title: Early blood pressure, antihypotensive therapy and outcomes at 18-22 months' corrected age in extremely preterm infants.
abstract: OBJECTIVE
  To investigate the relationships between early blood pressure (BP) changes, receipt of antihypotensive therapy and 18-22 months' corrected age (CA) outcomes for extremely preterm infants.
  
  
  METHODS
  Prospective observational study of infants 23(0/7)-26(6/7) weeks' gestational age (GA). Hourly BP values and antihypotensive therapy exposure in the first 24 h were recorded. Four groups were defined: infants who did or did not receive antihypotensive therapy in whom BP did or did not rise at the expected rate (defined as an increase in the mean arterial BP of ≥5 mm Hg/day). Random-intercept logistic modelling controlling for centre clustering, GA and illness severity was used to investigate the relationship between BP, antihypotensive therapies and infant outcomes.
  
  
  METHODS
  Sixteen academic centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
  
  
  METHODS
  Death or neurodevelopmental impairment/developmental delay (NIDD) at 18-22 months' CA.
  
  
  RESULTS
  Of 367 infants, 203 (55%) received an antihypotensive therapy, 272 (74%) survived to discharge and 331 (90%) had a known outcome at 18-22 months' CA. With logistic regression, there was an increased risk of death/NIDD with antihypotensive therapy versus no treatment (OR 1.836, 95% CI 1.092 to 3.086), but not NIDD alone (OR 1.53, 95% CI 0.708 to 3.307).
  
  
  CONCLUSIONS
  Independent of early BP changes, antihypotensive therapy exposure was associated with an increased risk of death/NIDD at 18-22 months' CA when controlling for risk factors known to affect survival and neurodevelopment.
  
  
  BACKGROUND
  clinicaltrials.gov #NCT00874393.
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
authors.forename: Beau
authors.initials: B
authors.lastname: Batton
authors.affiliation: Statistics & Epidemiology Unit, RTI International, Research Triangle Park, Raleigh, North Carolina, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.affiliation: Statistics & Epidemiology Unit, RTI International, Rockville, Maryland, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Watterberg
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Faix
authors.affiliation: Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Laughon
authors.affiliation: Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
mesh_terms: D000046:Academic Medical Centers; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D002658:Developmental Disabilities / Q000453:epidemiology*; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007022:Hypotension / Q000188:drug therapy*; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007552:Isotonic Solutions / Q000627:therapeutic use; D016015:Logistic Models; D011446:Prospective Studies; D013566:Sympathomimetics / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D002316:Cardiotonic Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D013566:Sympathomimetics; D004280:Dobutamine; D004298:Dopamine; D006854:Hydrocortisone; D004837:Epinephrine
keywords: Cardiology; Neonatology; Neurodevelopment