Kirstin Faust1, Christoph Härtel1, Michael Preuß2, Heike Rabe3, Claudia Roll4, Michael Emeis5, Christian Wieg6, Miklos Szabo7, Egbert Herting1, Wolfgang Göpel1. 1. Department of Paediatrics, University of Lübeck, Lübeck, Germany. 2. Institute of Medical Biometrics and Statistics, University of Lübeck, Lübeck, Germany. 3. Academic Department of Paediatrics, Brighton & Sussex Medical School, Brighton, UK. 4. Department of Neonatology, Vest Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany. 5. Department of Neonatology, Vivantes Hospital, Berlin-Neukölln, Berlin, Germany. 6. Department of Neonatology, Children's Hospital Aschaffenburg, Aschaffenburg, Germany. 7. Department of Neonatology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Abstract
OBJECTIVE: To evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP(24)) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome. DESIGN: Retrospective cohort analysis of the minMAP(24) of 4907 VLBW infants with a gestational age <32 weeks in correlation with clinical data. Hypotension was defined as minMAP(24) being lower than the median value of all patients of the same gestational age. RESULTS: MinMAP(24) values correlated with gestational age. Median minMAP(24) 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. MinMAP(24) 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP(24)) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome. DESIGN: Retrospective cohort analysis of the minMAP(24) of 4907 VLBW infants with a gestational age <32 weeks in correlation with clinical data. Hypotension was defined as minMAP(24) being lower than the median value of all patients of the same gestational age. RESULTS: MinMAP(24) values correlated with gestational age. Median minMAP(24) values of VLBW infants ≤29 weeks' gestation were 1-2 mm Hg lower than gestational age in completed weeks. Hypotensiveinfants 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. MinMAP(24) 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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