title: International survey on diagnosis and management of hypotension in extremely preterm babies.
abstract: Hypotension is a commonly diagnosed and treated complication of extremely low gestational age newborns (ELGAN), but enormous variation in diagnosis, management and clinical practice has been documented. We sought to evaluate practice regarding the management of hypotension in ELGANs and developed a web-based questionnaire addressing diagnosis, intervention thresholds and modes of treatment of hypotension in ELGANs. We received 216 completed questionnaires from respondents in 38 countries. Most responses (83 %) were from specialist units where, together, over 26,000 very low birth weight (VLBW) infants are cared for annually. The majority (73 %) defined hypotension as a mean blood pressure (BP) in mmHg less than the gestational age in weeks. Sixty percent assessed the circulation with additional methods; echocardiography was the most commonly used (74 %), with left ventricular output and fractional shortening the two most common measurements made. The majority (85 %) used volume administration as the initial intervention. Dopamine was the inotrope most commonly used initially (80 %). If the initial inotrope therapy failed, dobutamine was the most popular second-line treatment (28 %). Delayed cord clamping was used at 51 % of the centres.
  
  
  CONCLUSIONS
  The definition of hypotension in ELGANs continues to follow traditional standards. Functional echocardiography is now used to assess the circulation at many centres. Volume expansion and dopamine remain the most frequently used therapies.
authors.affiliation: Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Podolske Nabrezi 157, 147 00, Prague 4, Czech Republic, z.stranak@seznam.cz.
authors.forename: Zbynek
authors.initials: Z
authors.lastname: Stranak
authors.forename: Jana
authors.initials: J
authors.lastname: Semberova
authors.forename: Keith
authors.initials: K
authors.lastname: Barrington
authors.forename: Colm
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
authors.forename: Gunnar
authors.initials: G
authors.lastname: Naulaers
authors.forename: Eugene
authors.initials: E
authors.lastname: Dempsey
mesh_terms: D006306:Health Surveys; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000188:drug therapy*; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D011795:Surveys and Questionnaires; D014421:Turkey