title: Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants.
abstract: OBJECTIVE
  The objective of this study was to characterize the incidence, management, and short-term outcomes of cardiovascular insufficiency (CVI) in mechanically ventilated newborns, evaluating four separate prespecified definitions.
  
  
  METHODS
  Multicenter, prospective cohort study of infants ≥34 weeks gestational age (GA) and on mechanical ventilation during the first 72 hours. CVI was prospectively defined as either (1) mean arterial pressure (MAP) < GA; (2) MAP < GA + signs of inadequate perfusion; (3) any therapy for CVI; or (4) inotropic therapy. Short-term outcomes included death, days on ventilation, oxygen, and to full feedings and discharge.
  
  
  RESULTS
  Of 647 who met inclusion criteria, 419 (65%) met ≥1 definition of CVI. Of these, 98% received fluid boluses, 36% inotropes, and 17% corticosteroids. Of treated infants, 46% did not have CVI as defined by a MAP < GA ± signs of inadequate perfusion. Inotropic therapy was associated with increased mortality (11.1 vs. 1.3%; p < 0.05).
  
  
  CONCLUSIONS
  More than half of the infants met at least one definition of CVI. However, almost half of the treated infants met none of the definitions. Inotropic therapy was associated with increased mortality. These findings can help guide the design of future studies of CVI in newborns.
authors: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors: Erika
authors: E
authors: Fernandez
authors: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors: Kristi L
authors: KL
authors: Watterberg
authors: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
authors: Roger G
authors: RG
authors: Faix
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
authors: Bradley A
authors: BA
authors: Yoder
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
authors: Michele C
authors: MC
authors: Walsh
authors: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors: Conra Backstrom
authors: CB
authors: Lacy
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
authors: Karen A
authors: KA
authors: Osborne
authors: Statistics and Epidemiology Unit, RTI International, Rockville, Maryland.
authors: Abhik
authors: A
authors: Das
authors: Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina.
authors: Douglas E
authors: DE
authors: Kendrick
authors: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: Barbara J
authors: BJ
authors: Stoll
authors: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Brenda B
authors: BB
authors: Poindexter
authors: Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island.
authors: Abbot R
authors: AR
authors: Laptook
authors: Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas.
authors: Kathleen A
authors: KA
authors: Kennedy
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors: Kurt
authors: K
authors: Schibler
authors: Department of Pediatrics, University of Iowa, Iowa City, Iowa.
authors: Edward F
authors: EF
authors: Bell
authors: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors: Krisa P
authors: KP
authors: Van Meurs
authors: Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts.
authors: Ivan D
authors: ID
authors: Frantz
authors: Department of Pediatrics, Duke University, Durham, North Carolina.
authors: Ronald N
authors: RN
authors: Goldberg
authors: Department of Pediatrics, Wayne State University, Detroit, Michigan.
authors: Seetha
authors: S
authors: Shankaran
authors: Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Waldemar A
authors: WA
authors: Carlo
authors: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors: Richard A
authors: RA
authors: Ehrenkranz
authors: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Pablo J
authors: PJ
authors: Sanchez
authors: Rosemary D
authors: RD
authors: Higgins
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000628:therapy*; D016638:Critical Illness; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012121:Respiration, Artificial; D047929:Term Birth