Hypotension in preterm neonates: low blood pressure alone does not affect neurodevelopmental outcome.
OBJECTIVE
To compare neurodevelopmental outcome, mean arterial blood pressure (MABP), and regional cerebral oxygenation (rSco2) between preterm neonates treated for hypotension and controls.


METHODS
Preterm neonates (N = 66) with a gestational age (GA) ≤32 weeks, without a patent ductus arteriosus, treated for hypotension (dopamine ≥5 μg/kg/min) were included. Neonates were matched to controls for GA, birth weight, sex, and year of birth. The rSco2 was determined by using near-infrared spectroscopy. Monitoring of MABP, rSco2, and arterial saturation was started at admission and continued for at least 72 hours. Neurodevelopmental outcome was assessed at 18 and 24 months' corrected age by using the Griffiths Mental Development Scales or the Bayley Scales of Infant and Toddler Development, Third Edition.


RESULTS
Infants treated for hypotension spent more time with an MABP less than GA (median 9% vs 0%, P < .001) and time with an MABP/rSco2 correlation >0.5 (27% vs 17%, P < .001). Time spent with an rSco2 <50% and neurodevelopmental outcome at 18 and 24 months' corrected age were not significantly different between infants treated for hypotension and controls. The 26 neonates with an rSco2 <50% for >10% of time had a lower neurodevelopmental outcome at 18 months (median 99 vs 104, P = .02).


CONCLUSIONS
An MABP less than GA (in weeks) was not associated with lower rSco2 or with lower neurodevelopmental outcome scores. However, regardless of MABP, low rSco2 was associated with lower neurodevelopmental outcome scores. Perfusion/oxygenation variables could be of additional value in neonatal intensive care.
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: t.alderliesten-2@umcutrecht.nl.
Thomas
T
Alderliesten
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Petra M A
PM
Lemmers
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Ingrid C
IC
van Haastert
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Linda S
LS
de Vries
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Hilde J C
HJ
Bonestroo
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Willem
W
Baerts
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Frank
F
van Bel
D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000098:blood supply; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
D015415:Biomarkers; D002316:Cardiotonic Agents; D010100:Oxygen; D004298:Dopamine