Physiology of Low Blood Pressure During the First Day After Birth Among Extremely Preterm Neonates

Aldana-Aguirre, Jose Carlos; Deshpande, Poorva; Jain, Amish; Weisz, Dany E.

doi:10.1016/j.jpeds.2021.05.026

Cited by 10 publications

(9 citation statements)

References 43 publications

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“…Interestingly, infants in the NPE groups received PDA treatment more frequently in the first three postnatal days than did the no-NPE group, and the latter showed no catch-up PDA treatments afterwards. We speculate that for these infants, NPE might have helped to identify PDA as the cause of hypotension and led to the administration of treatment ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

In-hospital Outcomes and Early Hemodynamic Management According to Echocardiography Use in Hypotensive Preterm Infants: A National Propensity-Matched Cohort Study

Raschetti

Torchin

Gascoin

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHypotension is a common condition during the first postnatal days of very preterm infants and has been associated with an increased risk of adverse outcomes but its management remains controversial. There is a consensus to promote the use of neonatologist-performed echocardiography (NPE) in hypotensive very preterm infants, although no clinical trial ever assessed this practice.MethodsWe conducted a retrospective analysis of prospectively collected data from the French national EPIPAGE-2 cohort to evaluate the association of NPE with survival, severe morbidity, and therapeutic management in very preterm infants with early hypotension. Reasons for administering antihypotensive treatments were also analyzed. We included infants born before 30 weeks of gestation with hypotension within 72 h of birth. Infants managed with (NPE group) or without (no-NPE group) NPE use were compared after matching on gestational age and a propensity score, reflecting each patient's probability of having an NPE based on his/her baseline covariates. This matching procedure intended to control for the indication bias of NPE.ResultsAmong 966 eligible infants, 809 were included (NPE group, n = 320; no-NPE group, n = 489), and 229 from each group could be matched. The NPE group did not differ significantly from the no-NPE group for survival (OR 1.01, 95% CI 0.64 to 1.60; p = 0.95) or survival without severe morbidity at discharge (OR 0.92, 95% CI 0.63 to 1.34; p = 0.66), but received more antihypotensive treatments [144/229 (62.9%) vs. 99/229 (43.0%), p < 0.001]. Isolated hypotension was the main reason for treatment in both groups. Among treated infants, volume expansion was administered at equal rates to the NPE and no-NPE groups [118/144 (82.1%) vs. 79/99 (80.1%), p = 0.67], but the NPE group received inotropic drugs more often [77/144 (53.7%) vs. 37/99 (37.8%), p = 0.023].ConclusionNPE use in hypotensive preterm infants was not associated with in-hospital outcomes and had little influence on the nature of and reasons for antihypotensive treatments. These results suggest the need to optimize NPE use.

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Section: Discussionmentioning

confidence: 99%

In-hospital Outcomes and Early Hemodynamic Management According to Echocardiography Use in Hypotensive Preterm Infants: A National Propensity-Matched Cohort Study

Raschetti

Torchin

Gascoin

et al. 2022

Front. Cardiovasc. Med.

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“…Although we agree that the state of current evidence necessitates an individualized approach, we suggest that further elucidation of the causal pathways of interest and potential treatments may be important. First, therapy for euvolemic neonates with a state of uncompensated low afterload would ostensibly include cardiovascular medications that augment left ventricular output (LVO) (eg, dobutamine), with avoidance of agents with predominantly vasopressor effects (eg, dopamine) that reduce LVO, 1 although the latter remain widely used. 2 Recent observational studies that have associated treatment of isolated hypotension with improved outcomes did not provide data regarding the treatment(s) administered and therefore have limited clinical applicability.…”

Section: Replymentioning

confidence: 99%

“…However, in several clinical trials, neonates with hypotension born preterm treated with dobutamine had similar clinical outcomes (including intraventricular hemorrhage [IVH]) as those treated with dopamine. 1 Although dobutamine has demonstrated some promise in improving indices of systemic blood flow in pilot trials of neonates born preterm with low superior vena cava flow, 4,5 reducing morbidity has proven elusive, 6 and blood pressure is demonstrably unreliable in helping clinicians identify neonates with low systemic blood flow in need of treatment. 7 Alternative methods of identifying cerebral hypoxia, such as near infrared spectroscopy, are associated with cerebral injury and may represent a useful modality to guide the initiation and titration of cardiovascular treatments among hypotensive neonates.…”

Section: Replymentioning

confidence: 99%

“…We read with interest the report by Aldana-Aguirre et al on the mechanisms of hypotension in infants born extremely preterm during the first postnatal day. 1 Compared with the case-control group, the hypotensive group had more frequent and larger patent ductus arteriosus (PDA) size, greater rate of peri/intraventricular hemorrhage (PIVH), greater indices of left ventricular (LV) systolic function, and lower afterload but similar left ventricular output (LVO). The preservation of LV systolic function is consistent with our findings in infants born extremely preterm who developed PIVH on the second or third postnatal day.…”

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confidence: 99%

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Hypotension and significant patent ductus arteriosus in infants born extremely preterm during the postnatal transitional period: normal adaptation?

Noori

Seri

2022

The Journal of Pediatrics

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“…Arterial hypotension (AH) is a frequent problem in neonates with the potential to affect both short-and long-term outcomes. Clinical conditions associated with cardiovascular instability and low arterial pressure (AP) in preterm neonates include difficulties with adaptation to extrauterine circulation during the first 72 h after birth [1][2][3] and severe neonatal complications, such as sepsis, necrotizing enterocolitis (NEC), persistent pulmonary hypertension of the neonate (PPHN), perinatal asphyxia, congenital heart disease, and patent ductus arteriosus (PDA) [2,[4][5][6]. Previous authors have outlined the controversies surrounding important issues, which include the lack of a generally accepted reference range of AP, the unclear definition of hypotension in neonates, and the effect of postnatal age on AP [7,8].…”

Section: Introductionmentioning

confidence: 99%

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

Agakidou,

Chatziioannidis,

Kontou

et al. 2024

Children

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Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.

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Physiology of Low Blood Pressure During the First Day After Birth Among Extremely Preterm Neonates

Cited by 10 publications

References 43 publications

In-hospital Outcomes and Early Hemodynamic Management According to Echocardiography Use in Hypotensive Preterm Infants: A National Propensity-Matched Cohort Study

In-hospital Outcomes and Early Hemodynamic Management According to Echocardiography Use in Hypotensive Preterm Infants: A National Propensity-Matched Cohort Study

Hypotension and significant patent ductus arteriosus in infants born extremely preterm during the postnatal transitional period: normal adaptation?

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

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