Early treated hypotension and outcome in very low birth weight infants.
BACKGROUND
Early hypotension is a common problem among preterm infants. Studies have shown conflicting data regarding the definition of hypotension, the way to treat it and the correlation to outcome.


OBJECTIVE
To investigate the risk factors for developing hypotension and its relations to short- and long-term outcomes.


METHODS
Medical charts of all surviving very low birth weight infants were retrospectively reviewed during a 4-year period. The data of infants suffering from early hypotension and needed treatment were compared with those of a control group with 'normal' blood pressure. In addition, medical charts were reviewed for neurodevelopment outcome.


RESULTS
The study and control groups comprised 109 infants each. The mean blood pressures were 24.1 +/- 3.2 and 30.3 +/- 4.3 mm Hg in the study and control groups (p < 0.0001). No significant perinatal variables were found to predict hypotension. Bronchopulmonary dysplasia and retinopathy of prematurity were related to treated hypotension. Logistic regression analysis found that neonatal treated hypotension was related to periventricular leukomalacia, with an odds ratio of 2.61 (95% CI 1.0-7.12), p = 0.049. Intraventricular hemorrhages grades 2-4 were found to be related to lower mean blood pressure, with an odds ratio of 1.3 (95% CI 1.12-1.51), p < 0.01. Major long-term neurological disability was found by regression analysis to be related to periventricular leukomalacia and treated hypotension, with odds ratios of 63.1 (95% CI 13.3-299, p < 0.001) and 5.4 (95% CI 1.29-22.7, p = 0.01).


CONCLUSIONS
This study supports the hypothesis that early provision of antihypotensive therapy is related to intraventricular hemorrhage, periventricular leukomalacia and major neurodevelopment impairment.
Kuint
Jacob
J
Department of Neonatology, and Child Development Clinic, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel-Hashomer, Israel. kuint-j@sheba.health.gov.il
Barak
Moran
M
Morag
Iris
I
Maayan-Metzger
Ayala
A
D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use; D004298:Dopamine / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D007231:Infant, Newborn / Q000502:physiology*; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000503:physiopathology; D007969:Leukomalacia, Periventricular / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013566:Sympathomimetics / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D013566:Sympathomimetics; D004280:Dobutamine; D004298:Dopamine; D004837:Epinephrine