Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants

Watkins, Andrew; West, Christopher C.; Cooke, Richard

doi:10.1016/0378-3782(89)90120-5

Cited by 306 publications

(198 citation statements)

References 12 publications

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“…As a matter of fact, these MAP values were similar to those previously reported for stable infants of comparable birth weight and GA by us 14 and by others. 8,21 In large premature infants, blood pressure has been reported to correlate with birth weight, 21,22,31 a fact supported by the lower MAP noted in concordant when compared with large discordant twins (almost 250 g heavier). This has not been observed in infants whose birth weights were 750 g, 14,26,27 a fact in line with our data that showed no significant MAP differences between small (669±71 g) and large (731±84 g) concordant twins.…”

Section: Cordero and Johnsonmentioning

confidence: 97%

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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Section: Cordero and Johnsonmentioning

confidence: 97%

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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“…In preterm infants it is associated with the development of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and poor neurodevelopmental outcomes. [1][2][3][4] Inadequate perfusion as a complication of sepsis, respiratory failure, severe birth depression or persistent pulmonary hypertension, is also detrimental to the critically ill term infant. While the etiologies of hypotension are multifactorial, there may exist a subset of infants with adrenal insufficiency manifesting as hypotension refractory to standard therapy.…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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Objective: The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment.Study Design: This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 mg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC.Result: Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol.Conclusion: HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

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“…Indeed, several studies have found an association between hypotension 9-12 and alterations in CBF [13][14][15] and central nervous system morbidity (IVH, PVL) and neurodevelopmental outcome. [16][17][18] However, it is important to note that, although data on an association between hypotension and/or abnormal CBF and short-and long-term central nervous system morbidity are abundant, [8][9][10][11][12][13][14][15][16][17][18] very little data are available demonstrating a causative relationship among these factors.…”

Section: Introductionmentioning

confidence: 99%

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Seri

2006

J Perinatol

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Systemic hypotension during the first postnatal week is associated with increased mortality and morbidity in the very low birth weight (VLBW) neonate. Hypotension is generally defined as blood pressure below the fifth percentile of the gestational-and postnatal-age dependent blood pressure norms. Recent studies indicate that in most VLBW neonates, cerebral blood flow autoregulation is indeed lost when blood pressure reaches the fifth percentile. Treatment of the circulatory compromise should address the primary pathogenic factor(s) of the condition (hypovolemia, myocardial compromise, failure of vasoregulation or a combination of factors). Recent findings also suggest that vasopressor resistance can be treated with a brief course of low-dose hydrocortisone. However, due to the short-and potential long-term side effects of early hydrocortisone treatment, its use should be restricted to neonates with vasopressor-resistant hypotension. Finally, concomitant administration of hydrocortisone with indomethacin should be avoided due to the increased incidence of gastrointestinal perforations.

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Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants

Cited by 306 publications

References 12 publications

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

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