Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants.
BACKGROUND
Neonatal hypotension may be a risk factor for neurologic impairment. Few studies have examined the impact of low blood pressure in extremely low birth weight (ELBW) infants weighing 400 to 999 g on neurodevelopmental outcome.


OBJECTIVE
We set out to explore the relationship between treated hypotension in the first 72 hours of life and perinatal factors, morbidity, and mortality in ELBW infants and then to compare neurosensory outcome in ELBW infants with treated hypotension and those who never received treatment for hypotension.


METHODS
We performed chart review of all 156 ELBW infants admitted to our level III NICU in 1998-1999. Infants had "treated hypotension" if they received fluid pushes, corticosteroids, and/or vasopressors during the first 72 hours of life in an attempt to increase blood pressure. Follow-up included neurologic examination, Bayley Scales of Infant Development, vision and hearing evaluation. Statistical analysis was performed by using SPSS 11.0. Univariate and multivariate analyses were conducted to determine morbidities associated with treated hypotension.


RESULTS
Fifty-nine infants received treatment for hypotension. Ninety-seven infants did not. The groups had similar race, gender, delivery mode, chorioamnionitis, and maternal socioeconomic status. Thirty-eight (24%) infants expired, including 20 who received treatment for hypotension. Of the 156 infants in the study group, 110 underwent neurodevelopment testing, and 103 were able to undergo complete neurodevelopment testing and Bayley examination. Multivariate analysis controlling for socioeconomic status and neonatal morbidity revealed that treated hypotension is associated with delayed motor development and hearing loss.


CONCLUSIONS
Treated hypotension in ELBW infants in the first 72 hours of life is associated with significant short-term and long-term morbidity. Infants with treated hypotension are more likely to have delayed motor development, hearing loss, and death.
Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA. jonathan.fanaroff@case.edu
Jonathan M
JM
Fanaroff
Deanne E
DE
Wilson-Costello
Nancy S
NS
Newman
Michelle M
MM
Montpetite
Avroy A
AA
Fanaroff
D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000150:complications; D002547:Cerebral Palsy / Q000150:complications; D002657:Child Development; D016057:Evoked Potentials, Auditory, Brain Stem; D034381:Hearing Loss / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D015997:Neonatal Screening; D009460:Neurologic Examination; D017084:Otoacoustic Emissions, Spontaneous