title: Abstention or intervention for isolated hypotension in the first 3 days of life in extremely preterm infants: association with short-term outcomes in the EPIPAGE 2 cohort study.
abstract: OBJECTIVE
  To compare outcomes at hospital discharge for preterm infants born before 29 weeks of gestation who had at least one episode of isolated hypotension during their first 72 hours of life for which they did or did not receive antihypotensive treatment.
  
  
  METHODS
  Etude Epidémiologique sur les Petits Ages Gestationnels 2 (EPIPAGE 2) French national prospective population-based cohort study in 2011.
  
  
  METHODS
  60 neonatal intensive care units.
  
  
  METHODS
  All infants with a minimum mean arterial blood pressure less than gestational age (in weeks) (minMAP<GA) within 72 hours of birth. Infants whose reason for receiving antihypotensive treatments was isolated hypotension only were compared with untreated hypotensive infants by propensity score matching.
  
  
  METHODS
  Fluid bolus and/or inotropes and/or corticosteroids.
  
  
  METHODS
  The primary outcome was survival at hospital discharge without major morbidity, defined as any of necrotising enterocolitis, severe cerebral abnormalities, severe bronchopulmonary dysplasia or severe retinopathy of prematurity.
  
  
  RESULTS
  Among the 1532 infants with available data, 662 had a minMAP<GA; 206 were treated for unknown or other reasons than isolated hypotension, 131 were treated for isolated hypotension only and 325 were untreated; 119 infants from each of these last two groups were matched. Treated infants had a significantly higher survival rate without major morbidity (61.3% vs 48.7%; OR, 1.67, 95% CI 1.00 to 2.78, p=0.049) and a lower rate of severe cerebral abnormalities (10.1% vs 26.5%, p=0.002).
  
  
  CONCLUSIONS
  In this population, antihypotensive treatment was associated with improved short-term outcomes. Therapeutic abstention should be cautiously considered for early isolated hypotension in extremely premature infants.
authors.affiliation: Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.|INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Marchand-Martin
authors.affiliation: INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Department of Neonatal Medicine, Angers University Hospital, Angers, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gascoin
authors.affiliation: Department of Neonatal Medicine, Nantes University Hospital, Nantes, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Roze
authors.affiliation: Department of Neonatal Medicine, Lille University Hospital, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Storme
authors.affiliation: Department of Neonatal Medicine, Tours University Hospital, Tours, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Favrais
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
authors.affiliation: Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
mesh_terms: D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D007363:Intensive Care Units, Neonatal; D008297:Male; D057216:Propensity Score; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D005938:Glucocorticoids
keywords: Circulatory; Epidemiology; Intensive Care; Neonatology