Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?
OBJECTIVE
To investigate the influence of perinatal risk factors, especially hypotension, on neuromotor status at term in surviving preterm infants born before 32 weeks of gestation.


METHODS
This study is part of the Leiden Follow-Up Project on Prematurity: a prospective, regional study of 266 live born infants with a gestational age (GA) < 32 weeks born in 1996-1997. Twenty-eight infants died before term age. Two hundred and eleven infants were examined neurologically at term according to Prechtl. The findings were classified as normal (N), mildly abnormal (MA) or definitely abnormal (DA). Hypotension was defined as a mean arterial blood pressure (MABP) < 30 mm Hg on at least two occasions.


RESULTS
One hundred and six (50%) infants were classified as neurologically N, 92 (44%) infants were classified as MA and 13 (6%) infants as DA. Hypotension, bronchopulmonary dysplasia (BPD), flaring and cystic periventricular leucomalacia (PVL) were risk factors for neurological morbidity. Of the 68 infants with hypotension, 33 (49%) were classified as MA and 7 (10%) as DA. Of the 141 infants without hypotension, 58 (41%) were MA, and 5 (4%) were DA. The odds ratio of hypotension for neurological morbidity was 1.9 (95% CI 1.06-3.40), adjusted for gestational age, birth weight, small for gestational age (SGA) and gender, it was 1.96 (95% CI 1.02-3.77). The adjusted odds ratio of PVL was 18.6 (4.4-78.5), of flaring was 2.37 (1.18-4.74) and of BPD was 2.44 (1.08-5.5).


CONCLUSIONS
Apart from gestational age, periventricular leucomalacia, and bronchopulmonary dysplasia, hypotension in preterm infants is a major risk factor for neurological morbidity at term.
Martens
S E
SE
Department of Paediatrics, Leiden University Medical Center, J6-S PO Box 9600 2300 RC, Leiden, The Netherlands. s.e.martens@lumc.nl
Rijken
M
M
Stoelhorst
G M S J
GM
van Zwieten
P H T
PH
Zwinderman
A H
AH
Wit
J M
JM
Hadders-Algra
M
M
Veen
S
S
D005865:Gestational Age; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000453:epidemiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D009017:Morbidity; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D009460:Neurologic Examination / Q000379:methods; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors