Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns.
OBJECTIVE
To evaluate in extremely low gestational age newborns, relationships between indicators of hypotension during the first 24 postnatal hours and developmental delay at 24 months of age.


METHODS
The 945 infants in this prospective study were born at <28 weeks, were assessed for three indicators of hypotension in the first 24 postnatal hours, and were evaluated with the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 24 months corrected age. Indicators of hypotension included: (1) mean arterial pressure in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile for the difference between the lowest and highest mean arterial pressure. Logistic regression was used to evaluate relationships between hypotension and developmental outcomes, adjusting for potential confounders.


RESULTS
78% of infants in this cohort received volume expansion or vasopressor; all who received a vasopressor were treated with volume expansion. 26% had an MDI <70 and 32% had a PDI <70. Low MDI and PDI were associated with low gestational age, which in turn, was associated with receipt of vasopressor treatment. Blood pressure in the lowest quartile for gestational age was associated with vasopressor treatment and labile blood pressure. After adjusting for potential confounders, none of the indicators of hypotension were associated with MDI <70 or PDI <70.


CONCLUSIONS
In this large cohort of extremely low gestational age newborns, we found little evidence that early postnatal hypotension indicators are associated with developmental delay at 24 months corrected gestational age.
New Hanover Regional Medical Center, Wilmington, North Carolina, USA. wells.logan@ccneo.net
J Wells
JW
Logan
T Michael
TM
O'Shea
Elizabeth N
EN
Allred
Matthew M
MM
Laughon
Carl L
CL
Bose
Olaf
O
Dammann
Daniel G
DG
Batton
Stephen C
SC
Engelke
Alan
A
Leviton
D001724:Birth Weight; D001794:Blood Pressure / Q000502:physiology; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011594:Psychometrics; D011597:Psychomotor Performance; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents