title: Short- and long-term consequences of hypotension in ELBW infants.
abstract: BACKGROUND
  Hypotension affects close to half of all ELBW infants, yet an agreement on its definition is still lacking. Despite the fact that neonatal hypotension may be a risk factor for neurologic impairment, there is a paucity of data on the impact of low blood pressure (BP) in extremely low birth weight (ELBW) infants weighing below 1000 g on neuro-developmental outcome.
  
  
  OBJECTIVE
  Explore the relationship between blood pressure in the first 72 hours of life, perinatal factors, morbidity, and mortality in ELBW infants. Compare neuro-sensory outcome in ELBW infants with and without symptomatic hypotension.
  
  
  METHODS
  We reviewed the outcome for all 156 infants with a birth weight <1000 g admitted to the neonatal intensive care unit covering the time period 1998 to 1999. Infants who received fluid pushes and/or pressors during the first 72 hours of life in an attempt to increase blood pressure were regarded as "symptomatic" or "treated infants"; the others were designated "non-treated infants." Follow-up at 20 months corrected age included neurologic status, Bayley motor/mental evaluation, plus tests of vision and hearing. Statistical analysis was by SPSS 11.0. Univariate and multivariate analyses were conducted to determine morbidities associated with symptomatic hypotension.
  
  
  RESULTS
  A total of 59 infants (mean BW 714 +/- 154 g; GA 24.9 +/- 1.7 weeks) required BP support; 97 infants (mean BW 768 +/- 141 g; GA 26.1 +/- 1.9 weeks) received no BP support. The groups had similar race, gender, delivery mode, and maternal socioeconomic status. Thirty-five (22%) infants died, including 20 who received BP support. There were more infants with severe IVH (grade III/IV), 19% versus 2%, and the mortality was greater, 34% versus 16%, in those infants who received BP support. Of the 121 survivors, 110 (91%) had complete follow-up evaluations. Multivariate analysis controlling for SES and neonatal morbidity revealed that symptomatic hypotension is associated with delayed motor development (-6.0; SE 3.1) and hearing loss (O.R. 8.9; CI 0.92-86.3).
  
  
  CONCLUSIONS
  Symptomatic hypotension in ELBW infants in the first 72 hours of life is associated with significant short-term and long-term morbidity. Infants with symptomatic hypotension are more likely to have delayed motor development, hearing loss, and death.
authors.affiliation: Department of Pediatrics, Case Western Reserve University School of Medicine, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA. aaf2@cwru.edu
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Fanaroff
mesh_terms: D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology / Q000401:mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000401:mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D012307:Risk Factors; D013997:Time Factors