Xavier Durrmeyer1,2, Laetitia Marchand-Martin2, Raphaël Porcher3, Geraldine Gascoin4, Jean-Christophe Roze5, Laurent Storme6, Geraldine Favrais7, Pierre-Yves Ancel2, Gilles Cambonie8. 1. Neonatal Intensive Care Unit, CHI Créteil, Créteil, France. 2. INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France. 3. INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France. 4. Department of Neonatal Medicine, Angers University Hospital, Angers, France. 5. Department of Neonatal Medicine, Nantes University Hospital, Nantes, France. 6. Department of Neonatal Medicine, Lille University Hospital, Lille, France. 7. Department of Neonatal Medicine, Tours University Hospital, Tours, France. 8. Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France.
Abstract
OBJECTIVE: To compare outcomes at hospital discharge for preterm infants born before 29 weeks of gestation who had at least one episode of isolated hypotension during their first 72 hours of life for which they did or did not receive antihypotensive treatment. DESIGN: Etude Epidémiologique sur les Petits Ages Gestationnels 2 (EPIPAGE 2) French national prospective population-based cohort study in 2011. SETTING: 60 neonatal intensive care units. PATIENTS: All infants with a minimum mean arterial blood pressure less than gestational age (in weeks) (minMAP<GA) within 72 hours of birth. Infants whose reason for receiving antihypotensive treatments was isolated hypotension only were compared with untreated hypotensive infants by propensity score matching. TREATMENTS: Fluid bolus and/or inotropes and/or corticosteroids. MAIN OUTCOMES AND MEASURES: The primary outcome was survival at hospital discharge without major morbidity, defined as any of necrotising enterocolitis, severe cerebral abnormalities, severe bronchopulmonary dysplasia or severe retinopathy of prematurity. RESULTS: Among the 1532 infants with available data, 662 had a minMAP<GA; 206 were treated for unknown or other reasons than isolated hypotension, 131 were treated for isolated hypotension only and 325 were untreated; 119 infants from each of these last two groups were matched. Treated infants had a significantly higher survival rate without major morbidity (61.3% vs 48.7%; OR, 1.67, 95% CI 1.00 to 2.78, p=0.049) and a lower rate of severe cerebral abnormalities (10.1% vs 26.5%, p=0.002). CONCLUSIONS: In this population, antihypotensive treatment was associated with improved short-term outcomes. Therapeutic abstention should be cautiously considered for early isolated hypotension in extremely premature infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To compare outcomes at hospital discharge for preterm infants born before 29 weeks of gestation who had at least one episode of isolated hypotension during their first 72 hours of life for which they did or did not receive antihypotensive treatment. DESIGN: Etude Epidémiologique sur les Petits Ages Gestationnels 2 (EPIPAGE 2) French national prospective population-based cohort study in 2011. SETTING: 60 neonatal intensive care units. PATIENTS: All infants with a minimum mean arterial blood pressure less than gestational age (in weeks) (minMAP<GA) within 72 hours of birth. Infants whose reason for receiving antihypotensive treatments was isolated hypotension only were compared with untreated hypotensive infants by propensity score matching. TREATMENTS: Fluid bolus and/or inotropes and/or corticosteroids. MAIN OUTCOMES AND MEASURES: The primary outcome was survival at hospital discharge without major morbidity, defined as any of necrotising enterocolitis, severe cerebral abnormalities, severe bronchopulmonary dysplasia or severe retinopathy of prematurity. RESULTS: Among the 1532 infants with available data, 662 had a minMAP<GA; 206 were treated for unknown or other reasons than isolated hypotension, 131 were treated for isolated hypotension only and 325 were untreated; 119 infants from each of these last two groups were matched. Treated infants had a significantly higher survival rate without major morbidity (61.3% vs 48.7%; OR, 1.67, 95% CI 1.00 to 2.78, p=0.049) and a lower rate of severe cerebral abnormalities (10.1% vs 26.5%, p=0.002). CONCLUSIONS: In this population, antihypotensive treatment was associated with improved short-term outcomes. Therapeutic abstention should be cautiously considered for early isolated hypotension in extremely premature infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Liesbeth Thewissen; Gunnar Naulaers; Dries Hendrikx; Alexander Caicedo; Keith Barrington; Geraldine Boylan; Po-Yin Cheung; David Corcoran; Afif El-Khuffash; Aisling Garvey; Jozef Macko; Neil Marlow; Jan Miletin; Colm P F O'Donnell; John M O'Toole; Zbyněk Straňák; David Van Laere; Hana Wiedermannova; Eugene Dempsey Journal: Pediatr Res Date: 2021-04-20 Impact factor: 3.756
Authors: Ningxin Luo; Siyuan Jiang; Patrick J McNamara; Xiaoying Li; Yan Guo; Yang Wang; Junyan Han; Yingping Deng; Yi Yang; Shoo K Lee; Yun Cao Journal: Front Pediatr Date: 2021-04-22 Impact factor: 3.418
Authors: Laura E Miller; Matthew M Laughon; Reese H Clark; Kanecia O Zimmerman; Christoph P Hornik; Samia Aleem; P Brian Smith; Rachel G Greenberg Journal: J Perinatol Date: 2021-03-23 Impact factor: 3.225