title: Dopamine-resistant hypotension and severe retinopathy of prematurity.
abstract: OBJECTIVE
  To examine the relationship between the cause or severity of hypotension and the development of severe ROP (sROP) (≥stage 3 or stage 2 with plus disease in zone I or II).
  
  
  METHODS
  Infants (<28 weeks' gestation, n = 242) were observed for hypotension and treated with a standardized hypotension-treatment protocol. Hypotension was classified as resulting from one of the following causes: (1) culture-positive infection and/or necrotizing enterocolitis; (2) patent ductus arteriosus ligation; or (3) "idiopathic" (no cause identified other than prematurity), and as being either dopamine responsive or dopamine resistant. Cortisol levels were measured for infants with dopamine-resistant hypotension. Eye examinations were performed until the retinopathy of prematurity resolved or the vasculature matured. Multivariable logistic regression analysis was performed to determine the relationship between the cause/severity of hypotension and sROP.
  
  
  RESULTS
  Overall, 66% of infants developed hypotension (41% were dopamine responsive and 25% were dopamine resistant). sROP developed in 19% of infants. "Idiopathic" dopamine-resistant hypotension was the only cause significantly related to sROP. Of the infants with dopamine-resistant hypotension, 66% had low serum cortisol (≤10 μg/dL). Low cortisol, in the presence of dopamine-resistant hypotension, was significantly associated with sROP and accounted for the relationship between "idiopathic" hypotension and sROP. When low cortisol was included in statistical models, other known risk factors, such as immature gestation, were no longer significantly related to sROP.
  
  
  CONCLUSIONS
  Low cortisol, in the presence of dopamine-resistant hypotension, has the greatest magnitude of association with sROP.
authors: Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0544, USA.
authors: Melissa
authors: M
authors: Catenacci
authors: Shogo
authors: S
authors: Miyagi
authors: Andrea C
authors: AC
authors: Wickremasinghe
authors: Sarah Scarpace
authors: SS
authors: Lucas
authors: Alejandra G
authors: AG
authors: de Alba Campomanes
authors: William V
authors: WV
authors: Good
authors: Ronald I
authors: RI
authors: Clyman
mesh_terms: D004298:Dopamine / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000209:etiology*; D012720:Severity of Illness Index
chemical_list: D004298:Dopamine
keywords: BP; BPD; Blood pressure; Bronchopulmonary dysplasia; NEC; Necrotizing enterocolitis; PDA; Patent ductus arteriosus; ROP; Retinopathy of prematurity; Severe ROP; sROP