Kurt Schibler10, Edward F Bell11, Krisa P Van Meurs12, Ivan D Frantz13, Ronald N Goldberg14, Seetha Shankaran15, Waldemar A Carlo16, Richard A Ehrenkranz17, Pablo J Sanchez18, Rosemary D Higgins. 1. Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. 2. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. 3. Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio. 4. Statistics and Epidemiology Unit, RTI International, Rockville, Maryland. 5. Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina. 6. Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia. 7. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. 8. Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island. 9. Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas. 10. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio. 11. Department of Pediatrics, University of Iowa, Iowa City, Iowa. 12. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. 13. Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts. 14. Department of Pediatrics, Duke University, Durham, North Carolina. 15. Department of Pediatrics, Wayne State University, Detroit, Michigan. 16. Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama. 17. Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut. 18. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
Abstract
OBJECTIVE: The objective of this study was to characterize the incidence, management, and short-term outcomes of cardiovascular insufficiency (CVI) in mechanically ventilated newborns, evaluating four separate prespecified definitions. STUDY DESIGN: Multicenter, prospective cohort study of infants ≥34 weeks gestational age (GA) and on mechanical ventilation during the first 72 hours. CVI was prospectively defined as either (1) mean arterial pressure (MAP) < GA; (2) MAP < GA + signs of inadequate perfusion; (3) any therapy for CVI; or (4) inotropic therapy. Short-term outcomes included death, days on ventilation, oxygen, and to full feedings and discharge. RESULTS: Of 647 who met inclusion criteria, 419 (65%) met ≥1 definition of CVI. Of these, 98% received fluid boluses, 36% inotropes, and 17% corticosteroids. Of treated infants, 46% did not have CVI as defined by a MAP < GA ± signs of inadequate perfusion. Inotropic therapy was associated with increased mortality (11.1 vs. 1.3%; p < 0.05). CONCLUSION: More than half of the infants met at least one definition of CVI. However, almost half of the treated infants met none of the definitions. Inotropic therapy was associated with increased mortality. These findings can help guide the design of future studies of CVI in newborns. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: The objective of this study was to characterize the incidence, management, and short-term outcomes of cardiovascular insufficiency (CVI) in mechanically ventilated newborns, evaluating four separate prespecified definitions. STUDY DESIGN: Multicenter, prospective cohort study of infants ≥34 weeks gestational age (GA) and on mechanical ventilation during the first 72 hours. CVI was prospectively defined as either (1) mean arterial pressure (MAP) < GA; (2) MAP < GA + signs of inadequate perfusion; (3) any therapy for CVI; or (4) inotropic therapy. Short-term outcomes included death, days on ventilation, oxygen, and to full feedings and discharge. RESULTS: Of 647 who met inclusion criteria, 419 (65%) met ≥1 definition of CVI. Of these, 98% received fluid boluses, 36% inotropes, and 17% corticosteroids. Of treated infants, 46% did not have CVI as defined by a MAP < GA ± signs of inadequate perfusion. Inotropic therapy was associated with increased mortality (11.1 vs. 1.3%; p < 0.05). CONCLUSION: More than half of the infants met at least one definition of CVI. However, almost half of the treated infants met none of the definitions. Inotropic therapy was associated with increased mortality. These findings can help guide the design of future studies of CVI in newborns. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Pak C Ng; Cheuk H Lee; Flora Liu Bnur; Iris H S Chan; Anthony W Y Lee; Eric Wong; Hin B Chan; Christopher W K Lam; Benjamin S C Lee; Tai F Fok Journal: Pediatrics Date: 2006-02 Impact factor: 7.124
Authors: Erika Fernandez; Kristi L Watterberg; Roger G Faix; Bradley A Yoder; Michele C Walsh; Conra Backstrom Lacy; Karen A Osborne; Abhik Das; Douglas E Kendrick; Barbara J Stoll; Brenda B Poindexter; Abbot R Laptook; Kathleen A Kennedy; Kurt Schibler; Edward F Bell; Krisa P Van Meurs; Ivan D Frantz; Ronald N Goldberg; Seetha Shankaran; Waldemar A Carlo; Richard A Ehrenkranz; Pablo J Sánchez; Rosemary D Higgins Journal: Am J Perinatol Date: 2015-03-31 Impact factor: 1.862
Authors: K L Watterberg; E Fernandez; M C Walsh; W E Truog; B J Stoll; G M Sokol; K A Kennedy; M V Fraga; S S Beauman; B Carper; A Das; A F Duncan; W F Buss; C Gauldin; C B Lacy; P J Sanchez; S Chawla; S Lakshminrusimha; C M Cotten; K P Van Meurs; B B Poindexter; E F Bell; W A Carlo; U Devaskar; M H Wyckoff; R D Higgins Journal: J Perinatol Date: 2017-09-07 Impact factor: 2.521