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

Durrmeyer, Xavier; Marchand-Martin, Laetitia; Porcher, Raphaël; Gascoin, Géraldine; Rozé, Jean‐Christophe; Storme, Laurent; Favrais, Géraldine; Ancel, Pierre‐Yves; Cambonie, Gilles

doi:10.1136/archdischild-2016-312104

Cited by 59 publications

(47 citation statements)

References 27 publications

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“…The incidence of BPD based on disease severity was reported in four data sources from Europe [31][32][33]43,45,49,51], three from North America [77,[88][89][90], and one from Asia [106]. Moderate BPD was defined as a requirement for <30% supplemental oxygen to maintain target oxygen saturation levels; severe BPD was defined as a requirement for !30% supplemental oxygen or positive pressure ventilation to maintain target levels.…”

Section: Incidence Of Bpd By Severitymentioning

confidence: 99%

Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review

Siffel

Kistler

Lewis

et al. 2019

The Journal of Maternal-Fetal & Neonatal Medicine

156

110

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Background: Infants born extremely preterm (<28 weeks gestational age (GA)) face a high risk of neonatal mortality. Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. Objective: To evaluate the global incidence of BPD among infants born extremely preterm. Design: A systematic review of the literature was conducted in Embase and MEDLINE (via PubMed) using a prespecified search strategy for BPD and prematurity. Observational studies published in English between 16 May 2006 and 16 October 2017 reporting on the occurrence of BPD in infants born <28 weeks GA were included. Results: Literature searches yielded 103 eligible studies encompassing 37 publications from Europe, 38 publications from North America, two publications from Europe and North America, 19 publications from Asia, one publication from Asia and North America, six publications from Oceania, and zero publications from Africa or South America. The reported global incidence range of BPD was 10-89% (10-73% in Europe, 18-89% in North America, 18-82% in Asia, and 30-62% in Oceania). When only population-based observational studies that defined BPD as requiring supplemental oxygen at 36 weeks postmenstrual age were included, the global incidence range of BPD was 17-75%. The wide range of incidences reflected interstudy differences in GA (which was inversely related to BPD incidence), birthweight, and survival rates across populations and institutions. Conclusions: BPD is a common health morbidity occurring with extremely preterm birth. Further study of factors that impact incidence, aside from low GA, may help to elucidate modifiable risks.

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Section: Incidence Of Bpd By Severitymentioning

confidence: 99%

Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review

Siffel

Kistler

Lewis

et al. 2019

The Journal of Maternal-Fetal & Neonatal Medicine

156

110

View full text Add to dashboard Cite

show abstract

“…Many neonatologists therefore consider low arterial blood pressure not as an indication for urgent medical intervention, if a baby is otherwise stable 8–10. However, experience in adults, children, and several observational studies in preterm infants3–6 11 12 promote a different approach with early volume replacement and intravenous application of catecholamines to prevent prolonged hypotension. As of yet, no large-scale randomised controlled trials of catecholamine treatment in preterm infants have been published 13 14…”

Section: Introductionmentioning

confidence: 99%

Genetic background of high blood pressure is associated with reduced mortality in premature neonates

Göpel

Müller

Rabe

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThe aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants.DesignProspective cohort study.SettingPatients were enrolled in 53 neonatal intensive care units.PatientsPreterm infants with a birth weight below 1500 g.ExposuresGenetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score).Main outcome measuresLowest blood pressure on the first day of life and mortality.Results5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (−1.26 mm Hg/week) and mechanical ventilation (−2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher’s exact test). This survival advantage was independent of treatment with catecholamines.ConclusionsOur study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.

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“…Dopamine is more effective than dobutamine at increasing blood pressure in hypotensive infants, although dobutamine or epinephrine may be a more rational choice in the setting of reduced ventricular function [174]. Randomised trials exploring thresholds for intervention with inotropes have been unsuccessful due to poor recruitment; however, a recent observational study showed that preterm infants treated for isolated hypotension, defined as mean arterial pressure less than gestational age, had a higher survival rate raising caution about “permissive hypotension” [175]. Hydrocortisone is also a reasonable choice for extremely preterm infants with hypotension, particularly those with documented low serum cortisol [176, 177].…”

Section: Managing Blood Pressure and Perfusionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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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: 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.

Cited by 59 publications

References 27 publications

Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review

Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review

Genetic background of high blood pressure is associated with reduced mortality in premature neonates

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

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